BackgroundMigrants are the unique production of China’s urbanization process. They are often excluded from social welfare and security systems of cities, and often exposed to high health risk related closely to their health problems. This research sought to unveil and explore the influencing factors on health services utilization of migrants in Beijing.MethodsA sample of 2014 inter-provincial migrants and 4578 residents with Beijing “Hukou” who were 15 years old and above was chosen by three-stage stratified cluster sampling method. A structured questionnaire survey was conducted via face-to-face interviews. Anderson health service utilization model was used to demonstrate the effects of the explanatory variables on health seeking behavior from predisposing, enabling and need variables.ResultsThe study reveals that the rate of ‘having symptoms’ of migrants was lower than that of residents with “Hukou” only in the group of 25 to 34 years old in the past month. 503 migrants (25.0%) and 1441 (31.5%) residents with “Hukou” reported at least one episode of discomfort in the past month, and the rate of health service seeking behavior among migrants (46.8%) was lower than residents with “Hukou” (62.6%) (P < 0.0001). Chi-square independence test shows that age, ethnicity, employment status, having chronic disease and the degree of symptom were the major determinants affecting migrants to receive health services. The binary logistic regression indicates that the degree of symptom as the need variable and ethnicity as the predisposing variable were the strong and consistent determinants of health services seeking behavior. The migrants with moderate degree and severe degree of symptom in the past month were at 1.623-times (OR = 1.623) and 5.035-times (OR = 5.035) higher chances of seeking health services respectively, comparing to mild degree of symptom. Minority migrants were less likely to seek health services than Han migrants (OR = 0.282).ConclusionsThe results indicate that the current health delivery system is not conducive for migrants to seek appropriate health services. Relevant policies and feasible measures, including increasing the coverage of health insurance and improving the health perception of migrants should be vigorously implemented to provide affordable health services and change health service utilization behaviors for migrants.

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BackgroundWe presented the pattern of health care consumption, and the utilization of available resources by describing the ecology of medical care in Beijing on a monthly basis and by describing the socio-demographic characteristics associated with receipt care in different settings. MethodsA cohort of 6,592 adults, 15 years of age and older were sampled to estimate the number of urban-resident adults per 1,000 who visited a medical facility at least once in a month, by the method of three-stage stratified and cluster random sampling. Separate logistic regression analyses assessed the association between those receiving care in different types of setting and their socio-demographic characteristics.ResultsOn average per 1,000 adults, 295 had at least one symptom, 217 considered seeking medical care, 173 consulted a physician, 129 visited western medical practitioners, 127 visited a hospital-based outpatient clinic, 78 visited traditional Chinese medical practitioners, 43 visited a primary care physician, 35 received care in an emergency department, 15 were hospitalized. Health care seeking behaviors varied with socio-demographic characteristics, such as gender, age, ethnicity, resident census register, marital status, education, income, and health insurance status. In term of primary care, the gate-keeping and referral roles of Community Health Centers have not yet been fully established in Beijing.ConclusionsThis study represents a first attempt to map the medical care ecology of Beijing urban population and provides timely baseline information for health care reform in China.

This study applied the non-parametric four-stage data envelopment analysis method (Four-Stage DEA) to measure the relative efficiencies of Chinese public hospitals from 2010 to 2016, and to determine how efficiencies were affected by eight factors. A sample of public hospitals (n = 84) was selected from Chongqing, China, including general hospitals and traditional Chinese medicine hospitals graded level 2 or above. The Four-Stage-DEA method was chosen since it enables the control of the impact of environment factors on efficiency evaluation results. Data on the number of staff, government financial subsidies, the number of beds and fixed assets were used as input whereas the number of out-patients and emergency department patients and visits, the number of discharged patients, medical and health service income and hospital bed utilization rate were chosen as study outputs. As relevant environmental variables, we selected GDP per capita, permanent population, population density, number of hospitals and number of available sickbeds in local medical institutions. The relative efficiencies (i.e. technical, pure technical, scale) of sample hospitals were also calculated to analyze the change between the first stage and fourth stage every year. The study found that Four-Stage-DEA can effectively filter the impact of environmental factors on evaluation results, which sets it apart from other models commonly used in existing studies.

BackgroundCommunity health service center (CHSC) and community health service station (CHSS) are the main institutions where general practitioners (GPs) deliver primary care in the urban area of China. Motivated by incentive policies, visits to community health service institutions (CHSIs) increased gradually in recent years, but concerns had been raised on the quality of general practice consultation. This is a preliminary study aimed to investigate the existing problems of general practice consultation in Beijing and provide practical evidence for developing relevant policies.MethodsSix GPs from 2 CHSCs and 3 CHSSs were selected by purposive sampling. The GPs were observed for 4 or 5 consecutive days during January 2013 to March 2013. The length and content of consultations were recorded in structured observation forms. Quantitative description was applied to describe the median, percentage and frequency of variables.ResultsA total of 1135 consultations were observed. The most frequent reason for consultations was specific prescription (61.6%), followed by presenting symptoms (20.7%), check-up (9.1%), counseling (5.4%), transfusion & injection (3.0%) and sickness certificate (0.2%). The median consultation length of all consultations was 2.0 minutes. The GPs prescribed in 81.0% of the consultations, on the other hand, history taking, physical examination, explanation of illness and health education only took place in 27.0%, 28.0%, 21.9% and 17.7% of the consultations respectively.ConclusionsThe adequacy of consultation length in CHSIs is in doubt. Most patients visited the CHSIs for prescription renewal. Health promotion e.g. health education are not adequately provided in consultations. The quality of general practice consultations was jeopardized by the large amount of patient flow for medicine renewal. Policies should be adjusted to reduce unnecessary consultations. Further studies are in need to evaluate the outcome and influencing factors of general practice consultation in China.