Factors associated with the choice of primary care facilities for initial treatment among rural and urban residents in Southwestern China

Abstract

ObjectiveTo explore influential factors contributing to the choice of primary care facilities (PCFs) for the initial treatment among rural and urban residents in Southwestern China.MethodsA face-to-face survey was conducted on a multistage stratified random sample of 456 rural and 459 urban residents in Sichuan Province from January to August in 2014. A structured questionnaire was used to collect data on residents’ characteristics, provider of initial treatment and principal reason for the choice. Multivariate logistic regression was performed to identify factors associated with choosing PCFs for the initial treatment.ResultsThe result showed that 65.4% of the rural residents and 50.5% of the urban residents chose PCFs as their initial contact for medical care. Among both rural and urban residents, the principal reason for choosing medical institutions for the initial treatment was convenience (42.3% versus 40.5%, respectively), followed by high quality of medical care (26.5% versus 29.4%, respectively). Compared to rural residents, urban residents were more likely to value trust in doctors and high quality of medical care but were less likely to value the insurance designation status of the facilities. Logistic regression analysis showed that both rural and urban residents were less likely to choose PCFs for the initial treatment if they lived more than 15 minutes (by walk) from the nearest facilities (rural: OR = 0.15, 95%CI = 0.09–0.26; urban: OR = 0.19, 95%CI = 0.10–0.36), had fair (rural: OR = 0.49, 95%CI = 0.26–0.92; urban: OR = 0.31, 95%CI = 0.15–0.64) or poor (rural: OR = 0.14, 95%CI = 0.07–0.30; urban: OR = 0.22, 95%CI = 0.11–0.44) self-reported health status. Among rural residents, attending college or higher education (OR = 0.21, 95%CI = 0.08–0.59), being retired (OR = 0.90, 95%CI = 0.44–1.84) and earning a per capita annual income of household of 10,000–29,999 (OR = 0.24, 95%CI = 0.11–0.52) and 30,000–49,999 (OR = 0.26, 95%CI = 0.07–0.92) were associated with lower rates of seeking care at PCFs.ConclusionEfforts should be made to improve the accessibility of PCFs and to upgrade the services capability of PCFs both in rural and urban areas in China. At the same time, resources should be prioritized to residents with poorer self-reported health status, and rural residents who retire or have better education and higher income levels should be taken into account.

Comparison of patient perceptions of primary care quality across healthcare facilities in Korea: A cross-sectional study

“…This user view might be partly linked to the belief that good facilities and equipment of large hospitals guarantee good qualities of care. [13,23] Similar user misperception and distorted health-seeking behaviors were also reported in China; community individuals preferred to seek care in second or tertiary hospitals rather than primary care facilities, although the latter provide more accessible and affordable care. An important driver for this health-seeking behavior was trust in doctors in tertiary hospitals.…”

“…An important driver for this health-seeking behavior was trust in doctors in tertiary hospitals. [13] Therefore, efforts to raise public trust in primary care physicians and facilities are essential.…”

“…[4][5][6][7][8][9][10] Despite the evidence for primary care, however, resource allocation in most countries is still skewed toward hospitals and specialist care. [6,[11][12][13] The Korean health system has developed very rapidly in a short period, especially after the introduction of National Health Insurance in 1989-a universal coverage system compulsory for all citizens. The nation's efforts have been heavily focused on hospital-centered specialty care to meet growing demands of the population.…”

Family medicine training in China: crisis and opportunity

“…Beijing ecology of care study5, for example, demonstrated fewer number of people seek primary care physicians in the community as their first contact care compared with a similar study conducted in the USA. People prefer tertiary care hospitals in urban centres for their first contact care 6…”

Evaluation of patient satisfaction in hospitals in China 2003–2013: A national longitudinal analysis of population-based survey data

“…To address the gap in medical quality between urban and rural areas, many previous studies found that compared with the healthcare institutions in the rural areas of China, those in the urban areas are equipped with more and better health resources, such as financial, human, and material resources [41]. As a result, the level of patient satisfaction and experience in China's public hospitals seemed to be higher in the urban than in the rural areas [42].…”