Objective  To examine the status and influencing factors of accessibility to immediate reimbursement for cross-provincial healthcare among rural residents and to provide evidence for improving related policies.

  Methods   With simple random sampling, a nationwide online questionnaire survey was conducted among 2 497 rural residents having cross-provincial hospitalization during past one year in 100 designated hospitals providing healthcare service to non-local residents and with leading amount of immediate reimbursement for the services from September 2019 through September 2020. Macro- and micro-factors affecting the accessibility of immediate reimbursement for cross-provincial healthcare of rural residents were analyzed using hierarchical model.

  Results   Of the 2 363 participants with valid responses, only 19.2% (n = 454) received cross-provincial immediate reimbursement for their out-of-pocket medical costs; the ratio of receiving cross-provincial immediate reimbursement was the highest among the participants with severe disease referrals (31.7% 152/480) and cross-provincial medication in tertiary hospitals (21.0% 351/1 674). For the participants with long-term living/working in non-home provinces, the probability of receiving immediate reimbursement for cross-provincial healthcare was only 25.4%/54.5% of that for the participants with severe disease referrals; for the participants having the cross-provincial healthcare in secondary hospitals, the probability was 64.4% of that for the participants having the healthcare in tertiary hospitals. Each 1% increase in the proportion of designated hospitals with immediate reimbursement for cross-provincial healthcare against all hospitals in a region is associated with a 36.8% increase in the probability of immediate reimbursement for cross-provincial healthcare among rural residents.

  Conclusion   The accessibility to immediate reimbursement for cross-provincial healthcare among rural residents is poor probably due to the gap between cross-provincial healthcare and the coverage of immediate reimbursement network and due to the restriction of the rural residents' migration. The results suggest that targeted strategies need to be developed to increase the accessibility.