Impact of China's referral reform on the equity and spatial accessibility of healthcare resources: A case study of Beijing

Lu, Chen; Zhang, Zixiao; Lan, Xiuting

doi:10.1016/j.socscimed.2019.112386

Cited by 112 publications

(103 citation statements)

References 41 publications

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“…All of these can be directly referred to the higher-level medical institutions. On the other hand, after receiving treatment at a higher-level medical institution, cases of acute-disease patients with stable disease and advanced non-surgical treatment of patients with malignant tumors can be transferred to lower-level medical institutions for further rehabilitation [10,11].…”

Section: Introductionmentioning

confidence: 99%

Analysis of the Impact of China’s Hierarchical Medical System and Online Appointment Diagnosis System on the Sustainable Development of Public Health: A Case Study of Shanghai

2019

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In the study of the sustainable development of public health in China, academic circles have little to do with the unique hierarchical medical system and online appointment diagnosis system in China's medical system. Therefore, based on the medical situation in Shanghai, China, in addition to the traditional dimension of medical expenses, this paper fully considers the impact of the current hierarchical medical policy, constructs a selection model for medical treatment behavior under the hierarchical medical system and online appointment diagnosis system, and carries out simulation analysis through the cellular automata grid dynamic model. This paper finds that the time-cost-oriented medical treatment behavior of Chinese patients will have different distribution under the current hierarchical medical system and online appointment diagnosis system. (1) When the medical treatment system neither allows online appointment nor referral, a large number of patients congregated in high-grade hospitals, with the most unreasonable distribution. (2) With the implementation of the system of allowing referral and online appointment, patients are gradually diverted to lower-grade hospitals or off-peak hours, and the distribution is relatively improved.(3) If the medical treatment system allows both referral and online appointment, the distribution of patients is the most reasonable. Therefore, China's current hierarchical medical system and online appointment diagnosis system will, to a considerable extent, become a policy tool that affects patients' choice of hospitals and an effective means to achieve the rational allocation of existing medical resources, which will play an important role in the sustainable development of public health in China.

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Section: Introductionmentioning

confidence: 99%

Analysis of the Impact of China’s Hierarchical Medical System and Online Appointment Diagnosis System on the Sustainable Development of Public Health: A Case Study of Shanghai

2019

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“…Moreover, we found an obvious regional disparity in spatial accessibility to county hospital exist across the Shaanxi Province. This disparity should be taken seriously, the regional disparities of spatial accessibility were also observed at primary health institutions in Sichuan Province and public hospitals in Beijing City [10,12]. Regional variations are also commonly existed in the world.…”

Section: Discussionmentioning

confidence: 96%

“…These studies find that the distribution of hospital beds at the county level has been highly spatially clustered [9]. There has been gaps of spatial access to primary health care within Sichuan Province in China [10], 69% of villages have lower spatial accessibility of health services comparing with the average of the county in Jiangsu Province [11], spatial accessibility of public hospitals in Beijing was improved by referral reform that was launched at 2015 and increased the inequality of access to medical resources between towns and streets [12]. Second, some studies have implemented various methods to evaluate the feasibility of using these methods to measure special accessibility.…”

Section: Introductionmentioning

confidence: 99%

Measuring spatial accessibility and disparity to county hospitals in western China: based on the web map navigation data

