Factors associated with the choice of primary treatment at the community level among the middle‐aged and elderly in China

Abstract

Background: As China is still in the process of establishing the hierarchical medical system, people have full autonomy in choosing medical institutions when they need to see a doctor. The basic working of a hierarchical medical system involves four parts: primary treatment at the community level, two-way referral, a partition of emergency and chronic disease, and a joint effort among different healthcare facilities. This study examines factors associated with primary healthcare use in a middle-aged and elderly Chinese population. Methods: Our study is a cross-sectional and observational survey involving 1659 adults aged 45 and above. The data are from the 2015 China Health and Retirement Longitudinal Study. According to the Andersen behavioral model, we used logistic regression to analyze the influencing factors of healthcare services utilization, including predisposing, enabling, and need factors. We also compared the relative importance of factors to healthcare services utilization by analysis of variance. Results: During the recently 1-month period, 63.89% of the sample had their last visit to a primary healthcare facility. In the final logistic model, there were three predisposing characteristics (education level, children number, and work status), three enabling factors (household status, out-of-pocket expenses, and travel time to the healthcare facilities), and one need factor (three specific chronic diseases) were significantly associated with

Understanding the Implementation of Hierarchical Medical System Policy: An Interrupted Time Series Analysis of a Pilot Scheme in China

“…This echoed an earlier study that adjustments in health insurance reimbursement can promote patient visits to PCFs. [22] As medical expenses are one of the most determining factor in uencing health-seeking behaviors of Chinese patients, [9,20] studies observed that decreasing user fees for primary care and raising user fees for hospital ambulatory care increased primary care utilization. [15,46,47] Although the HMS policy in the Yinzhou model has been successfully implemented, many other pilots in China were not led by PCFs and PCPs remained peripheral within professional networks.…”

“…[1] Fragmentation of services negatively impacts patient satisfaction and further aggravated health inequity among residents. [10] To optimize residents' current healthcare-seeking behaviors and improve the e ciency of healthcare delivery, the Chinese government introduced the HMS policy package in 2014 [20]. Under this policy package, different levels of hospitals have a clear division of labor and coordinate to provide continuous, comprehensive and integrated care to individuals.…”

“…By the end of 2016, there were four municipalities and 266 cities that have launched HMS, covering 88.1% of mainland China. [20] Despite the importance and the expansion of the HMS at the national level, we know very little about the impact of the HMS policy in China. Previous studies focused on cognition, [21] factors, [20]theoretical analysis and health-seeking behavior of residents, [22] but empirical research is scarce.…”

“…[20] Despite the importance and the expansion of the HMS at the national level, we know very little about the impact of the HMS policy in China. Previous studies focused on cognition, [21] factors, [20]theoretical analysis and health-seeking behavior of residents, [22] but empirical research is scarce. Whether the HMS has been successfully implemented in these pilot cities is still unascertained.…”

Effectiveness of hierarchical medical system policy: an interrupted time series analysis of a pilot scheme in China

“…To improve the efficiency of healthcare delivery, the Chinese government introduced the HMS policy package in 2014 to alter patients’ healthcare-seeking behaviours and thus strengthen the role of primary care in delivering healthcare services ( Tao et al. , 2021 ).…”