中国跨区域就医的空间格局与影响因素分析-以慢性肾脏病为例

It is of great significance to explore the spatial pattern and driving factors of cross-regional health-seeking (CRHS) patient behavior with chronic kidney disease (CKD) in China, which can help to improve the cognition of residents' treatment needs. In the current situation of imbalanced development of medical resources in China, it is necessary to reform the medical system and develop residents' medical services. In this study, a total of 4.39 million hospitalizations diagnosed with CKD from 2014 to 2018 were identified based on the medical record front page (MRFP) data of the hospital quality monitoring system of China. We calculated the inflow and outflow rates of the CRHS patient behavior to characterize patients' health-seeking behavior between cities. Then we explored the impact of urban medical resources, transportation and economic development on CRHS patient behavior and its regional heterogeneity with generalized regression model. The results are as follows: (1) The CRHS patient behavior is common across China, showing the characteristics of a large floating population and a wide range of mobility. Beijing, Shanghai, Guangzhou and other regional central cities have the largest patient flow. (2) The level of medical resources and the level of urban economic development have a significant driving effect on patients' cross- regional treatment behavior, among which the number of nephrologists per capita has the greatest impact. (3) The level of medical resources and urban economic development have a certain regional heterogeneity and gradient effect on CRHS patient behavior. For cities with high levels of development, increasing the number of kidney disease doctors in cities has a stronger promoting effect on the influx of patients seeking treatment across regions. The city size and per capita GDP have both positive and negative effects on patient mobility. The research results can expand our understanding of the patient healthcare flow behavior, and provide some reference for the allocation of regional medical resources and the development of public health policies.