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

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  • Lu, Chen
  • Zhang, Zixiao
  • Lan, Xiuting

Abstract

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.

Suggested Citation

  • 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.
    • Handle: RePEc:eee:socmed:v:235:y:2019:i:c:16
    DOI: 10.1016/j.socscimed.2019.112386
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    Cited by:

    1. Linlin Zhang & Tao Zhou & Chao Mao, 2019. "Does the Difference in Urban Public Facility Allocation Cause Spatial Inequality in Housing Prices? Evidence from Chongqing, China," Sustainability, MDPI, vol. 11(21), pages 1-20, November.
    2. 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).
    3. 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.
    4. 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).
    5. Tao, Zhuolin & Zhao, Min, 2023. "Planning for equal transit-based accessibility of healthcare facilities: A case study of Shenzhen, China," Socio-Economic Planning Sciences, Elsevier, vol. 88(C).
    6. 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).
    7. Yuhui Ruan & Chenyang Zhuang & Weisin Chen & Jinyu Xie & Yaodong Zhao & Lufa Zhang & Hong Lin, 2021. "Limited knowledge and distrust are important social factors of out‐patient’ s ‘inappropriate diagnosed seeking behaviour’: a qualitative research in Shanghai," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(3), pages 847-865, May.

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