The Different Classification of Hospitals Impact on the Equity of Medical Outcomes of Patients in China

Background: In the context of Healthy China Strategy, the traditional idea that large hospitals provide better medical care is still deeply rooted in people's minds. The characteristics of the medical inverted pyramid structure—higher-level medical institutions are overwhelmed, while lower-level medical institutions are deserted—have existed for a long time. Because of the unreasonable allocation of resources, it is difficult to meet the healthcare needs of citizens and to establish a tiered delivery system. The objective of this paper is to study the effect of different classification of hospitals (COH) on the equity of Medical Outcomes of patients.Methods: The data used was from Urban Employee Basic Medical Insurance (UEBMI) enrolment records of Chengdu. We conducted a retrospective study and used Nested Multinomial Logit Model (NMNL) to estimate the effect of COH on the equity of Medical Outcomes.Results: COH had a significant effect on the equity of Medical Outcomes, but the effectiveness and direction of the hospital level on different outcomes were not consistent. The reimbursement rate, medical expenditures, gender, age, disease type and others factors were associated with the effect(p<0.01); length of stay has a limited effect on health outcomes. It was not the case that the longer the hospital stay was, the higher the quality of care would be. When COH was distinguished, there were significant differences in the effect of different levels of hospitals on the equity of Medical Outcomes. Horizontally speaking, hospitals of the same level had different effects on different the equity of Medical Outcomes(p<0.01). From a longitudinal perspective, different levels of hospitals had different effects on the equity of Medical Outcomes(p<0.01). It was not the case that the higher the level of hospital, the better the medical outcome. When hospital levels and disease types were distinguished, the effect of hospitals of different levels on the medical outcome of different disease types was significantly different.Conclusions: COH made a difference in the equity of Medical Outcomes. Hospitals of different levels should be reasonably selected according to disease types to achieve the optimal medical outcome. Therefore, China should promote the construction of a tiered delivery system.