Inpatient care and ambulatory care constitute the national and regional health care system. The relationship between the two subsystems is a significant topic that needs to be studied. Using publicly released data of China and international agencies, this paper preliminarily analyses the status and trends of hospital inpatient service provision and utilization and potential influencing factors, as well as the relationship between primary care and inpatient care. The results show that hospital admission rates in China are positively correlated with the degree of population aging and the availability of hospital beds, with synchronous growth observed in bed availability, utilization rates, and general practitioner resources. Hospital admission rates vary significantly across provinces. The hospitalization rate cannot be satisfactorily explained with commonly used indicators such as socioeconomic, population structure, and health resource allocation, but geographic density of hospital beds is related to socioeconomic and population indicators and other resource structures. Internationally, the supply of hospital beds is decreasing in high-income countries, increasing in middle-income countries, and remaining at a low level in low-income countries; the hospitalization rate is related to population aging, economic development, and hospital governance policies. It has been widely realized that excessive provision of expensive inpatient care will make the health system unsustainable. The healthcare system reforms are focusing on early disease prevention, consolidating and strengthening primary health care and basic medical care, and changing the traditional role of hospitals. High-income countries have reduced the supply and utilization of hospitalization services through various measures, middle-income countries are exploring the governance of hospitalization services, and low-income countries are exploring how to increase supply and utilization of inpatient care. Strengthening basic medical services does not necessarily lead to a reduction in inpatient services, but to improve the cost-effectiveness and fairness of regional medical services and optimize the use of inpatient resources. Effective governance of inpatient care and primary care, establishment and development of large-scale and competent basic medical services, implementation of shared care across the subsystems and apply gatekeeper systems, and measures to reduce avoidable hospitalizations for specific diseases and specific populations can help primary care contribute more rational inpatient care.

住院服务和非住院服务组成了国家和区域医疗服务系统。关注这两个子系统之间的关系是需要深入研究的问题。本文采用国内和国际的主要公开数据，初步分析医院住院服务提供和利用的状况和趋势及其影响因素，以及初级保健与住院服务的关系。结果显示中国住院率与人口老龄化程度和床位供应量呈正相关，且床位供应、利用率及全科医生资源同步增长。各省住院率存在明显差异。住院率高低难以用常用的社会经济、人口结构、卫生资源配置量等指标来解释，不过每百平方公里医院病床数与社会经济和人口指标以及其他资源结构有关。国际上的每千人口医院病床数在高收入国家呈下降趋势，在中收入国家呈增长趋势，在低收入国家维持低水平；住院率与人口老化程度、经济发展程度、医院治理政策等因素有关。世界各国已经意识到过度提供昂贵的住院服务会造成卫生系统不可持续性，均在致力于结构性的改革，将重点放在早期疾病的预防、巩固和加强初级卫生保健和基本医疗、改变医院的传统角色等。高收入国家已经通过各种措施降低了住院服务的供应和利用，中收入国家探讨住院服务的治理，低收入国家则探讨如何应对住院服务供应和利用不足的问题。因此，加强基本医疗服务不必然导致住院服务减少，不断发展基本医疗可以提高区域医疗服务的成本效益和公平性，优化住院服务资源的利用。对住院服务和基本医疗服务进行有效治理、建立和发展有规模和胜任的基本医疗服务、严格执行分级诊疗和守门人制度、针对特定病种和人群采取措施减少可避免住院等，有助于基本医疗促进更合理的住院服务提供和利用。