Abstract
BackgroundMedical Financial Assistance (MFA) provides health insurance and financial support for millions of low income and disabled Chinese people, yet there has been little systematic analysis focused on this vulnerable population. This study aims to advance our understanding of MFA recipients’ access to health care and whether their inpatient care use varies by remoteness.MethodsData were collected from the Surveillance System of Civil Affairs of Shaanxi province in 2016. To better proxy remoteness (geographic access), drive time from the respondent’s village to the nearest county-level or city-level hospital was obtained by a web crawler. Multilevel models were used to explore the impacts of remoteness on inpatient services utilization by MFA recipients. Furthermore, the potential moderating role of hospital grade (i.e. the grade of medical institution where recipient’s latest inpatient care services were taken in the previous year) on the relationship between geographic access and inpatient care use was explored.ResultsThe analytical sample consisted of 9516 inpatient claims within 73 counties of Shaanxi province in 2016. We find that drive time to the nearest hospital and hospital grade are salient predictors of inpatient care use and there is a significant moderation effect of hospital grade. Compared to those with shortest drive time to the nearest hospital, longer drive time is associated with a longer inpatient stay but fewer admissions and lower annual total and out-of-pocket (OOP) inpatient costs. In addition, these associations are lower when recipients are admitted to a tertiary hospital, for annual total and OOP inpatient expenditures, but higher for length of the most recent inpatient stay no matter what medical treatments are taken in secondary or tertiary hospitals for the most remote recipients.ConclusionOur results suggest that remoteness has a significant and negative association with the frequency of inpatient care use. These findings advance our understanding of inpatient care use of the extremely poor and provide meaningful insights for further MFA program development as well as pro-poor health strategies.
Highlights
Medical Financial Assistance (MFA) provides health insurance and financial support for millions of low income and disabled Chinese people, yet there has been little systematic analysis focused on this vulnerable population
According to the Poverty Monitoring Report of rural China, in rural areas, the percentage of residents unable to receive timely health care due to financial handicaps dropped by 7.8%; the number increased by 10.1% due to long and essential drive times and transportation costs [4]
This study investigated whether inpatient health services utilization varied by the remoteness, which was proxied by the drive time to the nearest hospital according to Compared to those with the shortest drive time to the nearest hospital, the shorter, the medium, the longer and the longest had a significantly longer inpatient stay in the latest inpatient care but fewer admissions as well as lower total and OOP inpatient costs over the past year
Summary
Medical Financial Assistance (MFA) provides health insurance and financial support for millions of low income and disabled Chinese people, yet there has been little systematic analysis focused on this vulnerable population. According to the Poverty Monitoring Report of rural China, in rural areas, the percentage of residents unable to receive timely health care due to financial handicaps dropped by 7.8%; the number increased by 10.1% due to long and essential drive times and transportation costs [4]. These vulnerable populations normally have poor health and live in rural and remote areas with limited access to health care [5,6,7,8,9]; they are more likely to delay or deter essential medical treatments [10,11,12]
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