甘肃省跨省异地就医时空格局及影响因素分析

Spatial-Temporal Variation and Influence Factors of Cross-provincial Medical Care in Gansu Province

目的:分析甘肃省参保人跨省异地就医的时空分布格局及影响因素,为医疗、医保资源的合理配置和相关政策制定提供依据。方法:使用全局空间自相关指数和地理探测器模型,量化2018年—2020年甘肃省跨省异地就医的空间集聚模式和影响因素作用程度。结果:作为参保省,2018年—2020年,甘肃省跨省异地就医人次和结算次均费用均呈增长趋势;在地市级尺度上,跨省异地就医不存在显著的空间集聚性;影响跨省异地就医的因素中,民用汽车拥有量(0.779)、每千人卫生技术人员数(0.645)和医疗卫生预算支出(0.609)解释能力较高,不同因素间存在正向交互作用。结论:甘肃省优质医疗资源不足,跨省异地就医人次增长迅速;参保地交通状况和医疗资源水平是影响跨省异地就医的主要因素。

Objective:Analyze the spatial-temporal variations and infl uencing factors of the phenomenon of cross-provincial medical care among the insured people in Gansu.Provide evidence for the rational allocation of medical resources and related policies.Methods:Using the Global Moran’s I index and geodetector model to quantify the spatial pattern and the degree of infl uencing factors of cross-provincial medical care in Gansu from 2018 to 2020.Results:As insured province,the number of cross-provincial medical visits and the average cost of settlements in three years in Gansu increasing by 349%and 15%respectively.At prefecture level,there is no signifi cant spatial agglomeration of cross-provincial medical care.Among the infl uencing factors,the number of civilian vehicles(0.779),the number of health technicians per thousand people(0.645)and the medical and health budget expenditure(0.609)have the highest infl uence.Positive interaction are observed between diff erent factors.Conclusion:Gansu lacks high-quality medical resources,and the number of cross-provincial medical visits is increasing rapidly.Transportation and the level of medical resources in the insured area are the main factors that cause the phenomenon of cross-provincial medical care in Gansu.