China's high-quality medical resources are concentrated in the urban areas of large cities, and patients tend to go to large hospitals, resulting in irrational access to medical care. For this reason, in recent years, the government has increased its financial expenditure to strengthen the construction of primary healthcare institutions, with the aim of promoting rational access to medical care by patients, and realizing hierarchical diagnosis and treatment.

To analyze the influence of suburban government health expenditure on suburban patients' choice of medical care, and provide a reference basis for promoting the reform of hierarchical diagnosis and treatment system.

On February 10, 2022, the number of outpatient visits (outpatient and emergency visits) and inpatient admissions to Beijing municipal hospitals, suburban hospitals, and suburban primary healthcare institutions in 10 suburbs of Beijing from 2015 to 2017 were collected as the explained variables. Per capita government health expenditure was selected as the explanatory variable, and the number of permanent residents, gross domestic product (GDP) per capita, and the number of health technicians per 1 000 population were selected as the control variables. Chow's test and Hausman's test were used to select appropriate data analysis models (mixed regression model, fixed-effects model, and random-effects model) in order to explore the influencing factors of patients' visits to municipal hospitals, suburban hospitals, and suburban primary healthcare institutions in suburban Beijing.

The results of the fixed-effects model to analyze the factors influencing the choice of suburban patients' visits to municipal hospitals and suburban hospitals in Beijing showed that per capita governmental health expenditure, the number of health technicians per 1 000 population, GDP per capita, and the number of permanent residents were not the influencing factors for suburban patients' visits to municipal hospitals for outpatient and inpatient care (P>0.05), per capita government health expenditure and GDP per capita were influencing factors for suburban patients' outpatient and emergency care visits to suburban hospitals (P<0.05). The results of the random effects model to analyze the factors influencing the choice of patients from suburban areas of Beijing to seek medical care in suburban primary health care institutions showed that the permanent residents, GDP per capita, and per capita government health expenditure were influential factors for suburban patients' outpatient and emergency care visits to suburban primary healthcare institutions (P<0.05) .

At present, the phenomenon of "siphoning" patients in large hospitals still exists, and government health expenditure has not significant impact on suburban patients' access to municipal hospitals. However, increased government health expenditure can promote suburban patients to seek care in the region, which helps to achieve hierarchical diagnosis and treatment. The number of health technicians per 1 000 population has no significant effect on patients' choice of medical care. It is recommended to further increase the suburban government health expenditure, improve the medical service capacity of suburban medical staff, and encourage patients to seek medical care in the region.

我国优质医疗资源集中在大城市的城区，患者倾向到大医院就医，产生了不合理就医现象。为此，近几年政府加大财政支出以加强基层医疗卫生机构的建设，旨在促进患者合理就医，实现分级诊疗。

分析郊区政府卫生支出对郊区患者就医选择的影响，为推进分级诊疗制度改革提供参考依据。

于2022-02-10选取2015—2017年北京市10个郊区的患者到北京市属医院、郊区医院和郊区基层医疗卫生机构的门、急诊人次数及住院人次数作为被解释变量，选取人均政府卫生支出作为解释变量，选取各郊区常住人口数、人均国内生产总值（GDP）和每千人口卫生技术人数作为控制变量。采用Chow检验和Hausman检验选择恰当的数据分析模型（混合回归模型、固定效应模型和随机效应模型），以探讨北京市郊区患者到市属医院、郊区医院、郊区基层医疗卫生机构就医的影响因素。

固定效应模型分析北京市郊区患者到市属医院和郊区医院就医选择影响因素的结果显示，人均政府卫生支出、每千人口卫生技术人员数、人均GDP、常住人口数不是郊区患者到市属医院门、急诊和住院就医的影响因素（P>0.05），人均政府卫生支出和人均GDP是郊区患者到郊区医院门、急诊就医的影响因素（P<0.05）；随机效应模型分析北京市郊区患者到郊区基层医疗卫生机构就医选择影响因素的结果显示，常住人口数、人均GDP和人均政府卫生支出是郊区患者到郊区基层医疗卫生机构门、急诊就医的影响因素（P<0.05）。

目前大医院对患者的"虹吸"现象依然存在，政府卫生支出未对郊区患者到市属医院就医产生明显影响。但是增加政府卫生支出能够促进郊区患者在区域内就医，有助于实现分级诊疗。每千人口卫生技术人员数对患者就医选择未产生明显影响，建议进一步增加郊区政府卫生支出，提升郊区医务人员医疗服务能力，促进患者在区域内就医。