Changes in the perceived quality of primary care in Shanghai and Shenzhen, China: a difference-in-difference analysis

Abstract

ObjectiveTo assess changes in the quality of primary care in two megacities following the introduction of health system reforms in China.MethodsWe conducted multistage stratified random face-to-face surveys of patients visiting community health centres in Shanghai in 2011 and 2013, and Shenzhen in 2012 and 2013. Quality of primary care was measured using an assessment tool. Difference-in-difference analyses based on multiple linear regressions were used to compare the changes over time, after controlling for potential confounders.FindingsMost (2721) of the 3214 participants used a community health centre as their regular source of care and were included in our analyses. The mean total scores for quality of primary care were similar for Shanghai and Shenzhen at baseline. In Shenzhen, the mean total scores for all participants and those on low incomes had worsened by 0.922 (95% CI: 0.629 to 1.215) and 1.203 (95% CI: 0.397 to 2.009), respectively. In Shanghai, however, there were improvements in the mean total scores which included increases in the scores for first-contact utilization, continuity, coordination of information and comprehensiveness.ConclusionThe quality of primary care improved in Shanghai but not in Shenzhen. This may be because, in Shanghai, beneficial long-term relationships between patients and general practitioners were supported by capitation payments and the provision of services tailored to the local health priorities.

Impact of China's essential medicines scheme and zero‐mark‐up policy on antibiotic prescriptions in county hospitals: a mixed methods study

“…We employed difference‐in‐differences analyses to control baseline data and any potential confounding factors. Second, the study was conducted in two county hospitals in rural Guangxi, and its results should not be overextrapolated to other parts of China because areas differ considerably as to their implementation of national policies . Third, the study was conducted in county hospitals, and the results may not apply to general practitioners in township and village clinics.…”

“…All data were analysed using Stata 13.1 (StataCorp LP, College Station, TX, USA). We employed difference‐in‐differences analysis to explore the potential policy effect on antibiotics prescribing at the individual level over the two time periods (2011 vs . 2014), after adjusting potential confounding variables including patients’ age, gender, whether the prescription was issued on a weekday or not and secondary diagnosis of lower respiratory tract infections for inpatient records.…”

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

“…Previous research showed that the more times a patient visits a basic-level health organization, the higher PCAT score that he/she would report [41]. This may be due to the fact that chronic condition management and health care for senior citizen are included in the basic public health service package, and the policy of implementing equalized public health services allowed these groups access to better primary care.…”

Private ownership of primary care providers associated with patient perceived quality of care

“…It reported that quality scores improved in Shanghai, where specific policies regarding clinical and preventive care were implemented in CHCs to promote general practitioner team service, while quality of care declined in Shenzhen, where CHCs were more profit-driven. [26] Studies in China also showed that government owned CHCs provided higher quality of care, and reported higher blood pressure control rates among hypertensive patients managed in CHCs when compared with hospital-owned or private-owned CHCs. [18,27,28] …”