Incentives to use primary care and their impact on healthcare utilization: Evidence using a public health insurance dataset in China

Shen, Menghan; He, Wen; Li, Linyan

doi:10.1016/j.socscimed.2020.112981

Cited by 28 publications

(32 citation statements)

References 30 publications

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“…However, according to the government guidelines, the diagnosis and treatment of chronic diseases, such as hypertension and diabetes, are considered an opportunity for a breakthrough in realizing gatekeeping function of PCIs. Consistent with this goal, Menghan Shan et al found an increasing utilization of healthcare in PCIs and a reduction in non-PCIs with no changes in total healthcare utilization in an economically advanced city of China (27). Our finding may indicate that the system in the study areas had not been effectively promoted.…”

Section: Discussionsupporting

confidence: 63%

Patient Choice and Willingness Toward Gatekeepers as First-Contact Medical Institutions in Chinese Tiered Healthcare Delivery System: A Cross-Sectional Study

Zhang

Zhong

et al. 2021

Front. Public Health

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Introduction: Gatekeeping mechanism of primary care institutions (PCIs) is essential in promoting tiered healthcare delivery system in China. However, patients seeking for higher-level institutions instead of gatekeepers as their first contact has persisted in the past decade. This study aims to explain patients' choice and willingness and to provide potential solutions.Methods: A survey was conducted among residents who had received medical care within the previous 14 days. Patients' choice and willingness of PCIs for first contact together with influencing factors were analyzed using binary logistic regression.Results: Of 728 sampled patients in Hubei, 55.22% chose PCIs for first contact. Patients who are older, less educated, with lower family income, not living near non-PCIs, with better self-perceived health status, only buying medicines, and living in rural instead of urban area had significantly higher probability of choosing PCIs. As of willingness, over 90% of the patients inclined to have the same choice for their first contact under similar health conditions. Service capability was the primary reason limiting patients' choice of PCIs.Conclusions: The gatekeeper system did not achieve its goal which was 70% of PCIs among all kinds of institutions for first contact. Future measures should aim to improve gate-keepers' capability.

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Section: Discussionsupporting

confidence: 63%

Patient Choice and Willingness Toward Gatekeepers as First-Contact Medical Institutions in Chinese Tiered Healthcare Delivery System: A Cross-Sectional Study

Zhang

Zhong

et al. 2021

Front. Public Health

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“…Studies about service quality satisfaction and trust indicated that patients rated PHC institutions lower than higher-tier hospitals [ 14 ]. Besides, there is no referral system in China, and patients can directly access hospital care without a referral from PHC institutions [ 6 , 9 , 38 , 39 ]. It is easy for patients to shift their primary care provider.…”

Section: Discussionmentioning

confidence: 99%

The trend in primary health care preference in China: a cohort study of 12,508 residents from 2012 to 2018

Wan

Wei

Yin

et al. 2021

BMC Health Serv Res

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Background Residents’ preference for primary health care (PHC) determined their utilization of PHC. This study aimed to assess the determinants of PHC service preference among the residents and the trend in PHC service preference over time in China. Methods We employed the nationally representative longitudinal data from 2012 to 2018 based on the China Family Panel Studies. The analysis framework was guided by the Andersen model of health service utilization. We included a total of 12,508 individuals who have been successfully followed up in the surveys of 2012, 2014, 2016, and 2018 without any missing data. Logistic regressions were performed to analyze potential predictors of PHC preference behavior. Results The results indicated that individuals’ socio-economic circumstances and their health status factors were statistically significant determinants of PHC preference. Notably, over time, the residents’ likelihood of choosing PHC service represented a decreasing trend. Compare to 2012, the likelihood of PHC service preference decreased by 18.6% (OR, 0.814; 95% CI, 0.764–0.867) in 2014, 30.0% (OR, 0.700; 95% CI, 0.657–0.745) in 2016, and 34.9% (OR, 0.651; 95% CI, 0.611–0.694) in 2018. The decrease was significantly associated with the changes in residents’ health status. Conclusions The residents’ likelihood of choosing PHC service represented a decreasing trend, which was contrary to the objective of China’s National Health Reform in 2009. We recommend that policymakers adjust the primary service items in PHC facilities and strengthen the coordination of service between PHC institutions and higher-level hospitals.

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“…This was an improvement on previous studies, which mainly used cross-sectional, cross-country ecological study design or before-and-after without control, 24 as well as Chinese studies on the effects of changes of cost sharing on primary care utilisations. 25 Our use of a comparison group reduced the risk of attribution of temporal changes unrelated to gatekeeping. Of note, the DiD approach attributes any difference in trends between the treatment and control groups to the effects of the intervention, so may be problematic in situations where treatment (ie, policy) has changed over time or where the parallel pretrends assumption was violated.…”

Section: Discussionmentioning

confidence: 99%

“…A study in Luohu (a district in the Guangdong province of China), where the salary of general practitioners has been raised substantially, reported increased visits to primary care. 27 Findings from recent reforms in two well-off cities 25 28 also suggested that lowering user fees for primary care and increasing user fees for hospital ambulatory care may shift some patients away from hospitals to primary care facilities.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of primary care gatekeeping: difference-in-differences evaluation of a pilot scheme in China

Powell‐Jackson

Mills

2020

BMJ Glob Health

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IntroductionThis paper evaluates the effectiveness of a gatekeeping pilot in shifting resources and patient visits from hospitals to primary care facilities under the Chinese New Rural Cooperative Medical Scheme.MethodsWe applied a difference-in-differences regression analysis using claims data from a pilot district in northern China. The study covered 200 685 enrollees in 17 townships in 2012 and followed-up the townships over 12 year-quarters until the end of 2014.ResultsThe gatekeeping pilot led to significantly more patients visiting primary care facilities (55.3%, p=0.001), but there was little evidence of increased ambulatory spending on primary care (1.6%, p=0.884). The pilot reduced hospital visits by 23.9% (p=0.048) and ambulatory spending at the hospitals by 22.4% (p=0.011).ConclusionsThis first impact evaluation of gatekeeping outside high-income countries found that gatekeeping policy did not seem to have expanded the care provided by primary care facilities, despite an increased volume of claimed visits. Although claimed patient visits and expenditure at hospitals reduced, we suspect this may have been because patients found it either cumbersome or difficult to obtain reimbursement for their care.

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Incentives to use primary care and their impact on healthcare utilization: Evidence using a public health insurance dataset in China

Cited by 28 publications

References 30 publications

Patient Choice and Willingness Toward Gatekeepers as First-Contact Medical Institutions in Chinese Tiered Healthcare Delivery System: A Cross-Sectional Study

Patient Choice and Willingness Toward Gatekeepers as First-Contact Medical Institutions in Chinese Tiered Healthcare Delivery System: A Cross-Sectional Study

The trend in primary health care preference in China: a cohort study of 12,508 residents from 2012 to 2018

Effectiveness of primary care gatekeeping: difference-in-differences evaluation of a pilot scheme in China

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