Research On Geographical Distribution Of Health Service Utilization And Costs Of Urban Hypertensive Patients Under The Urbanization Background

[Purpose]Through analysis of the geographical distribution and geographical factors of the health service utilization and costs of urban hypertension patients to provide evidence for the improvement of health resources allocation and health service supply.[Methods]1.On the basis of literature and policy review,we learned about the related contents of urbanization and health,geographical factors and health service utilization at home and abroad,and excavate the theoretical basis and potential geographical factors of health service utilization and costs under the urbanization background.2.This research was carried out in the four districts in Yichang City,including Xiling,Wujiagang,Xiaoting and Dianjun.Based on Yichang Health Management Center,we calculated the population information from the database of urban residents,outpatient and inpatient information of hypertensive patients from Health Information Systems(HIS)in 9 public hospitals and other information.By matching the above information,demography and health service information of hypertensive patients in the 4 districts of Yichang City(“urban hypertensive patients”)were obtained.With geographic information system(GIS),town or street level as the first research unit,we visualized the geographic distribution of health service utilization and costs of urban hypertensive patients.3.Urban hypertensive patients with basic types in health insurances in the top general hospitals,were selected as the second research unit.The non-parametric test analysis and multiple linear regression analysis were used to explore the effects of geographical factors on health service utilization and costs of urban hypertensive patients.[Results]1.Theoretical basis and potential geographical elements of health service utilization and costs under the urbanization background.(1)Theory of spatial auto-correlation is the basis for studying the distribution characteristics of things or phenomena in the geographical space.Andersen health service model is the basis for studying the factors of residents’ health services.Therefore,theoretical basis of this study were spatial auto-correlation theory and Andersen health service model.(2)According to the connotation of urbanization and geographical elements,we outlined and defined potential geographical factors of health service utilization and costs of urban hypertensive patients,including resident type,urban regional gradation and geographical time accessibility.2.Geographical distribution of health service utilization and costs of urban hypertensive patients(1)There were 32124 urban hypertensive patients were included in this study.The person-times per outpatient and the person-times per inpatient were 5.26 and 4.08.The outpatient cost per person-time and the inpatient cost per person-time were 373.71 Yuan and 12 804.27 Yuan.(2)There were more health service utilization in some streets along the Yangtze River and in the central area including Yunji and Dagongqiao Street,and higher health service costs in some towns far away from the central area including Yaowan Town at the street/town level.3.Geographical factors of health service utilization and costs of urban hypertensive patients(1)With the non-parametric test,we found that there were significant difference of the distribution of health service utilization and costs in terms of the urban regional gradation and geographical time accessibility.However,resident type was only statistically correlated with the distribution of outpatient utilization and inpatient costs.(2)Results of multiple linear regression showed that the impact of urban regional gradation,geographical time accessibility and resident type on health service utilization and costs were different.There were fewer outpatient and inpatient utilization,lower outpatient costs and higher inpatient costs in far urban and suburban areas than in central areas.With increase of travel time from patient home to hospital visited,outpatient utilization decreased and outpatient costs increased.Outpatient utilization without local domicile were fewer than that with local domicile,but more inpatient costs.4.Other factors of health service utilization and costs of urban hypertensive patients(1)It was showed that patients with New Rural Cooperative Medical System(NRCMS)had fewer outpatient utilization,more outpatient costs and inpatient utilization and inpatient costs than patients with Urban Residents’ Basic Medical Insurance(URBMI).(2)Outpatient costs increased with age of hypertensive increasing.(3)Female hypertensive patients had fewer outpatient costs and more inpatient costs than male ones.[Conclusions]1.In this study,considering urban hypertensive patients in public hospitals facing high health service costs,which may be caused by patients’ condition,choosing high-quality health service.Therefore,it is suggested that we should strengthen hypertensive management in basic health institutions.2.Under the urbanization background,hypertensive patients in streets and towns along the Yangtze River and in the central area had more utilization of high-quality health resources that those far away from the central area.Besides,health service utilization and costs of urban hypertensive patients are affected by urban regional gradation,geographical time accessibility and resident type,whose characteristics are relatively objective and inflexible.Therefore,it is suggested to promote the diversified supply of high-quality health resources to enrich health resources in far urban and suburban areas,with specific measures including promoting high-quality resources to rural areas,improving healthcare union and building regional telemedicine centers.Besides,we suggest accelerating the process of civilization of residents without local domicile in order to promote effective health services utilization of residents.3.Hypertensive patients with NRCMS face more health costs than those with URBMI,with elderly patients more inpatient costs.Therefore,on the basis of promoting Urban and Rural Residents’ Basic Medical Insurance(URRBMI),the gap of insurance coverage and directory between NRCMS and URBMI should be reduced,and we should adhere to the development of outpatient reimbursement for hypertensive elderly patients.4.Female hypertensive patients had fewer outpatient costs and more inpatient costs,which may be caused by the lower attention to their own health and disease diagnosis and treatment.Improving awareness of health maintenance and disease management for female hypertensive patients is suggested.