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

机译：中国推荐改革对医疗资源股权及空间可见性的影响 - 以北京市为例

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摘要

In 2015, the Chinese government implemented referral reform in its hierarchical medical system by adjusting the reimbursement rules of medical insurance, in order to guide patients' hospital preference. This reform has impacted the equity and spatial accessibility of healthcare resources in different regions. Taking Beijing as a case study, we calculated and compared the equity and accessibility of healthcare resources before and after referral reform with a three-stage two-step floating catchment area method. We set different referral rates and explored their effects on medical service accessibility and equity. The results showed that the referral reform improved total accessibility of public hospitals in Beijing, but at the same time aggravated the inequality of healthcare resource accessibility among towns and streets. Healthcare accessibility demonstrated a U shape with an increase in referral rates. After testing five scenarios, we conclude that a 90% referral rate from the secondary hospitals to tertiary hospitals could be a trade-off when the government strikes a balance between equal chance of access to health services and high accessibility.
机译：2015年，中国政府通过调整医疗保险的报销规则，在其等级医疗系统中实施转介改革，以指导患者的医院偏好。该改革影响了不同地区医疗资源的股权和空间可达性。以北京为例，我们计算并比较了推荐改革前后的医疗资源的公平和可达性与三阶段两步浮动区域方法。我们设置了不同的推荐率，并探讨了他们对医疗服务可访问性和公平的影响。结果表明，推荐改革改善了北京公立医院的总可达性，但同时加剧了城镇和街道的医疗保健资源可访问性的不平等。医疗保健可访问性展示了U形状，增加了推荐率。在测试五个方案之后，我们得出结论，当政府在获得卫生服务机会平衡与高可访问性之间平衡时，次级医院的推荐率为90％来自二级医院的转票率可能是一个权衡。

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