The quality of primary care in community health centers: comparison among urban, suburban and rural users in Shanghai, China

Shi, Jianwei; Jin, Hua; Shi, Leiyu; Chen, Chen; Ge, Xuhua; Lü, Yuan; Zhang, Hanzhi; Wang, Zhaoxin; Yu, Dehua

doi:10.1186/s12875-020-01250-6

Cited by 16 publications

(13 citation statements)

References 18 publications

(25 reference statements)

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“…This study also showed that the attractiveness of Beijing's community hospitals was unsatisfactory, regardless of central urban or suburban location. This result is consistent with previous findings [67,68]. In China, community hospital developments depend largely on the government's financial subsidies and competition from surrounding medical institutions.…”

Section: Scope and Attractiveness Of Community Hospital Servicessupporting

confidence: 93%

Assessing Spatial Accessibility of Community Hospitals for the Elderly in Beijing, China

Luan

Tian

Jim

et al. 2023

IJERPH

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Accessibility of health services signifies the quality and equitability of universal health provision. The hierarchical medical system recently implemented in China offers the policy instruments to improve medical services to the elderly in an aging society. As the critical primary care gateway, accessibility to community hospitals has significant impacts on people’s health. However, current research has paid little attention to spatial accessibility within walking distance of community hospitals, especially for the elderly. This study selected four districts with different urbanization levels in the rapidly developing Beijing metropolis. The spatial interaction model was applied to measure the accessibility of community hospitals for the elderly at the community level. An attractiveness index was computed based on key hospital traits. The results showed that: (1) community hospitals could cover 82.66% of elderly residents, and 77.63% of the communities were within walking distance. The served elderly proportion was relatively high in central urban areas and low in the suburbs. (2) The attractiveness indices of hospitals varied notably between districts, with higher values in more urbanized areas. (3) The spatial accessibility for the elderly of hospitals differed significantly between the four districts, with a descending gradient from central to suburban and rural areas, as indicated by the Gini coefficients and Lorenz curves. (4) The accessibility index was strongly related to the served elderly population and the hospital–residence distance. The findings provide policy directions to the government, including providing more primary-care resources to suburban and rural areas, building new community hospitals in identified provision gaps, upgrading some clinics to hospitals in rural areas, and planning hospitals according to the projected trend of the elderly population in terms of quantity and distribution. The considerable provision disparity between core urban, suburban and rural areas can be addressed by refined spatial health planning informed by research.

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Section: Scope and Attractiveness Of Community Hospital Servicessupporting

confidence: 93%

Assessing Spatial Accessibility of Community Hospitals for the Elderly in Beijing, China

Luan

Tian

Jim

et al. 2023

IJERPH

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“…Possible reasons for this effect is that the existing organization of medical resources is adequate in urban areas, and residents have been accustomed to seeing a doctor in secondary and tertiary hospitals, which leads to the proportions of the key population and seniors aged 65 years and above who have signed contracts being lower in urban areas. 25,26 This result indicated that, for those regions with abundant medical service from large hospitals, there should be more incentive measures for promoting the programs.…”

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confidence: 95%

Facilitate Signing with the Family Doctor: A Study of the Practice in Shanghai, China

Dai¹,

Tang²,

Wang

et al. 2021

IJGM

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Background: In the time since primary care was implemented in China in 2009, programs of promoting residents signing with family doctor services have been key. However, there has been a lack of effective evaluation of its implementation. Methods: We used mixed methods for evaluating existing measures of facilitating signing with family doctors in Shanghai. Based on the Donabedian model, qualitative informant interviews were conducted to obtain experts' evaluations in aspects of team construction (structure) and innovative solutions for promoting and supervising signings (process). Quantitative data were used to analyse the utilization situation (outcome) from "Shanghai Family Doctor Signing Data Platform". Results: Measures of signing with family doctors in Shanghai have functioned well, but there is still a lack of sufficient family doctors and specialists, including paediatricians and gynaecologists. Although proportions of the key population (average=62.59%) and the elderly population (>65 years) (average=78.10%) who had signed with family doctors were relatively high, the proportion of the permanent resident population (average=29.36%) who had signed with family doctors was low from 2017 to 2020 in Shanghai. The proportions of residents seeking medical advice in signed community health centres in outskirts (71.08%) were higher than those in suburbs (63.51%) and urban areas (53.49%), whereas the proportion of those seeking medical advice from recommended multiple medical institutions were similarly low in urban areas, outskirts and suburbs. Conclusion:The practice of facilitate signing with family doctors in Shanghai has increased. However, we showed that numbers of family doctors were relatively low, and there remains a need for more experienced gynaecology and paediatrics professionals, compared with Western countries. Additionally, efforts should be made to increase proportions of residents who utilize the program, especially in urban areas, and seek medical services in contracted group hospitals and community health centres.

