Abstract:BackgroundUsual source of care (USC) is one of the hallmarks of primary care. We aimed to examine the status of having a USC and its patient-related sociodemographic factors among Korean adults.MethodsData were obtained from the 2012 Korea Health Panel survey. Panel participants were selected for the study who were aged 18 years or older and who replied to questionnaire items on having a USC (n = 11,935).ResultsOf the participants, 21.5% had a usual place and 13.9% had a usual physician. Reasons for not having… Show more
“…Furthermore, since all studied participants have been covered by the New Rural Cooperative Medical Scheme, we did not include insurance coverage as a necessary enabling factor. Finally, although not shown in this figure, factors that would influence whether patients have a usual primary care provider include age, gender, education, culture, family economic status, health status, perceived quality of health care and patients’ attitudes toward primary care providers [ 30 , 31 ]. Fig.…”
IntroductionWithin China’s multi-tiered medical system, many patients seek care in higher-tiered hospitals without a referral by a primary-care provider. This trend, generally referred to as patient self-referral behavior, may reduce the efficiency of the health care system. This study seeks to test the hypothesis that having a usual primary care provider could reduce patients’ self-referral behavior.MethodsWe obtained medical records of 832 patients who were hospitalized for common respiratory diseases from township hospitals in Qianjiang District of Chongqing City during 2012–2014. Logit regressions were performed to examine the association between having a township hospital as a usual provider and self-referring to a county hospital after being discharged from a township hospital, while controlling for patients’ gender, age, income, education, severity of disease, distance to the nearest county hospital and the general quality of the township hospitals in their community. A propensity score weighting approach was applied.ResultsWe found that having a usual primary care provider was associated with a lower likelihood of self-referral (odds ratio = 0.58, 95% confidence interval [CI] =0.41–0.82), and a 9% (95% CI: -14%, − 3%) reduction in the probability of patients’ self-referral behavior.Discussion/conclusionThe results suggest that establishing a long-term relationship between patients and primary care providers may enhance the patient-physician relationship and reduce patients’ tendency for unnecessary use of medical resources.Electronic supplementary materialThe online version of this article (10.1186/s12913-017-2673-6) contains supplementary material, which is available to authorized users.
“…Furthermore, since all studied participants have been covered by the New Rural Cooperative Medical Scheme, we did not include insurance coverage as a necessary enabling factor. Finally, although not shown in this figure, factors that would influence whether patients have a usual primary care provider include age, gender, education, culture, family economic status, health status, perceived quality of health care and patients’ attitudes toward primary care providers [ 30 , 31 ]. Fig.…”
IntroductionWithin China’s multi-tiered medical system, many patients seek care in higher-tiered hospitals without a referral by a primary-care provider. This trend, generally referred to as patient self-referral behavior, may reduce the efficiency of the health care system. This study seeks to test the hypothesis that having a usual primary care provider could reduce patients’ self-referral behavior.MethodsWe obtained medical records of 832 patients who were hospitalized for common respiratory diseases from township hospitals in Qianjiang District of Chongqing City during 2012–2014. Logit regressions were performed to examine the association between having a township hospital as a usual provider and self-referring to a county hospital after being discharged from a township hospital, while controlling for patients’ gender, age, income, education, severity of disease, distance to the nearest county hospital and the general quality of the township hospitals in their community. A propensity score weighting approach was applied.ResultsWe found that having a usual primary care provider was associated with a lower likelihood of self-referral (odds ratio = 0.58, 95% confidence interval [CI] =0.41–0.82), and a 9% (95% CI: -14%, − 3%) reduction in the probability of patients’ self-referral behavior.Discussion/conclusionThe results suggest that establishing a long-term relationship between patients and primary care providers may enhance the patient-physician relationship and reduce patients’ tendency for unnecessary use of medical resources.Electronic supplementary materialThe online version of this article (10.1186/s12913-017-2673-6) contains supplementary material, which is available to authorized users.
