Advancing primary care to promote equitable health: implications for China

Hung, Li Mei; Rane, Sarika; Tsai, Jenna; Shi, Leiyu

doi:10.1186/1475-9276-11-2

Cited by 40 publications

(33 citation statements)

References 5 publications

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“…Hung argued that a big gap in resources and services between hospitals and primary care institutions exists and it continues to be increase despite the government’s favorable investment policies for the primary care sector [16]. But there is paucity in the literature documenting inequity in resources and services between hospitals and primary care institutions.…”

Section: Introductionmentioning

confidence: 99%

Inequality in the distribution of health resources and health services in China: hospitals versus primary care institutions

Zhang

Ren

et al. 2017

Int J Equity Health

241

227

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BackgroundEquity is one of the major goals of China’s recent health system reform. This study aimed to evaluate the equality of the distribution of health resources and health services between hospitals and primary care institutions.MethodsData of this study were drawn from the China Health Statistical Year Books. We calculated Gini coefficients based on population size and geographic size, respectively, for the indicators: number of institutions, number of health workers and number of beds; and the concentration index (CI) for the indicators: per capita outpatient visits and annual hospitalization rates.ResultsThe Gini coefficients against population size ranged between 0.17 and 0.44 in the hospital sector, indicating a relatively good equality. The primary care sector showed a slightly higher level of Gini coefficients (around 0.45) in the number of health workers. However, inequality was evident in the geographic distribution of health resources. The Gini coefficients exceeded 0.7 in the geographic distribution of institutions, health workers and beds in both the hospital and the primary care sectors, indicating high levels of inequality. The CI values of hospital inpatient care and outpatient visits to primary care institutions were small (ranging from -0.02 to 0.02), indicating good wealth-related equality. The CI values of outpatient visits to hospitals ranged from 0.16 to 0.21, indicating a concentration of services towards the richer populations. By contrast, the CI values of inpatient care in primary care institutions ranged from -0.24 to -0.22, indicating a concentration of services towards the poorer populations. The eastern developed region also had a high internal inequality compared with the other less developed regions.ConclusionSignificant inequality in the geographic distribution of health resources is evident, despite a more equitable per capita distribution of resources. Richer people are more likely to use well-resourced hospitals for outpatient care. By contrast, poorer people are more likely to use poorly-resourced primary care institutions for inpatient care. There is a risk of the emergence of a two-tiered health care delivery system.

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Section: Introductionmentioning

confidence: 99%

Inequality in the distribution of health resources and health services in China: hospitals versus primary care institutions

Zhang

Ren

et al. 2017

Int J Equity Health

241

227

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“…In many countries, research on health care reform has proven that a strong primary care system forms a solid foundation to provide accessible and affordable primary care to residents and improves the performance of the entire health system [1,2]. China’s 2009 health care reform aims to achieve the objective of “health for all” by expanding basic health insurance coverage and strengthening the primary care system.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Primary Care Experiences in Village Clinics with Different Ownership Models in Guangdong Province, China

et al. 2017

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ObjectivesIn order to improve the quality of services at village clinics (VCs), which are important primary care service providers in rural China, the Chinese government has encouraged the township hospitals to own and manage VCs. There are currently three models of ownership and management of VCs: township hospital-owned and -managed (HVC), village committee-owned and -managed (VVC), and private-owned and -managed (PVC). This study aims to examine the association between these ownership models of VCs and patients' primary care experiences.MethodsVillagers were selected by multistage stratified sampling and their experiences with primary care were measured using the Primary Care Assessment Tool—Adult Edition (PCAT-AS). Data were collected through face-to-face interviews and the questionnaires administered by investigators in the cross-sectional study from February to April 2015. The PCAT scores were compared among the three models by covariance analysis, and multiple linear regression was used to analyze factors associated with the PCAT total scores.ResultsA total of 1491 questionnaires were collected. After controlling for covariates, HVCs reported the highest PCAT scores and satisfaction rate. In terms of the domains, HVC reported the highest scores in the coordination and comprehensiveness domains, while PVC had the highest scores in the first contact-accessibility domain. Multivariate linear regression showed that HVC, married participants, aged 60 and older, satisfied with the services, receiving six or more visits, and those with medical expenditures over 20% of their total family expenditures, were also positively associated with better primary care quality.ConclusionsThis study demonstrates that villagers receiving medical care at HVCs perceived better primary care than those at PVCs and VVCs. In order to improve the quality of primary care at VCs, it is necessary to increase government subsidies for public service packages, tighten the township hospital's supervision of PVCs and VVCs, and develop performance-based incentive plans to motivate improvements in the accessibility of HVCs.

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“…12,13 This phenomenon will complicate tobacco control in China further where health resources and social benefits are unequally allocated among the subpopulations. 36,37 The disadvantaged social groups that are marginalized already by a lack of health resources, will be burdened additionally by smoking-attributed health problems.…”

Section: Discussionmentioning

confidence: 99%