Does the Direct Settlement Policy of Trans-Provincial Outpatient Expenses Aggravate the Siphoning Effect? An Empirical Study on Yangtze River Delta, China

To solve the problem of reimbursing trans-regional medical expenses, using only cross-regional manual reimbursement but not direct medical insurance card settlement, China implemented a pilot policy of direct settlement of trans-provincial outpatient expenses (DSTOE) in the Yangtze River Delta region. Due to the differences in inter-regional medical development, patients often migrate from areas with low-level medical resources to the high-level areas, a phenomenon that we define as the “siphoning” of trans-regional patients, which can cause a variety of problems. To study whether DSTOE aggravates the siphoning effect, we analyzed the changes in the volume of trans-provincial outpatient visits and conducted a questionnaire survey and factor analysis on the willingness of trans-provincial medical treatment under DSTOE. Results showed that manual reimbursement was gradually replaced by direct settlement, while the total volume was not increased significantly, and the ratio of outpatient visits flowing into and out from Shanghai decreased. The majority of questionnaire respondents confessed that their willingness toward trans-regional medical treatment increased, while their first choice of medical location was still mainly local, with only a few indicating that they would directly choose a cross-regional, higher-level medical institution. Spatial accessibility significantly restricted the seeking of trans-regional medical treatment, whereas age, education level, and policy awareness served as significant protective factors for the choice of medical location. In conclusion, due to space accessibility constraints, insufficient policy coverage, and the rationale for choice of location, DSTOE did not aggravate the siphoning effect of trans-regional patients.

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An Index-Based Assessment of Perceived Climate Risk and Vulnerability for the Urban Cluster in the Yangtze River Delta Region of China

Sustainability ◽

10.3390/su11072099 ◽

2019 ◽

Vol 11 (7) ◽

pp. 2099 ◽

Cited By ~ 3

Author(s):

Landong Sun ◽

Zhan Tian ◽

Huan Zou ◽

Lanzhu Shao ◽

Laixiang Sun ◽

...

Keyword(s):

Yangtze River ◽

Assessment Tool ◽

Yangtze River Delta ◽

River Delta ◽

Climate Risk ◽

The Yangtze River ◽

Delta Region ◽

Yangtze River Delta Region ◽

High Level ◽

The Yangtze River Delta

This paper proposes an index-based assessment tool to consolidate diverse opinions of various stakeholders on their assessments of sector-specific risks posed by climate change, and to aggregate these opinions into intuitive and comparable graphs. This tool enables cities to measure and monitor the multiple factors that contribute to their resilience towards climate risk and hazard in the long term. We applied this tool to five key infrastructure sectors in six representative cities in the Yangtze River Delta region. The graphs generated provide for the first time first-hand insights into the aggregative understanding of various stakeholders with regard to the current and future climate risk in their concerned sectors and cities. Our results indicate that a high level of exposure is not automatically associated with a high level of vulnerability across our selected cities. While all cities need to make efforts to reduce their vulnerability towards climate hazards, those characterized by “lower level of exposure but higher level of vulnerability” need to make more urgent and much greater efforts.

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