Identification of Factors Influencing Out-of-county Hospitalizations in the New Cooperative Medical Scheme

Throughout the duration of the New Cooperative Medical Scheme (NCMS), it was found that an increasing number of rural patients were seeking out-of-county medical treatment, which posed a great burden on the NCMS fund. Our study was conducted to examine the prevalence of out-of-county hospitalizations and its related factors, and to provide a scientific basis for follow-up health insurance policies. A total of 215 counties in central and western China from 2008 to 2016 were selected. The total out-of-county hospitalization rate in nine years was 16.95%, which increased from 12.37% in 2008 to 19.21% in 2016 with an average annual growth rate of 5.66%. Its related expenses and compensations were shown to increase each year, with those in the central region being higher than those in the western region. Stepwise logistic regression reveals that the increase in out-of-county hospitalization rate was associated with region (X1), rural population (X2), per capita per year net income (X3), per capita gross domestic product (GDP) (X4), per capita funding amount of NCMS (X5), compensation ratio of out-of-county hospitalization cost (X6), per time average in-county (X7) and out-of-county hospitalization cost (X8). According to Bayesian network (BN), the marginal probability of high out-of-county hospitalization rate was as high as 81.7%. Out-of-county hospitalizations were directly related to X8, X3, X4 and X6. The probability of high out-of-county hospitalization obtained based on hospitalization expenses factors, economy factors, regional characteristics and NCMS policy factors was 95.7%, 91.1%, 93.0% and 88.8%, respectively. And how these factors affect out-of-county hospitalization and their interrelationships were found out. Our findings suggest that more attention should be paid to the influence mechanism of these factors on out-of-county hospitalizations, and the increase of hospitalizations outside the county should be reasonably supervised and controlled and our results will be used to help guide the formulation of proper intervention policies.