“…The method of remuneration is mainly based on fee-for-service so that physicians lack an incentive to focus on reducing unnecessary services and focusing more on disease prevention and health promotion [ 16 , 17 ]. A national representative survey in 2012 reported that only 13.9% of Korean adults aged 18 years and older had a physician as a USC [ 18 ], in contrast with the proportions of other countries: the USA 80%, Canada 84%, Australia 88%, the United Kingdom and New Zealand 89% each, Germany 92%, and the Netherlands 100% [ 19 ]. It seems natural that Korea had the highest frequency (16.0) of doctor consultations per person among the OECD countries compared with the OECD average of 6.9 per person per year in 2015 [ 20 ].…”
Hypertension has been the leading risk factor contributing to cardiovascular morbidity and mortality, which needs comprehensive measures to manage and can be controlled effectively in primary care. In the health care context of South Korea, where specialists can see patients directly at their own community clinics and there has been no consensus on the definition of primary care, the authors used the nationally representative 2013 Korea Health Panel data, categorized adults (≥18 years) with hypertension by types of usual source of care (USC), and analyzed the association of having a comprehensive community clinic (i.e., primary care) physician as a USC with experience of emergency department (ED) visits and hospitalization within a year. After adjusting for cofounding variables including Charlson comorbidity index scores, those having a primary care physician as a USC remained associated with a decrease in an experience of ED visits (OR: 0.61, 95% CI: 0.40–0.93) and hospitalization (OR: 0.69, 95% CI: 0.49–0.96), compared to those not having a usual physician. Health policies that promote having a primary care physician as a USC could decrease unnecessary experience of ED visits and hospitalization by adults with hypertension. This can partly reduce ED overcrowding and avoidable hospitalization in Korea.
“…In addition, Korean patients experience much poorer health care coordination than those in other industrialized countries ( 31 ). Regarding the coordination of care that patients experience from their RDs, the percent of those who answered positively is only 34.5% in Korean adults in a previous study ( 23 ). In our study, it was only 27.1% in Korean diabetic adults.…”
Section: Discussionmentioning
confidence: 79%
“…The 2007 international survey by the Commonwealth Fund has reported that the proportion of adults who have a RD is 100% in the Netherlands, 89% in the United Kingdom, 88% in Australia, 92% in Germany, 89% in New Zealand, 84% in Canada, and 80% in the United States ( 30 ). Compared to these countries, the proportion of adults who have a RD is extremely low (13.9%) in Korea ( 23 ). This study showed that, even in adults having diabetes as a chronic disease, the percentage of those having a RD was very low.…”
Section: Discussionmentioning
confidence: 99%
“…Only 13.9% of Korean adults have a regular doctor (RD). The most influential factor of having a USC is having a chronic disease and the main (66.1%) reason for not having a USC is seldom becoming ill ( 23 ).…”
Chronic diseases pose a major challenge to population health worldwide. Diabetes is a major chronic disease that is managed overwhelmingly in primary care. There is an increasing recognition of the role that primary care physicians play to achieve high-quality care for patients with diabetes. By analyzing 2013 Korean Health Panel data, the authors aimed to determine the current status of having a regular doctor (RD) for adults (aged 18 years or older) with diabetes. In addition, the association of having a RD with the experience of emergency department (ED) visits was determined in this study. Among adults with diabetes, those with RD accounted for 41.0%. The older the age group and the higher the Charlson comorbidity index score, the higher the percentage of adults with diabetes had RD. Even for those with RD, coordination of care was very poor (positive answer: 27.1%). After adjustment for confounding variables, those having (vs. not having) a RD (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.35–0.94), especially those whose RDs delivered good comprehensiveness of care (OR, 0.47; 95% CI, 0.26–0.84) or worked at a primary care clinic (OR, 0.43; 95% CI, 0.22–0.81), and those whose longitudinal relationship with a RD was 5 years or less (OR, 0.45; 95% CI, 0.22–0.91) were less likely to have ED visits within the last year. In conclusion, health care policies that promote having a RD who delivers high-quality primary care could decrease unnecessary ED visits by diabetic adults. This can partly reduce ED overcrowding in Korea.
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