Relationship analysis between the supply structure of health resources with the growth structure of medical expenditure of Fuzhou / 中华医院管理杂志

ABSTRACT

Objective:To analyze the relationship between the structure of health resource supply and the growth structure of medical expenditure in Fuzhou.Methods:In accordance with hospital scale category standards, health resources provided for medium and large hospitals were categorized as high quality resources, while those provided for urban community health centers and township hospitals, and those for hospitals with less than 200 beds were categorized as primary health resources. The descriptive statistical method was used to analyze the health resource allocation and supply in Fuzhou; The structure decomposition method was used to decompose 2016—2019 hospitalization expenditure, and the principal component analysis was used to discuss the influencing factors of differences in the growth structure of hospitalization expenses.Results:In accordance with such factors as the economic development level, health service needs and geographical locations of districts and counties of Fuzhou city, 12 districts/counties were divided into three levels. The number of high-quality health resource medical institutions deployed in the first and second-level regions accounted for 78.95% of all. Among them, GL and TJ districts were equipped with hospital beds accounting for 44.29% of the total high-quality beds of all, while those resources of third-level regions were mostly primary health resources.From 2016 to 2019, medical expenditure of public hospitals kept rising. As found in structural decomposition, scale effect was the fundamental driver, followed by the structural effect, and then the inflation effect. This study identified increased inpatient service demand as the main driver for increased costs. Principal component regression results found that increased supply of high quality health resources as having a positive pull effect on the increase of hospitalization expenditure.For example, expansion of hospital beds at large hospitals contributes positive effect on the cost inflation( β1=0.421, P<0.001). On the other hand, investment in primary health resources could play a constraint role on excessive growth of medical expenditure, while the overall deployment level of their health resources affected negatively the patient flow(beds/per thousand population β2=-0.303, P<0.001). Conclusions:The structure of health resource supply is strongly related to the structure of medical expenditure growth. It is suggested to differentiate the allocation of high-quality and basic-quality health resources and optimize the supply structure of resources. It is also imperative to strengthen the investment in basic health resources and enhance the medical and health service capabilities of related institutions, in order to optimize the flow of residents′ medical visit flow and guide medical expenditure growth in a reasonable manner.