Creating accountable hospital service areas in China: a case analysis of health expenditure in the metropolis of Chengdu
Objectives To delineate hospital service areas (HSAs) using the Dartmouth approach in China and identify the hypothesised demand-side, supply-side and region-specific factors of health expenditure within HSAs.Design Population-based descriptive study.Setting We selected the metropolis of Chengdu, on...
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BMJ Publishing Group
2022-01-01
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| Series: | BMJ Open |
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| author | Jay Pan Peiya Cao Xiaoshuang Zhao Yili Yang |
| author_facet | Jay Pan Peiya Cao Xiaoshuang Zhao Yili Yang |
| author_sort | Jay Pan |
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| description | Objectives To delineate hospital service areas (HSAs) using the Dartmouth approach in China and identify the hypothesised demand-side, supply-side and region-specific factors of health expenditure within HSAs.Design Population-based descriptive study.Setting We selected the metropolis of Chengdu, one of the three most populous cities in China as a case for the analysis, where approximately 16.33 million residents living.Participants Individual-level in-patient discharge records (n=904 298) during the fourth quarter of 2018 (from 1 September to 31 December) were extracted from Sichuan Health Commission. Cases of non-residents of Chengdu were excluded from the datasets.Methods We conducted three sets of analyses: (1) apply Dartmouth approach to delineate HSAs; (2) use Geographic Information System (GIS)-based method to demonstrate health expenditure variations across delineated HSAs and (3) employ a three-level multilevel linear model to examine the association between health expenditure and demand-side, supply-side and region-specific factors.Results A total of 113 HSAs with a median population of 60 472 (ranging from 7022 to 827 750) was delineated. Total in-patient expenditure per admission varied more than threefold across HSAs after adjusting for age and gender. Apart from a list of demand-side factors, an increased number of physicians, healthcare facilities at higher levels and for-profit healthcare facilities were significantly associated with increased total in-patient expenditures. At the HSA level, the proportion of private healthcare facilities located in a single HSA was associated with increased total in-patient expenditure generated by that HSA, while the increased number of healthcare facilities in a HSA was negatively associated with the total in-patient expenditures.Conclusion HSAs were delineated to help establish an accountable healthcare delivery system, which serves as local hospital markets to provide in-patient healthcare via connecting demanders with suppliers inside particular HSAs. Policy-makers should adopt HSAs to identify variations of total in-patient expenditures among different areas and the potential associated factors. Findings from the HSA-based analysis could inform the formulation of relevant health policies and the optimisation of healthcare resource allocations. |
| format | Article |
| id | doaj-art-93a5580d7f964c559c1c25f1804f73b3 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-93a5580d7f964c559c1c25f1804f73b32025-02-07T08:10:12ZengBMJ Publishing GroupBMJ Open2044-60552022-01-0112110.1136/bmjopen-2021-051538Creating accountable hospital service areas in China: a case analysis of health expenditure in the metropolis of ChengduJay Pan0Peiya Cao1Xiaoshuang Zhao2Yili Yang3HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, ChinaWest China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, ChinaShenzhen Longgang Chronic Disease Hospital, Shenzhen, Guangdong, ChinaHEOA Group, Institute for Healthy Cities and West China Center for Rural Health Development, Sichuan University, Chengdu, Sichuan, ChinaObjectives To delineate hospital service areas (HSAs) using the Dartmouth approach in China and identify the hypothesised demand-side, supply-side and region-specific factors of health expenditure within HSAs.Design Population-based descriptive study.Setting We selected the metropolis of Chengdu, one of the three most populous cities in China as a case for the analysis, where approximately 16.33 million residents living.Participants Individual-level in-patient discharge records (n=904 298) during the fourth quarter of 2018 (from 1 September to 31 December) were extracted from Sichuan Health Commission. Cases of non-residents of Chengdu were excluded from the datasets.Methods We conducted three sets of analyses: (1) apply Dartmouth approach to delineate HSAs; (2) use Geographic Information System (GIS)-based method to demonstrate health expenditure variations across delineated HSAs and (3) employ a three-level multilevel linear model to examine the association between health expenditure and demand-side, supply-side and region-specific factors.Results A total of 113 HSAs with a median population of 60 472 (ranging from 7022 to 827 750) was delineated. Total in-patient expenditure per admission varied more than threefold across HSAs after adjusting for age and gender. Apart from a list of demand-side factors, an increased number of physicians, healthcare facilities at higher levels and for-profit healthcare facilities were significantly associated with increased total in-patient expenditures. At the HSA level, the proportion of private healthcare facilities located in a single HSA was associated with increased total in-patient expenditure generated by that HSA, while the increased number of healthcare facilities in a HSA was negatively associated with the total in-patient expenditures.Conclusion HSAs were delineated to help establish an accountable healthcare delivery system, which serves as local hospital markets to provide in-patient healthcare via connecting demanders with suppliers inside particular HSAs. Policy-makers should adopt HSAs to identify variations of total in-patient expenditures among different areas and the potential associated factors. Findings from the HSA-based analysis could inform the formulation of relevant health policies and the optimisation of healthcare resource allocations.https://bmjopen.bmj.com/content/12/1/e051538.full |
| spellingShingle | Jay Pan Peiya Cao Xiaoshuang Zhao Yili Yang Creating accountable hospital service areas in China: a case analysis of health expenditure in the metropolis of Chengdu BMJ Open |
| title | Creating accountable hospital service areas in China: a case analysis of health expenditure in the metropolis of Chengdu |
| title_full | Creating accountable hospital service areas in China: a case analysis of health expenditure in the metropolis of Chengdu |
| title_fullStr | Creating accountable hospital service areas in China: a case analysis of health expenditure in the metropolis of Chengdu |
| title_full_unstemmed | Creating accountable hospital service areas in China: a case analysis of health expenditure in the metropolis of Chengdu |
| title_short | Creating accountable hospital service areas in China: a case analysis of health expenditure in the metropolis of Chengdu |
| title_sort | creating accountable hospital service areas in china a case analysis of health expenditure in the metropolis of chengdu |
| url | https://bmjopen.bmj.com/content/12/1/e051538.full |
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