Towards healthy China 2030: Modeling health care accessibility with patient referral.

One primary action plan in the Healthy China 2030 initiative is to build innovativepatient referral models for health care reform in China. To ensure people have sufficient and equitable health care access when the patient referral policy is enforced, a systematic evaluation of its effects on the health care system is needed. In this paper, we focus on one health policy metric, the health care accessibility, by considering the patient transfer between different levels of health care facilities under the context that the need for specialized treatment cannot be fulfilled by a low-level facility. We then propose three conceptual patient referral models and a hierarchical two-step floating catchment area method to evaluate health care accessibility in different patient referral scenarios. A case study of hospitals in Beijing, China has been conducted to justify the proposed model, revealing the spatial inequality of health care accessibility. We find that while the patient referral can leverage health care resources to a certain extent, such effects are only prominent in areas with good coverage of health care facilities; and the efficiency of the health care system can be compromised in areas with limited health care provisioning. To this end, the study provides scientific evidence for the planning and reform of the health care policy in the Healthy China 2030 initiative.