Shen

Zhou

Lai

et al. 2020

Preprint

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Background The Chinese government proposed the initiative of "XIAO BING BU CHU CUN, DA BING BU CHU XIAN” in 2016, which means the rate of health care service provided by county hospitals should reach 90%. The prerequisite for achieving this goal is that residents can access to county hospitals’ services conveniently and impartially. However, little research reported the level of spatial accessibility of county hospitals in western China. Therefore, we aim to measure the spatial accessibility to county hospitals of county residents and identify regional disparities in Shaanxi Province in western China. Methods We implemented a novel method – navigation data of the AutoNavi map (knows as Gaode map in Chinese) – to assess time and distance from villages and neighborhoods to county hospitals. The navigation data was collected by requesting an application-programming-interface using a web crawler in Python. The minimum driving time and distance were extracted from the navigation data. The travel impedance to the nearest provider was used to measure spatial accessibility. Results The results show that county residents in northwestern China's Shaanxi Province have poor spatial accessibility to county hospitals. Only 68.8% of villages and neighborhoods can reach the county hospitals within 60 minutes, while 13.4% of them are reachable beyond 90 minutes. Moreover, a significant within-province disparity exists, with residents in the central area most accessible to county hospitals, while the north and south areas still need improvement. Conclusions Health resource planning is required to improve spatial accessibility and eliminate the regional disparity. Further studies are called for to integrate navigation data of web map with GIS methods to measure spatial accessibility of health facilities in more complex contexts.

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“…The exploration of the spatial equity of urban public facility allocation that is based on spatial accessibility [17] focuses on the layout of facilities, which aims to enable citizens to gain equal access to public facilities [18]. The research subjects mainly focused on public service facilities [19][20][21], including essential livelihood facilities such as basic education facilities [22] and medical service resources [23,24] and nursing homes [25], as well as facilities that serve higher-level needs such as parks and green spaces [26] and recreational facilities [27]. However, spatial equity does not consider the distinct needs or preferences of social groups [28].…”

Section: Equity Of Urban Public Facilities Allocationmentioning

confidence: 99%

Does the Difference in Urban Public Facility Allocation Cause Spatial Inequality in Housing Prices? Evidence from Chongqing, China

2019

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The current study argues that the capitalisation effect of urban public facilities on housing will be considerable when the accessibility or availability of facilities has a serious stake in the location or property rights of houses. The supply level and supply quantity of urban public facilities determine whether there is a significant difference in the accessibility or availability of facilities amongst neighbourhoods, and subsequently determines whether the capitalisation effect of facilities on surrounding houses is considerable, which ultimately affects the spatial inequality in housing prices (i.e. spatial dispersion of housing prices). However, previous studies have rarely considered the fact that the supply and demand of urban public facilities vary with the type of facilities. Thus, according to the law of diminishing marginal utility, the current study proposes a theoretical framework for the impact of the allocation of urban public facilities at different supply levels on the spatial inequity in housing prices and verifies this through a case study. Results indicate that the difference in urban public facility allocation caused by the unequal supply quantity or unbalanced spatial distribution has a notable impact on the spatial inequality in housing prices. There are three states of allocation of urban public facilities available according to different supply levels, namely, disequilibrium, quantitative equilibrium and spatial equilibrium:(І) Scarce and high-quality public resources that may always be in the disequilibrium state create a substantial capitalisation effect on nearby housing, and their presence will aggravate spatial inequality in housing prices; (П) Public facilities that can only reach the quantitative equilibrium state have a considerable capitalisation effect on nearby housing, and their supply densities have a positive impact on the spatial inequality in housing prices; (Ш) Public facilities in the spatial equilibrium state have a negligible capitalisation effect on nearby housing, and their supply densities have a negative impact on the spatial inequality in housing prices. Therefore, it is reasonable to argue that urban public facilities at different supply levels have a diversified impact on the housing market. This study can contribute to having a comprehensive and in-depth understanding of the diversified impact of urban public facilities on the housing market.

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Impact of China's referral reform on the equity and spatial accessibility of healthcare resources: A case study of Beijing

Cited by 112 publications

References 41 publications

Analysis of the Impact of China’s Hierarchical Medical System and Online Appointment Diagnosis System on the Sustainable Development of Public Health: A Case Study of Shanghai

Analysis of the Impact of China’s Hierarchical Medical System and Online Appointment Diagnosis System on the Sustainable Development of Public Health: A Case Study of Shanghai

Measuring spatial accessibility and disparity to county hospitals in western China: based on the web map navigation data

Does the Difference in Urban Public Facility Allocation Cause Spatial Inequality in Housing Prices? Evidence from Chongqing, China

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