Beyond geography: Cross-regional healthcare-seeking and hospitalization costs in Shandong, China

Yike Zhang ,Qiulin Huang ,Mengwei Song ,Yuxin Zhang ,Quanjun Liu ,Qing Wang

doi:10.24294/jipd0007

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Beyond geography: Cross-regional healthcare-seeking and hospitalization costs in Shandong, China

Yike Zhang

Qiulin Huang

Mengwei Song

Yuxin Zhang

Quanjun Liu

Qing Wang

Journal of Infrastructure Policy and Development 2026, 10(1), 0007; https://doi.org/10.24294/jipd0007

Submitted：31 Dec 2025

Accepted：03 Apr 2026

Published：21 Apr 2026

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Abstract

Cross-regional healthcare-seeking, defined as utilizing medical services beyond one’s residential area, helps mitigate geographic disparities in health resources but may correlate with elevated financial burdens. As this practice grows in China, particularly in resource-diverse provinces like Shandong, its relationship with hospitalization costs remains insufficiently quantified. This study aims to measure the association between cross-regional care and hospitalization expenditures in Shandong Province, China. Analysis of 2.27 million hospitalizations showed that cross-regional care was associated with higher hospitalization costs but differed by types of cross-regional healthcare-seeking. Seeking care at primary or secondary hospitals within adjacent cities was correlated with reduced expenditures, reflecting proximity-oriented behavior. In contrast, treatment at interprovincial tertiary hospitals was associated with the largest cost increase, with expenditures 206% higher than those for local care. A portion of the association between cross-regional healthcare-seeking and hospitalization costs was transmitted through prolonged length of stay as an intermediary pathway, and this pattern was not evident for interprovincial tertiary care. These heterogeneous cost patterns in Shandong support the development of differentiated governance strategies tailored to these heterogeneous cost drivers.

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References

Berta, P., Guerriero, C., & Levaggi, R. (2021). Hospitals’ strategic behaviours and patient mobility: Evidence from Italy. Socio-Economic Planning Sciences, 77, 101030. https://doi.org/10.1016/j.seps.2021.101030

Cai, X., Yang, F., & Bian, Y. (2019). Gap analysis on hospitalized health service utilization in floating population covered by different medical insurances: case study from Jiangsu Province, China. International Journal for Equity in Health, 18(1), 84. https://doi.org/10.1186/s12939-019-0992-4

Chen, J., Lin, Z., Li, L. A., et al. (2021). Ten years of China’s new healthcare reform: a longitudinal study on changes in health resources. BMC Public Health, 21(1), 2272. https://doi.org/10.1186/s12889-021-12248-9

Dong, X., & Wang, Y. (2024). The geography of healthcare: Mapping patient flow and medical resource allocation in China. Econ Hum Biol, 55, 101431. https://doi.org/10.1016/j.ehb.2024.101431

Du, W. Y., Yin, C. N., Wang, H. T., et al. (2021). Infectious diseases among elderly persons: Results from a population-based observational study in Shandong province, China, 2013-2017. J Glob Health, 11, 08010. https://doi.org/10.7189/jogh.11.08010

Fattore, G., Petrarca, G., & Torbica, A. (2014). Traveling for care: inter-regional mobility for aortic valve substitution in Italy. Health Policy, 117(1), 90-97. https://doi.org/10.1016/j.healthpol.2014.03.002

General Office of the State Council (2014). Notice of the State Council on Adjusting the Standards for Classifying City Sizes. Available online: https://www.gov.cn/gongbao/content/2014/content_2779012.htm (accessed on 20 January 2026)

Gonçalves-Bradley, D. C., Iliffe, S., Doll, H. A., et al. (2017). Early discharge hospital at home. Cochrane Database Syst Rev, 6(6), Cd000356. https://doi.org/10.1002/14651858.CD000356.pub4

Koylu, C., Delil, S., Guo, D., et al. (2018). Analysis of big patient mobility data for identifying medical regions, spatio-temporal characteristics and care demands of patients on the move. Int J Health Geogr, 17(1), 32. https://doi.org/10.1186/s12942-018-0152-x

Laugesen, M. J., & Vargas-Bustamante, A. (2010). A patient mobility framework that travels: European and United States–Mexican comparisons. Health Policy, 97(2), 225-231. https://doi.org/10.1016/j.healthpol.2010.05.006

Li, D., Zhou, Z., Si, Y., et al. (2018). Unequal distribution of health human resource in mainland China: what are the determinants from a comprehensive perspective? Int J Equity Health, 17(1), 29. https://doi.org/10.1186/s12939-018-0742-z

Li, Q., Fan, X., & Jian, W. (2023). Impact of Diagnosis-Related-Group (DRG) payment on variation in hospitalization expenditure: evidence from China. BMC Health Serv Res, 23(1), 688. https://doi.org/10.1186/s12913-023-09686-z

