Improving The Accessibility Of Health Services For Urban Poor Through Providing Hospitals At Home By Community Organizations

Objective: To compare medical costs incurred in different levels of health organizations and for different types of beds (inpatient vs hospital at home), and to analyze the necessity of developing hospital at home; To investigate the demands and utilization of health services (including hospitals at home) and associated factors of community residents in Chengdu and their attitudes towards hospitals at home; To illustrate the difficulties and main issues in relation to developing hospitals at home; To promote the utilization of hospitals at home of community residents, especially for those who live in poverty, and to provide scientific evidence for policy decision-making.Methods: Medical costs data came from the insurance schemes database; A household questionnaire survey was conducted in four communities, with 900 respondents selected by randomized cluster sampling. The survey investigated the demands and utilization of health services of community residents. 100 patients who had utilized hospitals at home were randomly selected from the medical insurance schemes and surveyed to collect information about their medical expenditure and their motivation of and attitudes towards using hospitals at home. 15 experts in health industry and social and medical insurance authorities were interviewed.Results: 1 According to the existing data kept in the insurance schemes, medical costs, costs per day and compensated rate of patients utilizing hospitals at home were lower than those of inpatients; With the decrease of the levels of hospitals, the medical costs and costs per day decreased while the compensated rate increased.2 Among 900 community residents, the medical insurance coverage for poor was lower than of non-poor; Compared to the none-poor, the two-week prevalence rate of illness in poor was greater, while the utilization rate of medical services in poor was lower. No difference appeared in the prevalence of chronic diseases between the two groups of community residents, however the hospitalization rate of poor was lower than none-poor. Nonetheless the poor residents felt more difficulties in paying medical expenses than the none-poor. About 42% of community residents knew hospitals at home; The main reasons for recognizing the needs of developing hospitals at home were "convenience" and "saving money", and the reasons for rejecting hospitals at home were "poor knowledge about hospitals at home", "high levels of deductible" and "medical safety".3 Among the residents who had utilized hospitals at home, there were 24 residents in poor group and 72 in general group. The differences of total medical expenses and rebates of hospitals at home between the poor and none-poor were significant, but the insurance compensate rates remained the same.4 As far as hospitals at home were concerned, the residents were mainly worrying about the payment system and medical safety, while medical quality and standardized supervision were what the medical organization concern about.Conclusion: Medical expenses of hospitals at home were lower than those of hospitalization, especial when they were provided by community health centers; Lower medical insurance level and higher disease financial burden have reduced the accessibility of health services for the urban poor; Developing policies favoring the use of hospitals at home by poor would increase the use of health services and improving the health of the residents living in poverty; The next research priority should be placed on enhancing the management of quality and risk of hospitals at home.