Hospital Availability in Rural Districts of China - A Secondary Data Analysis on Multiple Utilisation of Hospital Services under the Conditions of the Chinese Medical Health-Care System

Background: The study explores the necessity to develop and to implement a sufficient referral system of patients for hospital care in rural China. Current rules of utilising hospital care result in a lack of effectiveness and quality due to fragmentation and insufficient exchange of patients' data, but particularly when the providing hospital has to be changed during one diagnosis-related care cycle. The study aims to describe patterns and diseases of particular concern regarding the lacking exchange of data between different providers leading to the disintegration and fragmentation of services. Material and Methods: For the purpose of this study data from the Cooperative Medical System for Urban and Rural Residents were collected in 2010. From a total of 443 355 enrollees a total of 29 062 was admitted to hospital at least once. That is an admission rate of 6.6%. Among these patients, those were counted who had changed the hospital within the same treatment cycle. Results: 1 199 inpatients from the total of 29 062 changed the provider during the same disease cycle (4.12%), and they caused a total of 35 866 visits. 2 547 visits were due to patients who changed hospital during the disease-related treatment cycle. About 75% of these inpatients were aged from 30 to 75 years. Distinguishing providing hospitals into higher and lower level ones, those inpatients moving "upwards" are mainly vulnerable to respiratory diseases while the inpatients moving "downwards" are mainly suffering from injury and poisoning. The simple linear correlation result shows that the capacity of providing hospitalisation service of low-level medical institutions might have an impact on the standardised number of the "upward" referred inpatients. Conclusion: A health service system with different levels of provision is badly in need of a sufficient referral mechanism, if it is intended to integrate competence and to save recourses. This raises fundamentally the problem of the providers' interests in cooperation, if the frames that are guiding them are influenced by economic incentives and market mechanisms.