Doctor Competence and the Demand for Healthcare: Evidence from Rural China

Fe, Eduardo; Powell‐Jackson, Timothy; Yip, Winnie

doi:10.1002/hec.3387

Cited by 11 publications

(8 citation statements)

References 46 publications

(47 reference statements)

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“…It is noteworthy that 33.9% were willing to accept DR after a doctor's advice. Due to the asymmetrical information between patients and doctors [46], patients rely more on the doctor's advice when making medical decisions. However, one study found that only 20.8% of doctors in tertiary hospitals are willing to recommend DR when the patient meets the criteria for referral [30].…”

Section: Discussionmentioning

confidence: 99%

The Willingness for Downward Referral and Its Influencing Factors: A Cross-Sectional Study among Older Adults in Shandong, China

Jing

Qin

et al. 2020

IJERPH

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Objectives: The aim of this study was to understand the willingness for downward referral among older adults who were hospitalized in the year before the survey and to explore its influencing factors. Methods: The sample was randomly selected by the multi-stage sampling method. A structural questionnaire was used to collect data from participants age 60 and above in Shandong, China, during August 2017. Data were analyzed by using descriptive statistics, one-way ANOVA, chi-square test, and multinomial logistic regression. Results: Of 1198 participants who were hospitalized in the year before the survey, 28.7% self-initiated downward referral, and 33.9% were willing to accept downward referral after a doctor’s advice. Multinomial logistic regression results showed that self-rated health, treatment effect in primary medical institutions, preference for outpatient service, choice of inpatient service, general understanding of essential medicines, the cost of essential medicines after zero-markup policy, and satisfaction with essential medicines’ reimbursement policy significantly correlated with older adults’ willingness for downward referral. Conclusions: The proportion of older adults who self-initiated downward referral was less than one-third. Doctors’ advice plays an important role in willingness for downward referral. More attention should be paid to improving the treatment effect of primary medical institutions, increasing the benefits of zero-markup policy, and ensuring a high reimbursement for the downward referral to work alongside doctors’ advice.

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Section: Discussionmentioning

confidence: 99%

The Willingness for Downward Referral and Its Influencing Factors: A Cross-Sectional Study among Older Adults in Shandong, China

Jing

Qin

et al. 2020

IJERPH

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“…tend to bypass primary care facilit ies and go directly to higher level hospitals even for minor conditions , which may lead to healthcare cost escalation (Fe et al, 2016).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…Previous literature has found substantial gaps in the quality of healthcare between primary care facilit ies and hospitals, in terms of the management of chronic d iseases (Li et al, 2017), treat ment errors (Sylv ia et al, 2014) and overuse of antibiotics (Yin et al, 2013) and in jections (Liu et al, 2015a, Yang et al, 2014. In addition, most patients have an unrealistic expectation towards specialised hospital care, and their sceptics about the quality of primary care are not necessarily related with the true quality level (Fe et al 2016). Patients tend to…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Demand for social health insurance: Evidence from the Chinese New Rural Cooperative Medical Scheme

Yang

2018

China Economic Review

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This paper assesses the determinants of enro lment in the New Rural Cooperative Medical Scheme (NRCM S), a heavily subsidized voluntary health insurance scheme in rural China. The analys es focus on the relationship between insurance purchase and health facility choice based on data drawn fro m the China Health and Nutrit ion Survey (CHNS). The results show that households fro m villages that reported use of village clin ics are more likely to be insured compared with households from villages that reported use of county hospitals. The results indicate that the perception of quality of care is an important factor affecting people's enrolment decisions. The NRCM S is expected to help patients obtain better quality health services fro m higher-t ier of the healthcare system that are unaffordable otherwise. However, given the prevailing fee-for-service pay ment mechanism for health care, the insurance may also drive up the healthcare cost and direct patients to use more expensive and unnecessary hospital care.

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“…For example, empirical studies have confirmed that patients’ perceptions of quality and observable signals (e.g., medicine and medical equipment availability) are related to patients’ healthcare-seeking behaviors [ 26 ]. However, the previous literature has shown no significant correlation between patients’ self-reported assessment of PHC quality and record-based quality [ 34 ] or clinicians’ medical knowledge [ 35 ]. Studies have also found no association between observable signals and healthcare quality [ 36 ].…”

Section: Introductionmentioning

confidence: 99%

Measurements of quality of village-level care and patients’ healthcare-seeking behaviors in rural China

et al. 2021

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Background Although the progress in global health initiatives has improved the availability of primary health care (PHC), unqualified healthcare remains a serious challenge in low- and middle-income countries, where PHC is often underutilized. This study examines factors associated with patients’ healthcare-seeking behaviors in rural Chin—seeking healthcare at village-level PHC providers, at higher-level health facilities, self-medicating, and refraining from seeking medical help. We focus on provider-side factors, including (1) the unobservable quality indicator, (2) the observable quality indicator, and (3) the observable signal indicator. Methods We analyzed 1578 episodes of healthcare-seeking behaviors of patients with diarrhea or cough/runny nose symptom from surveys conducted in July 2017 and January 2018 in 114 villages of the Yunnan province. We investigated the correlation between quality-related factors with patients’ healthcare-seeking behaviors by multinomial logit regression. Results We found that rural patients were insensitive to the unobservable quality of healthcare providers, as measured by standardized clinical vignettes, which might be attributable to the credence nature of PHC. The observable quality indicator, whether the clinician has received full-time junior college formal medical education, was associated with patients’ healthcare choices. Patients, however, were more likely to select healthcare based on the observable signal indicator, which was measured by the availability of medicines. Additionally, the observable signal indicator had no significant association with two quality indicators. Notably, socioeconomically-disadvantaged patients relied more on the village-level PHC, which emphasized the role of PHC in promoting the welfare of rural populations. Conclusions Our study found an inconsistency between objective quality of healthcare provided by providers and subjective quality perceived by patients. Patients could not identify the actual quality of PHC precisely, while they were more likely to make decisions based on the observable signal indicator. Therefore, the quality of PHC should be more observable to patients. This study not only supplements the literature on healthcare-seeking choices by examining four types of behaviors simultaneously but also clarifies rural patients’ perceptions of the quality of PHC for policy decision-making on increasing the utilization of PHC and improving the medical welfare of the vulnerable.

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Doctor Competence and the Demand for Healthcare: Evidence from Rural China

Cited by 11 publications

References 46 publications

The Willingness for Downward Referral and Its Influencing Factors: A Cross-Sectional Study among Older Adults in Shandong, China

The Willingness for Downward Referral and Its Influencing Factors: A Cross-Sectional Study among Older Adults in Shandong, China

Demand for social health insurance: Evidence from the Chinese New Rural Cooperative Medical Scheme

Measurements of quality of village-level care and patients’ healthcare-seeking behaviors in rural China

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