中国跨区域就医的空间格局与影响因素分析——以慢性肾脏病为例

Exploring the spatial distribution and driving factors of Chinese cross-regional health seeking behavior:A case study of chronic kidney disease

探究中国慢性肾病患者跨区域就医的空间格局及其驱动因素,有助于提升对居民就诊需求的认知,在中国医疗资源发展不均衡的现状下,对于医疗体制改革与居民医疗保障的发展具有一定参考意义。研究基于2014—2018年中国居民慢性肾病就医病案首页信息,提取了非常住地跨区域就医数据并计算了患者的跨区域就医流入率与流出率指标,构建了广义线性模型探究了城市医疗资源以及交通与经济发展水平等指标对跨区域就医的影响及其区域差异。结果表明:①中国跨区域就医现象在全国范围内较为普遍,呈现流动人口多,流动范围广等特点。北京、上海、广州等区域中心城市具有最大的就诊流量。②医疗资源水平与城市经济发展水平对于患者跨区域就医具有显著驱动作用,其中人均肾脏病医生人数指标对于患者的跨区域就医影响最大。③医疗资源水平以及城市经济发展水平对于跨区域就医的影响具有一定的梯度效应,对于高发展水平的城市,提升城市肾脏病医生人数对于跨区域就医患者的流入具有更强的促进作用。而城市规模与人均GDP对于患者流动呈现正向与负向作用并存的态势。研究结果扩展了对患者就诊流动行为的认知,可以为区域医疗资源配置与公共卫生政策制定提供一定参考依据。

It is of great significance to explore the spatial pattern and driving factors of cross-regional health-seeking(CRHS)patient behavior with chronic kidney disease(CKD)in China,which can help to improve the cognition of residents'treatment needs.In the current situation of imbalanced development of medical resources in China,it is necessary to reform the medical system and develop residents'medical services.In this study,a total of 4.39 million hospitalizations diagnosed with CKD from 2014 to 2018 were identified based on the medical record front page(MRFP)data of the hospital quality monitoring system of China.We calculated the inflow and outflow rates of the CRHS patient behavior to characterize patients'health-seeking behavior between cities.Then we explored the impact of urban medical resources,transportation and economic development on CRHS patient behavior and its regional heterogeneity with generalized regression model.The results are as follows:(1)The CRHS patient behavior is common across China,showing the characteristics of a large floating population and a wide range of mobility.Beijing,Shanghai,Guangzhou and other regional central cities have the largest patient flow.(2)The level of medical resources and the level of urban economic development have a significant driving effect on patients'cross-regional treatment behavior,among which the number of nephrologists per capita has the greatest impact.(3)The level of medical resources and urban economic development have a certain regional heterogeneity and gradient effect on CRHS patient behavior.For cities with high levels of development,increasing the number of kidney disease doctors in cities has a stronger promoting effect on the influx of patients seeking treatment across regions.The city size and per capita GDP have both positive and negative effects on patient mobility.The research results can expand our understanding of the patient healthcare flow behavior,and provide some reference for the allocation of regional medical resources and the development of public health policies.