Does distrust in providers affect health-care utilization in China?

Abstract

How trust affects health-care utilization is not well-understood, especially in low- and middle-income countries. This article focuses on China, a middle-income country where low trust in health-care settings has become a prominent issue, but actual levels of distrust and their implications for utilization are unknown. We conducted a nationally representative survey of the Chinese population (November 2012 to January 2013), which resulted in a sample of 3680 adult men and women. Respondents rated their trust in different types of health-care providers. Using multivariate logistic and negative binomial regression models, we estimated the association between distrust in clinics and respondents’ hospital visits in the last year; whether they had sought hospital treatment first for two common symptoms (headache, cold) in the last 2 months; and whether they said they would go first to a hospital if they had a minor or major illness. We analysed these associations before and after adjusting for performance evaluations of clinics and hospitals, controlling for sex, age, education, income, insurance status, household registration and self-assessed health. We found that distrust in hospitals is low, but distrust in clinics is high and strongly associated with increased hospital utilization, especially for minor symptoms and illnesses. Further research is needed to understand the reasons for distrust in clinics because its effects are not fully accounted for by poor evaluations of their competence.

Demand for social health insurance: Evidence from the Chinese New Rural Cooperative Medical Scheme

“…Although most facilities are publicly o wned, they rely heavily on revenues from drug sales and service charges to cover the difference between operational cost and budget allocation fro m governments (Liu, 2004). Following the market-oriented healthcare reform in the 1980s, the decentralized fiscal system and the commercialisation of healthcare providers have led to various problems, such as lack of funding and supervision for public health facilit ies and overuse of high-tech diagnostics and expensive drugs (Duckett et al, 2016, Wong et al, 2017. Most of the negative impact fall on primary care facilities, resulting in inadequate funding, poor infrastructure, lack of well-t rained clinicians and doctors and low quality of care at primary care level .…”

Healthcare Providers’ Accounts of Parental Influence on Their Behavior With Respect to the Use of Antibiotics for Children: A Qualitative Study in China

“…Parents were seen as distrusting China's healthcare institutions and having particular suspicions about CHIs, a finding in line with Duckett et al's national survey [47] and with evidence of a shortage of well-trained personal in retail pharmacies in China [10,48]. In qualitative studies in HICs [49,50], providers have also noted the importance of trust in facilitating parents' acceptance of their antibiotic prescribing decisions.…”

“…In our study, familiarity and a good relationship had an additional economic dimension: to ensure that patients returned. Because of the professional status of hospital doctors and the funding structure of hospitals, hospital-based providers expressed no concerns about patient retention and, in consequence, about their job security and the hospitals' survival [12,47]. The workload and time pressures that result from high levels of demand for hospital appointments also provided fewer opportunities to develop 'familiarity' and therefore worry about its lack.…”

Healthcare Providers’ Accounts of Influences of Antibiotic-Related Reforms on their Behavior with Respect to the Use of Antibiotics for Children: A Qualitative Study in China

“…The overutilization of hospitals for all forms of healthcare provision is a long-standing problem in China; even after the 2009 healthcare reform, hospitals remain the main healthcare provider [32], with higher levels of trust and resources than primary care institutions [14,49,59]. High patient demand and the resulting pressure on the hospital pediatricians evident in our study required them to maintain high levels of patient throughput, a factor that appeared to increase pressures on them to prescribe antibiotics.…”