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Optimization referral rate design for hierarchical diagnosis and treatment system based on accessibility-utilization efficiency bi-objective collaboration: A case study of China

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  • Wei, Zhongyu
  • Bai, Jianjun
  • Feng, Ruitao

Abstract

The hierarchical diagnosis and treatment reform of China can guide residents to seek medical treatment in an orderly manner and improve access to medical treatment. Most existing studies on hierarchical diagnosis and treatment used accessibility as the evaluation index to determine the referral rate between hospitals. However, the blind pursuit of accessibility will cause the problem of uneven utilization efficiency of hospitals at different levels. In response to this, we constructed a bi-objective optimization model based on the perspective of residents and medical institutions. This model can give the optimal referral rate for each province considering the accessibility of residents and the utilization efficiency of hospitals, to improve the utilization efficiency and equality of access for hospitals. The results showed that the applicability of bi-objective optimization model is good, and the optimal referral rate based on the model can ensure the maximum benefit of the two optimization goals. In the optimal referral rate model, residents' medical accessibility is relatively balanced overall. In terms of obtaining high-grade medical resources, the accessibility is better in the eastern and central regions, but poorer in the western China. According to the current allocation of medical resources in China, the medical tasks undertaken by high-grade hospitals account for 60%–78%, which are still the main force of medical services. In this way, there is a big gap in realizing the “serious diseases do not leave the county” goal of hierarchical diagnosis and treatment reform.

Suggested Citation

  • Wei, Zhongyu & Bai, Jianjun & Feng, Ruitao, 2023. "Optimization referral rate design for hierarchical diagnosis and treatment system based on accessibility-utilization efficiency bi-objective collaboration: A case study of China," Social Science & Medicine, Elsevier, vol. 322(C).
    • Handle: RePEc:eee:socmed:v:322:y:2023:i:c:s0277953623001843
    DOI: 10.1016/j.socscimed.2023.115827
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    1. Shao, Yaxiong & Luo, Wei, 2022. "Supply-demand adjusted two-steps floating catchment area (SDA-2SFCA) model for measuring spatial access to health care," Social Science & Medicine, Elsevier, vol. 296(C).
    2. Pan, Jay & Zhao, Hanqing & Wang, Xiuli & Shi, Xun, 2016. "Assessing spatial access to public and private hospitals in Sichuan, China: The influence of the private sector on the healthcare geography in China," Social Science & Medicine, Elsevier, vol. 170(C), pages 35-45.
    3. Jia, Peng & Wang, Youfa & Yang, Min & Wang, Limin & Yang, Xuchao & Shi, Xinyu & Yang, Lijian & Wen, Jin & Liu, Yi & Yang, Maokang & Xin, Junguo & Zhang, Fengying & Jiang, Lihua & Chi, Chunhua & Zhang,, 2022. "Inequalities of spatial primary healthcare accessibility in China," Social Science & Medicine, Elsevier, vol. 314(C).
    4. Xiaojuan Shen & Weixin Yang & Shaorong Sun, 2019. "Analysis of the Impact of China’s Hierarchical Medical System and Online Appointment Diagnosis System on the Sustainable Development of Public Health: A Case Study of Shanghai," Sustainability, MDPI, vol. 11(23), pages 1-26, November.
    5. Yun Liu & Qingxia Kong & Shasha Yuan & Joris van de Klundert, 2018. "Factors influencing choice of health system access level in China: A systematic review," PLOS ONE, Public Library of Science, vol. 13(8), pages 1-21, August.
    6. Tao, Zhuolin & Cheng, Yang & Du, Shishuai & Feng, Ling & Wang, Shaoshuai, 2020. "Accessibility to delivery care in Hubei Province, China," Social Science & Medicine, Elsevier, vol. 260(C).
    7. Yang, Nan & Shen, Liyin & Shu, Tianheng & Liao, Shiju & Peng, Yi & Wang, Jinhuan, 2021. "An integrative method for analyzing spatial accessibility in the hierarchical diagnosis and treatment system in China," Social Science & Medicine, Elsevier, vol. 270(C).
    8. Li, Chuanyao & Wang, Junren, 2022. "A hierarchical two-step floating catchment area analysis for high-tier hospital accessibility in an urban agglomeration region," Journal of Transport Geography, Elsevier, vol. 102(C).
    9. Lu, Chen & Zhang, Zixiao & Lan, Xiuting, 2019. "Impact of China's referral reform on the equity and spatial accessibility of healthcare resources: A case study of Beijing," Social Science & Medicine, Elsevier, vol. 235(C), pages 1-1.
    10. Fang Wu & Wei Chen & Lingling Lin & Xu Ren & Yingna Qu, 2022. "The Balanced Allocation of Medical and Health Resources in Urban Areas of China from the Perspective of Sustainable Development: A Case Study of Nanjing," Sustainability, MDPI, vol. 14(11), pages 1-28, May.
    11. Zhou, Zhongliang & Zhao, Yaxin & Shen, Chi & Lai, Sha & Nawaz, Rashed & Gao, Jianmin, 2021. "Evaluating the effect of hierarchical medical system on health seeking behavior: A difference-in-differences analysis in China," Social Science & Medicine, Elsevier, vol. 268(C).
    12. Shuster, Stef M. & Lubben, Noah, 2022. "The uneven consequences of rapid organizational change: COVID-19 and healthcare workers," Social Science & Medicine, Elsevier, vol. 315(C).
    13. Páez, Antonio & Scott, Darren M. & Morency, Catherine, 2012. "Measuring accessibility: positive and normative implementations of various accessibility indicators," Journal of Transport Geography, Elsevier, vol. 25(C), pages 141-153.
    14. Chen, Yunwei & Sylvia, Sean & Wu, Paiou & Yi, Hongmei, 2022. "Explaining the declining utilization of village clinics in rural China over time: A decomposition approach," Social Science & Medicine, Elsevier, vol. 301(C).
    15. Xiao, Yixiong & Chen, Xiang & Li, Qiang & Jia, Pengfei & Li, Luning & Chen, Zhifen, 2021. "Towards healthy China 2030: Modeling health care accessibility with patient referral," Social Science & Medicine, Elsevier, vol. 276(C).
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