Physician patient-sharing relationships and healthcare costs and utilization in China: social network analysis based on health insurance data

ABSTRACT

Objectives

Evidence on physician patient-sharing relationships from developing countries is limited. This study aimed to identify patient-sharing networks among physicians in China and explore the effect of attributes of physician networks on healthcare utilization and costs.

Methods

Retrospective analysis was undertaken based on healthcare claims from Urban Employee Basic Medical Insurance Data spanning the years 2015 to 2018. We identified patients with hypertension and modeled physician patient-sharing networks using social network analysis. Relationships among physicians were further quantified using network measures. We fitted a log-linear model to examine the association between networks and healthcare at the physician level.

Results

29,321 patients, seen by 3,429 physicians from 57 hospitals in one eastern city of China were included. Physicians were connected to 21 other physicians (threshold = 1 shared patients) or 7 other physicians (threshold = 4, 6, or 8 shared patients). Degree and centrality measures of physicians at primary care facilities were significantly lower than those at secondary or tertiary hospitals (p < 0.001). The links between physicians at different hospital grades were weak and patients tended to flow among physicians at the same hospital grade. Compared with a low closeness centrality, a medium level was associated with fewer hospitalization costs and days, and high closeness centrality was accompanied by a sharper decrease (all P < 0.001).

Conclusions

Primary care physicians were located in peripheral positions in China, and the links between primary care facilities and higher-grade hospitals were still weak. Characteristics of physicians’ networks and the position of physicians in the network were associated with spending and utilization of services, but not all associations were in the same direction.

KEYWORDS:

• Social network
• patient sharing
• health care delivery
• healthcare utilization
• healthcare costs

Notes on Contributions

HH: Conceptualization, Methodology, Formal analysis, Writing-Original draft preparation. YZ: Data curation, Investigation. DZ: Software, Visualization. XG: Validation, Writing-Reviewing and Editing, Supervision. LS: Conceptualization, Resources, Project administration. The study idea originated from HH and was further developed in discussions with XG and LS and finalized in communication with all authors. All authors contributed to the submitted version and approved the final manuscript. XG is the overall guarantor for the manuscript.

Declaration of financial/ other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Data availability statement:

The corresponding author had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Declaration of interest

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This work was supported by National Natural Science Foundation of China (NSFC: 72074007)