Qualitative Analysis Of Hospitalization Factors Of Urban And Rural Residents In 50 Counties Of Anhui Province

Objective: since the promotion of the new medical reform,there has been no significant decline in the extraterritorial hospitalization rate of the county,which poses a challenge to the sustainable development of the medical insurance fund for urban and rural residents.The purpose of this study is to understand the current situation of extraterritorial hospitalization of urban and rural residents in Anhui Province from 2016 to 2019,and explore the key factors and paths of the phenomenon of high extraterritorial hospitalization rate of the county,so as to reduce the extraterritorial hospitalization rate of the county,Provide basis for promoting graded diagnosis and treatment.Methods: Based on the Anhui provincial medical insurance information platform,the basic information of medical insurance inpatients of urban and rural residents in 50 counties was obtained,and the hospitalization flow direction,hospitalization expenses and the distribution of medical insurance compensation fund of inpatients were statistically described.At the same time,based on Smith’s policy implementation theory,the county statistical yearbook and county statistical bulletin are used to collect relevant influencing factor data.Through the method of qualitative comparative analysis,the key factors and paths of the overseas hospitalization rate in Gaoxian county are analyzed.Results:（1）from 2016 to 2019,the number of inpatients outside the medical insurance County of urban and rural residents in Anhui province accounted for 28.38% ～ 30.79%;The average annual growth rates of total hospitalization expenses,medical insurance compensation fund and average hospitalization expenses were 6.76%,11.34% and4.79% respectively;The proportion of total hospitalization expenses and medical insurance compensation fund outside the county is the largest and increases year by year;The hospitalization compensation ratio was 53.78% ～ 61.42%,and the hospitalization compensation ratio outside the county increased year by year.（2）From 2016 to 2019,there was little change in the extraterritorial hospitalization rate of counties and counties in the sample of medical insurance for urban and rural residents in Anhui Province,which increased from 28.38% in 2016 to 30.24% in 2019.However,the proportion of extraterritorial hospitalization expenses of counties,the proportion of extraterritorial compensation funds of counties and the proportion of extraterritorial compensation of counties increased year by year.（3）Smith’s policy model suggests that the four dimensions of idealized policy,target group,executing agency and environmental factors,including hospitalization compensation ratio,average hospitalization cost,beds per thousand population,per capita GDP,net outflow rate of county population and the availability of high-speed railway,are the antecedents of high hospitalization rate outside the county.（4）The configuration results of qualitative comparative analysis method reveal that taking the high hospitalization rate outside the county as the case result,three types of high hospitalization rate outside the county are formed,namely "target group obstruction + failure of executing agency","superficial policy implementation" and "environmental impact".Conclusion:（1）from the flow of medical insurance inpatients in urban and rural areas,the effect of graded diagnosis and treatment has not been shown,and the trend of medical insurance compensation fund flowing outside the county has not been effectively controlled.（2）"Failure of executing agencies + obstruction of target groups" is an important path for high hospitalization rate outside the county.（3）Measures should be taken to strengthen the construction of close medical community and improve the service capacity of grass-roots units,expand the compensation proportion gap between medical institutions inside and outside the county,reduce the hospitalization rate outside the county,support the implementation of hierarchical diagnosis and treatment system,and ensure the sustainable development of medical insurance fund.