Health reforms in china: the public’s choices for first-contact care in urban areas

Abstract

Purpose. To examine the public's views towards their choice of first-contact care and its associated factors in urban China. Methods. A mixed-method study was adopted using individual interviews, focus group interviews and a cross-sectional survey. The study was conducted among the general public between September 2014 and September 2015 in Zhejiang province, China. Results. Six focus groups and 13 individual interviews were conducted. The questionnaire was completed by 1248 respondents with a response rate of 83%. Survey results showed that 70% of the respondents preferred hospital-based services for first-contact care, it is especially the case with paediatric patients (83.3%). The qualitative data revealed that a major cause was the public distrust in the competence of primary care practitioners with lower educational qualifications. In the decision-making process, compared to cost factors like medical expenses and waiting times, participants attached greater emphasis on organizational characteristics. Respondents who rated sophisticated medical equipment, reputation of the facility, average education of doctors as important were significantly more inclined to choose hospital services. Respective adjusted odds ratios (AOR) were 2.14 (P < 0.001), 1.83 (P < 0.001) and 1.40 (P = 0.043) for their own conditions and 2.19 (P = 0.004), 1.94 (P = 0.002) and 1.86 (P = 0.003) for their children's conditions. Availability of medications and perceived severity of illness were also significantly associated with their choice of hospital services for their children. Conclusion. The public's preference for hospital-based services for first-contact care places a huge obstacle to promoting community-based primary care. Addressing the public's concerns about the primary care practitioners' competence is worth more efforts.

Training Pathways to Working as a General Practitioner in China

“…This analysis illustrating significant heterogeneity in the quality in GP training approaches helps explain in part why GPs face a significant challenge for earning the public's trust. 7,33,36,37 We agree with Wu, et al, 7 on the need to build on positive public perceptions about primary care providers' value as a trusted source for referral, drug dispensing, managing chronic diseases, and providing patient education. Trainees may benefit from discussion on how to advocate their skills as providers SPECIAL ARTICLE of choice for first-contact care to patients.…”

Older adults’ choices of first‐contact care and related factors in Zhejiang and Qinghai Province, China

“…Variables were chosen based on availability in questionnaires, the Andersen Health Service Utilization Model and their associations with choices of first‐contact care shown by previous studies…”

“…Their choices of first‐contact care would play an important role in taking full advantage of medical resources, which should be paid more attention to. Previous researchers found that there were complex relationships between factors and healthcare utilization preferences . Although most of the previous studies focused on all age groups and used descriptive statistics or regression models, which could not clearly show direct and indirect pathways from factors to older adults’ choices of first‐contact care.…”

“…Secondary and tertiary care institutions refer to other high‐level medical facilities, providing specialized medical services . In China, residents are free to choose medical facilities without being restricted by a gate‐keeping mechanism . Thus, PHI are underused, whereas hospital‐based services are abused .…”

“…According to the Andersen Health Service Utilization Model, predisposing (such as age and sex), enabling (such as income and medical insurance) and need factors (such as self‐reported health and chronic diseases) could influence the utilization of health services . Previous studies found that education level, income, job, medical costs, self‐rated health status, distance to health institutions and quality of medical service were associated with preferred health services. Therefore, based on the Andersen Health Service Utilization Model and related variables from previous studies, the present investigation carried out a conceptual model to explore pathways to older adults’ choices of first‐contact care (Fig.…”