Li, Y., & Chen, Z. (2023). Health-seeking behavior and patient welfare: Evidence from China. China Economic Review, 80, 102015. https://doi.org/https://doi.org/10.1016/j.chieco.2023.102015

Li, Z.-W., Yin, C.-N., Wang, H.-T., et al. (2022). Incidence trend and disease burden of seven vaccine-preventable diseases in Shandong province, China, 2013–2017: Findings from a population-based observational study. Vaccine: X, 10, 100145. https://doi.org/https://doi.org/10.1016/j.jvacx.2022.100145

Li, Z., & Li, J. (2019). Lessons and prospects of Universal Health Coverage in China: the importance of equity, quality, and affordability. Asian Bioeth Rev, 11(1), 21-40. https://doi.org/10.1007/s41649-019-00077-3

National Health Commission. (2018). China health statistical yearbook 2018: Peking Union Medical College Press.

Rasooly, A., Pan, Y., Tang, Z., et al. (2022). Quality and Performance Measurement in Primary Diabetes Care: A Qualitative Study in Urban China. Int J Health Policy Manag, 11(12), 3019-3031. https://doi.org/10.34172/ijhpm.2022.6372

Ren, H., Li, C., & Huang, Y. (2023). Spatial and temporal analysis of China’s healthcare resource allocation measurements based on provincial data: 2010-2021. Front Public Health, 11, 1269886. https://doi.org/10.3389/fpubh.2023.1269886

Shandong Provincial Bureau of Statistics. (2021). Announcement on the Seventh National Population Census in Shandong Province.

Sun, J., & Luo, H. (2017). Evaluation on equality and efficiency of health resources allocation and health services utilization in China. Int J Equity Health, 16(1), 127. https://doi.org/10.1186/s12939-017-0614-y

Tarkowski, K., Bojar, I., Kister, A., et al. (2019). Changes in interregional migration of patients hospitalized in Poland – 2013–2017. Annals of Agricultural and Environmental Medicine, 26(3), 469-503. https://doi.org/10.26444/aaem/105389

Tian, J., Chen, Z., Wang, Y., et al. (2025). Does the trans-provincial immediate reimbursement reduce health gap between urban and rural floating population? Evidence from China. BMC Public Health, 25(1), 1826. https://doi.org/10.1186/s12889-025-23027-1

Wang, Q., Jiang, Q., Yang, Y., et al. (2022). The burden of travel for care and its influencing factors in China: An inpatient-based study of travel time. Journal of Transport & Health, 25, 101353. https://doi.org/https://doi.org/10.1016/j.jth.2022.101353

Yan, X., Shan, L., He, S., et al. (2022). Cross-city patient mobility and healthcare equity and efficiency: Evidence from Hefei, China. Travel Behaviour and Society, 28, 1-12. https://doi.org/10.1016/j.tbs.2022.02.001

Yin, X., Xu, Y., Man, X., et al. (2019). Direct costs of both inpatient and outpatient care for all type cancers: The evidence from Beijing, China. Cancer Med, 8(6), 3250-3260. https://doi.org/10.1002/cam4.2184

Yuan, L., Cao, J., Wang, D., et al. (2023). Regional disparities and influencing factors of high quality medical resources distribution in China. Int J Equity Health, 22(1), 8. https://doi.org/10.1186/s12939-023-01825-6

Zhang, B., Wang, H., Zhang, H., et al. (2022). The influence of cross-regional medical treatment on total medical expenses, medical insurance payments, and out-of-pocket expenses of patients with malignant tumors in Chinese low-income areas. Cost Effectiveness and Resource Allocation, 20(1), 35. https://doi.org/10.1186/s12962-022-00368-x

Zhang, T., Xu, Y., Ren, J., et al. (2017). Inequality in the distribution of health resources and health services in China: hospitals versus primary care institutions. International Journal for Equity in Health, 16(1), 42. https://doi.org/10.1186/s12939-017-0543-9

Zhang, X., & Zhang, L. (2022). The Impact of Instant Reimbursement of Cross-Regional Medical Services on Hospitalization Costs Incurred by the Floating Population—Evidence from China. Healthcare, 10(6), 1099.

Zhang, X., Zhao, L., Cui, Z., et al. (2015). Study on Equity and Efficiency of Health Resources and Services Based on Key Indicators in China. PLoS One, 10(12), e0144809. https://doi.org/10.1371/journal.pone.0144809

Zhao, L., Wang, H.-T., Ye, R.-Z., et al. (2022). Profile and dynamics of infectious diseases: a population-based observational study using multi-source big data. BMC Infectious Diseases, 22(1), 332. https://doi.org/10.1186/s12879-022-07313-6

Zhao, X., Li, L., & Zhang, D. (2024). The cross-regional settlement methods in hospitals and the treatment-seeking behavior of patients with malignant tumors in China: an evolutionary game model. Front Public Health, 12, 1427164. https://doi.org/10.3389/fpubh.2024.1427164

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