| ObjectiveThis study uses counties(districts)as the spatial unit and new rural cooperative medical system("New Rural Cooperative Medical System")reimbursement records as data to establish a geographic information database,and conduct temporal and spatial aggregation of the utilization rate of thyroid cancer inpatient services for rural residents in Fujian Province from 2012 to 2016 research on characteristics and explore risk factors that may affect its spatial distribution.At the same time,assess the economic burden of thyroid tumors of rural residents in Fujian Province under the guarantee of the new rural cooperative medical system;determine the predictors of the economic burden of thyroid tumors in rural areas of Fujian Province,and establish an interpretation model,and finally make accurate decisions for the regional prevention and control of thyroid tumors in Fujian Province provide evidence.Methods1.To obtain hospitalization reimbursement records for malignant tumors of the digestive tract of rural residents in Fujian Province from 2012 to 2016 from 2025 hospitals,and obtained the 2012-2016 Fujian Provincial Census Data from the Fujian Provincial Statistical Yearbook.2.To calculate the utilization rate of hospitalization services;use Arc GIS software to make a thematic map of the geographic distribution of hospitalization services utilization rate for thyroid malignant tumors in Fujian Province,use global autocorrelation Moran’s I to test whether the utilization rate of hospitalization services is spatially clustered,and analyze local spatial autocorrelation LISA Reveal the area where the inpatient service high-demand space is concentrated;use Sa TScan software to use time and space scanning statistics to further obtain the location of the concentrated area,the elapsed time period,and the gathering radius.3.To use geographic detectors to explore the explanatory power of risk factors on the spatial differentiation of thyroid malignant inpatient service utilization,and analyze the interaction between factors.4.To use economic indicators such as average hospitalization expenses,out-ofpocket ratio,and index to evaluate the economic burden of thyroid malignant tumors under the new rural cooperative medical insurance.The ordinary least squares model was used to determine and evaluate important factors related to hospitalization expenses;at the same time,Arc GIS software is used to make maps that reflect the temporal and spatial changes of economic burden,and geographic weighted regression(GWR)was used to evaluate the impact of key factors on average hospitalization expenses.Results1.Totally 25274 hospitalization records were collected in this study.There is obvious temporal and spatial heterogeneity in the utilization rate of inpatient services for gastrointestinal malignant tumors in Fujian Province,which were mainly concentrated in Fuzhou,with Lianjiang County as the center,and the gathering area involves 26 counties and cities.2.The results of the Geographic Detector show that the main factors affecting the spatial differentiation of hospitalization rates were AQI,carbon sequestration and carbon emissions,with q values of 0.481,0.161 and 0.155,respectively.Among them,AQI and carbon emissions were generally positively correlated with hospitalization rates,and carbon sequestration was negatively correlated.After the interaction of the two factors,the interpretation of the hospitalization rate was enhanced,and the interpretation of the interaction between AQI and the amount of carbon sequestration was the largest,reaching 0.734.3.The mean hospitalization cost for surgical patients was 11,671 yuan,and the average hospitalization cost for non-surgical patients was 4,994 yuan.As the level of hospitals increases,hospitalization costs increase.The medical expenses incurred by choosing a provincial medical institution for medical treatment are higher than choosing a county medical institution(2.05 times for surgical patients and 4.21 times for non-surgical patients).However,the out-of-pocket ratio of choosing provincial medical institutions for medical treatment is also higher than that of county medical institutions(3.82 times for surgical patients and 7.96 times for non-surgical patients)4.Thyroid cancer malignant tumors cause higher average hospitalization expenses(different regions account for 38.53%-231.57% of per capita annual disposable income)and higher out-of-pocket expenses(different regions account for9.86%-145.65% of per capita annual disposable income).The map shows that the economic burden was unevenly distributed across counties and cities,and most of the hot spots were located in eastern Fujian Province.5.The results of GWR show that the impact of rural residents’ net income,the proportion of low-income households,the proportion of medical treatment in provincial hospitals,and the proportion of medical treatment in tertiary hospitals on hospitalization expenses are significantly different in space and all have positive effects.ConclusionsThere is obvious spatial heterogeneity in the utilization rate of inpatient services for thyroid cancer malignant tumors among rural residents in Fujian Province.It is recommended that relevant departments adjust measures to local conditions and allocate medical resources rationally to ease the pressure of seeking medical attention in high-demand areas.Thyroid malignant tumors pose a serious economic burden to some areas and individuals in the area.Relevant public health departments and policy makers should formulate corresponding policies to reduce the economic burden and improve the accessibility of high-level medical care. |