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“…The establishment of the first consultation system of general practitioners can give full play to the core role of rational allocation and effective utilisation of health resources [ 11 ]. General practitioners guide patients to seek medical treatment in a scientific and orderly manner and on-demand [ 12 ]. This also showed that under the hierarchical health system, primary healthcare and its capabilities were gradually improved.…”

Section: Discussionmentioning

confidence: 99%

The Service Capability of Primary Health Institutions under the Hierarchical Medical System

Liu

Lin

et al. 2022

Healthcare

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Background: Primary health institutions (PHIs) are the foundation of the whole health system and the basic link to achieve the goal of all people enjoying primary health care. However, the service capability of primary health institutions is not under the hierarchical medical system. Method: Data were collected from the China Health Statistics Yearbook between 2014 and 2020. PHIs included community health centres, community health stations, and township hospitals in our study. The service capability of primary health institutions was analysed from the perspective of structure, process, and results. Structure capability was evaluated using the number of beds, number of personnel, number of health technicians, and proportion of the number of personnel in PHIs accounting for the total number of health personnel. Process capability was evaluated using the number of general practitioners. The number of outpatients and inpatients, medical income, the proportion of drug income, and the average number of patients and beds served by physicians in PHIs per day were employed to evaluate the resulting capability. Results: From 2014 to 2020, the number of community health service centres/stations increased, while the number of township health centres decreased. In the aspect of structure capability, the total number of personnel and health technicians in community health centres/stations and township hospitals both increased during 2014 and 2020. However, the increasing rate in PHIs was a little bit less than that of general medical institutions. The proportion of male health technicians in community health centres and township hospitals both decreased, while the proportion of female technicians in both increased. From 2014 to 2020, the number of beds in PHIs also increased from 138.12 × 104 to 164.94 × 104. However, the proportion of beds in PHIs accounting for the total number of beds in medical institutions decreased. For the resulting capability, from 2014 to 2019, the proportion of diagnosis and treatment times in PHIs decreased from 57.41% to 51.96%, although it increased in 2020. The proportion of inpatients in PHIs decreased from 20.03% to 16.11%. From 2014 to 2020, the utilisation rate of hospital beds in PHIs decreased (from 55.6% to 34% for community health centres and 60.5% to 53.6% for township hospitals). The average daily bed days of doctors in township hospitals was higher than that of doctors in community health service centres. However, the average medical cost of outpatients and the per capita medical cost of inpatients in community health service centres were higher than in township hospitals. Conclusion: In recent years, although the service capability showed an increasing trend in PHIs, the growth rate was lower than the general health institutions. The utilisation rates of PHIs, including beds and physicians, were decreased. Among PHIs, the utilisation in township hospitals was higher than in community health centres with a relatively low price. Under the hierarchical medical system and normalisation period of the COVID-19 epidemic, it is important to improve the service capability to achieve its goal of increasing PHI utilisation and decreasing secondary and tertiary hospital utilisation.

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The quality of primary care in community health centers: comparison among urban, suburban and rural users in Shanghai, China

Cited by 16 publications

References 18 publications

Assessing Spatial Accessibility of Community Hospitals for the Elderly in Beijing, China

Assessing Spatial Accessibility of Community Hospitals for the Elderly in Beijing, China

Facilitate Signing with the Family Doctor: A Study of the Practice in Shanghai, China

The Service Capability of Primary Health Institutions under the Hierarchical Medical System

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