Rural and urban differences in patient experience in China: a coarsened exact matching study from the perspective of residents

Abstract

Background Patient experience is a key measure widely used to evaluate quality of healthcare, yet there is little discussion about it in China using national survey data. This study aimed to explore rural and urban differences in patient experience in China. Methods Data regarding this study were drawn from Chinese General Social Survey (CGSS) 2015, with a sample size of 9604. Patient experience was measured by the evaluation on healthcare services. Coarsened exact matching (CEM) method was used to balance covariates between the rural and urban respondents. Three thousand three hundred seventy-two participants finally comprised the matched cohort, including 1592 rural residents and 1780 urban residents. Rural and urban differences in patient experience were tested by ordinary least-squares regression and ordered logistic regression. Results The mean (SD) score of patient experience for rural and urban residents was 72.35(17.32) and 69.45(17.00), respectively. Urban residents reported worse patient experience than rural counterparts (Crude analysis: Coef. = − 2.897, 95%CI: − 4.434, − 1.361; OR = 0.706, 95%CI: 0.595, 0.838; Multivariate analysis: Coef. = − 3.040, 95%CI: − 4.473, − 1.607; OR = 0.675, 95%CI: 0.569, 0.801). Older (Coef. = 2.029, 95%CI: 0.338, 3.719) and healthier (Coef. = 2.287, 95%CI: 0.729, 3.845; OR = 1.217, 95%CI: 1.008, 1.469) rural residents living in western area (Coef. = 2.098, 95%CI: 0.464, 3.732; OR = 1.276, 95%CI: 1.044, 1.560) with higher social status (Coef. = 1.158, 95%CI: 0.756, 1.561; OR = 1.145, 95%CI: 1.090, 1.204), evaluation on adequacy (Coef. = 7.018, 95%CI: 5.045, 8.992; OR = 2.163, 95%CI: 1.719, 2.721), distribution (Coef. = 4.464, 95%CI: 2.471, 6.456; OR = 1.658, 95%CI: 1.312, 2.096) and accessibility (Coef. = 2.995, 95%CI: 0.963, 5.026; OR = 1.525, 95%CI: 1.217, 1.911) of healthcare resources had better patient experience. In addition, urban peers with lower education (OR = 0.763, 95%CI: 0.625, 0.931) and higher family economic status (Coef. = 2.990, 95%CI: 0.959, 5.021; OR = 1.371, 95%CI: 1.090,1.723) reported better patient experience. Conclusions Differences in patient experience for rural and urban residents were observed in this study. It is necessary to not only encourage residents to form a habit of seeking healthcare services in local primary healthcare institutions first and then go to large hospitals in urban areas when necessary, but also endeavor to reduce the disparity of healthcare resources between rural and urban areas by improving quality and capacity of rural healthcare institutions and primary healthcare system of China.

Gender differences in depressive symptoms of rural Chinese grandparents caring for grandchildren

“…Initially, we used the Coarsened exact matching (CEM) method put forward by Iacus et al [ 61 , 62 ] to balance the multidimensional distribution of covariates between the two compared groups (non-caregivers and caregivers), and thereby reduce the explanatory variable’s degree of dependence on the estimation model and further decrease the biases. CEM is a matching method of the class Monotonic Imbalance Bounding (MIB), which shows the basic advantage over other matching methods that the bound on balance for one covariate can be studied and improved in isolation, as this won’t affect any other covariates chosen for balancing [ 62 , 63 ]. It is preferable to other matching procedures (e.g., propensity score matching, PSM) in terms of processing more efficiently and reducing model dependence, estimation error, variance and bias [ 64 ].…”

Satisfaction and its determinants of rural upper gastrointestinal cancer screening in China: a preliminary cross-sectional study

“… 35 36 However, this finding differs from the national situation, where the time for doctor–patient communication is shortened due to the uneven distribution of medical resources and a general increase in the demand for medical services. 37 38 The reasons for our finding may be that only a moderate number of participants are invited to the screening each day after considering each centre’s screening capacity. Moreover, all staff involved in the screening attended training that is regularly organised by the EDTUGCP specialist group to improve the quality of the service processes.…”

The Urban-Rural Disparities and Associated Factors of Health Care Utilization Among Cancer Patients in China

“…Rural cancer patients were more likely to be diagnosed with cancer after developing symptoms and less likely to visit two or more hospitals than urban ones. This discrepancy is mainly because there are obvious disparities in healthcare resources including infrastructure and human resource between rural and urban areas (18). It was reported that in 2015, the number of health technicians and hospital beds per thousand persons in urban areas was nearly 2.62 times and 2.23 times more than those in rural areas in China, respectively (36).…”

“…Therefore, patients in rural areas may have less access to specialist medical care, and this should be an important consideration when defining future healthcare investment and policy (37). It is vital to reduce the disparity of healthcare resources between rural and urban areas by improving the capacity of rural healthcare institutions in China (18). During the study period, rural residents were mostly insured by the New Rural Cooperative Medical System, which had less coverage and higher coinsurance rates than the insurance that covered urban employees and residents (19).…”

“…There is noticeable urban-rural inequality in access to health care and health resources in China. Urban residents are likely to have more healthcare utilization, more healthcare resources, more access to government sponsored public programs/healthcare services and less risk to suffer from diseases (18). Rural populations also have more restricted access to health care than urban residents due to low funds for health insurance scheme (19).…”