Spatial Variation Of Medical Expenditure And Its Influencing Factors Since The New Healthcare Reform In Sichuan

Objective Since the New Health System Reform,the growth trend of medical expenditure in China has been slowed down through various medical reform measures,but the cost gap between different regions is still obvious,and the level of fineness of the control policy is still insufficient.This study will present the spatial differentiation of medical expenditure in Sichuan Province through the platform of ArcGIS,and use the Geographical Weighted Regression(GWR)model instead of the traditional least squares(OLS)model to reveal the complex relationship between various influencing factors and medical expenditure.Regional medical service quality and medical cost rankings.Finally,based on the above analysis,how to reduce the difference in cost space distribution,improve the quality of medical services,formulate a fine control fee policy,and improve the efficiency of medical and health system configuration.Methods Firstly used the coefficient of variation(CV)to compare the degree of variation between medical expenditure in 183 counties(districts and municipalities)from 2009 to 2017.Secondly,it used the global spatial autocorrelation index(Global Moran’s I)and hotspot analysis to explore the space of medical cost data.Correlation and agglomeration patterns;then establish an least squares(OLS)model for variable selection and collinearity diagnosis,and then establish a geographically weighted regression(GWR)model to analyze the complex relationship between various influencing factors and medical costs,and The effectiveness is compared.Finally,the sequential selection technique(TOPSIS),which introduces the similarity between entropy weight and ideal scheme,is used to comprehensively evaluate the treatment status of inpatient medical services in counties(districts and municipalities).Results In the 9 years since the New Health System Reform,the average outpatient service and per capita hospitalization expenses among 183 counties(districts and municipalities)in Sichuan Province have increased year by year.The average outpatient service cost has increased from 126.82 yuan in 2009 to 237.87 yuan in2017.The per capita hospitalization expenses are from 2009.The annual growth rate of 4962.16 yuan rose to 7592.47 yuan in 2017.The growth rate has slowed down inrecent years,but the gap between the cost levels in different regions has expanded.Regardless of the average outpatient cost or per capita hospitalization expenses,the Global Moran’s I index is higher than 0.3 in each period.,showing a strong spatial correlation,and the hotspots are mainly concentrated in the “Chengdu and its surrounding areas”,Panzhihua City and a few other areas in eastern Sichuan;the factors affecting the spatial variation of sub-examination outpatient expenses are practice per thousand population(assistant The number of physicians,population density,road mileage and per capita GDP,and the spatial variation of per capita hospitalization expenses are the number of practicing(assistant)physicians per thousand population,the number of hospitalization days per hospitalized patient,per capita GDP,highway mileage and population density;OLS model Explain 46% and71% of the variation in the average outpatient cost and per capita hospitalization cost respectively.After using the GWR model,explain the power.Increased by at least 10 percentage points,and the AICc value is much lower than the OLS model;the medical expenditure of most counties(districts,cities)and their medical quality are significantly mismatched.Conclusion The gap between medical expenditure and geographical distribution in different regions is increasing year by year.The distribution of medical expenditure shows a strong spatial correlation and spatial aggregation mode.The hotspots are mostly districts and counties where large-scale urban public hospitals gather.It is also the political and economic situation of Sichuan Province.The cultural development level is more developed,and the cold spot areas are mostly remote areas where the three ethnic minorities “Ganzi,Aba,Liangshan” live.The GWR model has obvious advantages over the traditional OLS model when dealing with such spatially non-stationary data.The impact of the number of practicing(assistant)physicians per thousand population on medical expenditure and the number of hospitalization days per capita on hospitalization expenses are positive,while the impact of per capita GDP,population density,and highway mileage on medical expenditure is positive and negative.Different regions are significantly different by the same factor;optimistic regions are more inclined to adopt low-cost and efficient treatment models.Extendingthis medical service model to a non-optimistic region will reduce unnecessary medical expenditures in such regions.Improve the efficiency of the health care system as a whole;use the GWR model for microscale analysis Additional information and a conclusion different from the macro-scale study will analyze the macro-scale and micro-scale analysis,we can better assess the medical model of health and development of different regions and to develop appropriate health policies and interventions to the characteristics of different regions.