Does inpatient health services utilization vary by remoteness in the medical financial assistance population? Evidence f
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RESEARCH ARTICLE
Open Access
Does inpatient health services utilization vary by remoteness in the medical financial assistance population? Evidence from Shaanxi province, China Yangling Ren1, Zhongliang Zhou1*, Guanping Liu1, Chi Shen1, Dan Cao1, Tiange Xu1, Jane M. Fry2, Rashed Nawaz1, Dantong Zhao1, Min Su3, Tingshuai Ge1, Yafei Si4 and Gang Chen2
Abstract Background: Medical Financial Assistance (MFA) provides health insurance and financial support for millions of low income and disabled Chinese people, yet there has been little systematic analysis focused on this vulnerable population. This study aims to advance our understanding of MFA recipients’ access to health care and whether their inpatient care use varies by remoteness. Methods: Data were collected from the Surveillance System of Civil Affairs of Shaanxi province in 2016. To better proxy remoteness (geographic access), drive time from the respondent’s village to the nearest county-level or citylevel hospital was obtained by a web crawler. Multilevel models were used to explore the impacts of remoteness on inpatient services utilization by MFA recipients. Furthermore, the potential moderating role of hospital grade (i.e. the grade of medical institution where recipient’s latest inpatient care services were taken in the previous year) on the relationship between geographic access and inpatient care use was explored. Results: The analytical sample consisted of 9516 inpatient claims within 73 counties of Shaanxi province in 2016. We find that drive time to the nearest hospital and hospital grade are salient predictors of inpatient care use and there is a significant moderation effect of hospital grade. Compared to those with shortest drive time to the nearest hospital, longer drive time is associated with a longer inpatient stay but fewer admissions and lower annual total and out-of-pocket (OOP) inpatient costs. In addition, these associations are lower when recipients are admitted to a tertiary hospital, for annual total and OOP inpatient expenditures, but higher for length of the most recent inpatient stay no matter what medical treatments are taken in secondary or tertiary hospitals for the most remote recipients. Conclusion: Our results suggest that remoteness has a significant and negative association with the frequency of inpatient care use. These findings advance our understanding of inpatient care use of the extremely poor and provide meaningful insights for further MFA program development as well as pro-poor health strategies. Keywords: Medical financial assistance (MFA), Geographic access, Inpatient care use, Moderation, China
* Correspondence: [email protected] 1 School of Public Policy and Administration, Xi’an Jiaotong University, No. 28 Xianning West Road, Xi’an 710049, Shaanxi, China Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reprod
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