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| Spatial Proximity Advantage, Internet Medical Services and Hierarchical Medical System: A Survey on the Choice of First Visit Medical Institutions for Urban Residents in Yangtze River Delta |
| Xu Zhaopeng Zhang Lufa |
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Abstract The comprehensive establishment of a mature and perfect hierarchical medical system is a key component of the Healthy China Strategy, and the key to implementing this hierarchical medical system lies in strengthening primary healthcare institutions (i.e. strengthening grassroots). Enhancing the accessibility of primary healthcare resources is one of the most important measures for strengthening the grassroots. Although the negative effect of distance on the patients’ choice has been widely verified in previous studies, whether strengthening the spatial proximity advantage of primary healthcare institutions can enhance their competitiveness has not been sufficiently explored due to the strong preference for higher-level hospitals in China. In addition, the explosive growth of Internet-based medical services in recent years, especially during the epidemic, has provided new possibilities for the promotion of the hierarchical medical system, but the effect may be twofold. Moreover, previous studies have mainly emphasized the “induced effect” of information about the impact of Internet-based medical services on patients’ choices, and the measurement validity of the core variables may be insufficient. As two new variables in China’s healthcare landscape in recent years, the burgeoning grassroots and the explosive growth of Internet-based medical services not only have interactive relationship with each other, but are also possible answers to shaping an efficient and well-organized healthcare system in China. Therefore, this paper therefore explores the impact of spatial proximity advantage of healthcare institutions and Internet-based medical services on residents’ choice of first visit, and the possible moderating role and the heterogeneity. The data for this study come from 15 481 valid questionnaires obtained from a multi-stage stratified sampling of 41 cities in the Yangtze River Delta, and the empirical analysis mainly uses methods such as multinomial logit regression. The results of the study show that (1) even in the current context of low trust in primary healthcare institutions, the spatial proximity advantage of each type of healthcare institution still significantly increases its attractiveness to residents for first visits. Even the competitive edge generated by the spatial proximity advantage of the primary healthcare institutions is greater than that of the tertiary hospitals. (2) Internet-based medical services significantly increase the rate of residents choosing tertiary hospitals as a substitute for primary healthcare institutions or secondary hospitals for their first visit, but this substitution effect does not show up in secondary hospitals versus primary health care institution. In the future, secondary hospitals may face the dilemma of “sandwich layer” in the promotion of the hierarchical medical system. (3) Internet-based medical services can strengthen the competitiveness generated by the spatial proximity advantage of each type of healthcare institution. Internet-based medical services and physical medical services may not necessarily be a substitute for each other, but may also promote each other. (4) Different types of Internet-based medical services have different effects on residents’ choice of first visit, and “online reservation + telehealth” has a significant positive effect on increasing the first-visit rate in primary health care institutions and strengthening their spatial proximity advantage. Therefore, this paper proposes that improving the primary healthcare service network and using suitable Internet-based medical services to connect high-level hospitals with primary healthcare institutions will likely be a new solution to improving the hierarchical medical system and the construction of an integrated healthcare service system.
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Published: 20 February 2025
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