Tertiary hospitals or community clinics? An enquiry into the factors affecting patients' choice for healthcare facilities in urban China

Jiang, Shan; Gu, Yuanyuan; Yang, Fan; Wu, Tao; Hui, Wang; Cutler, Henry; Zhang, Lufa

doi:10.1016/j.chieco.2020.101538

Cited by 28 publications

(30 citation statements)

References 29 publications

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“…We aimed to answer three questions: (1) what factors affect patient choice to use FDCS? ; (2) what is the relative importance between these factors? and (3) how much are they willing to pay for a desirable feature of the FDCS?…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…This is despite primary care facilities providing care that is usually more accessible and less costly. 2 3 In the health system in China, primary care facilities consist of township hospitals and village clinics in rural areas.…”

Section: Introductionmentioning

confidence: 99%

“…There has been a growing number of studies on consumer preferences for the attributes of primary care services in China. 2 7–9 The general finding is that, when choosing primary care facilities, Chinese patients value the quality and attitude of doctors, out-of-pocket costs, travel time, total visit time, etc. These results cannot be directly transferred to the case of FDCS as it is a primary care service in the form of contract with specific types of services agreed on signing.…”

Section: Introductionmentioning

confidence: 99%

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Stated preferences for family doctor contract services: a survey of the rural elderly in Anhui Province, China

Wang

Zhao

et al. 2022

BMJ Open

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ObjectiveA number of factors contribute to the utilisation of family doctor contract services (FDCS) in China. This study aims to measure the preferences of the elderly for the FDCS and identify the key factors (and their relative importance) that may guide policymakers in more accurately providing the FDCS.Participants and methodsA discrete choice experiment was performed to elicit the preferences for FDCS among the rural elderly in China. Attributes and levels were established based on qualitative methods. Four attributes were included: service type, service package, physician’s reputation and annual contract costs. A D-efficient design was used to create a set of profiles that represented FDCS. The survey was conducted face to face using a sample of participants aged 60 and above in rural areas of Anhui Province. The data were analysed using a latent class logit (LCL) model.ResultsA total of 545 valid questionnaires were included in the analysis. The average age of the participants was 69.44 (SD 5.80). Two latent classes were identified with the LCL model. All four attributes proved statistically significant at the level of both the population mean and the two classes. The rural elderly showed a preference for FDCS with a relatively good reputation, lower annual contract costs, the basic service with the add-on of chronic disease service and home visit. Age, gender, education, self-reported health status and the number of chronic diseases were found to be associated with latent class membership.ConclusionIn this study, the physician’s reputation had the largest impact on the rural elderly’s choice of FDCS. Policy recommendations included the need to strengthen family doctor team training, devote greater attention to improving the family doctor’s medical skills and service approaches, and increased FDCS efficiency for the care of the rural elderly.

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Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Stated preferences for family doctor contract services: a survey of the rural elderly in Anhui Province, China

Wang

Zhao

et al. 2022

BMJ Open

Self Cite

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“…To achieve the global goals of UHC, the strategy of Healthy China 2020 was proposed, with the aim of providing basic healthcare coverage to all residents living in urban and rural areas by the year 2020. A new round health system reform was launched in 2009 [ 25 ]. The objectives of this reform included improving the accessibility and equity of healthcare services, providing well-rounded health services, and improving the medical insurance system [ 26 ].…”

Section: Multi-tiered Medical System In Chinamentioning

confidence: 99%

Evaluations of Spatial Accessibility and Equity of Multi-Tiered Medical System: A Case Study of Shenzhen, China

Meng

Yuan

Guo

et al. 2022

IJERPH

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The Chinese government has implemented a medical system reform to improve the equity of healthcare resources since 2009. We selected Shenzhen as our study area and evaluated the accessibility and equity of the multi-tiered medical system in China using a novel multi-tiered two-step floating catchment area (MT2SFCA) method. We proposed the benchmark and applied the independent variables of travel time and facility attractiveness, along with a combination of the two factors, as tolerances to determine the new logistic cumulative distribution decay functions. Community health centers (CHCs) and hospitals were included while integrating their features. Results revealed that the MT2SFCA method was able to determine the particular advantages of CHCs and hospitals in the multi-tiered medical system. The CHCs offset the lower accessibility of hospitals in suburban areas and hospitals balanced the regional inequity caused by the CHC. Travel time is the main consideration of patients who have access to CHCs, whereas facility features are the main considerations of patients who have access to hospitals. Notably, both CHCs and hospitals are crucial for the whole multi-tiered medical system. Finally, we suggested modifications in different travel modes, weights of contributing factors, and the validation of decay functions to improve the MT2SFCA method.

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“…Guiding the hospital choices of patients is an efficient way to optimize healthcare utilization and improve healthcare accessibility; therefore, factors associated with the hospital choices of patients have been widely explored. Overall, the factors can be classified as spatial factors (e.g., distance to healthcare facilities), and non-spatial factors (e.g., socioeconomic attributes, severity of illness, quality of medical services, medical costs, and healthcare insurance) [16]. Accordingly, a number of measures for guiding the hospital choices of patients have been implemented.…”

Section: Hospital Allocation and Health Reformsmentioning

confidence: 99%

Whether Public Hospital Reform Affects the Hospital Choices of Patients in Urban Areas: New Evidence from Smart Card Data

Wang

Jin

2021

IJERPH

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The effects of public hospital reforms on spatial and temporal patterns of health-seeking behavior have received little attention due to small sample sizes and low spatiotemporal resolution of survey data. Without such information, however, health planners might be unable to adjust interventions in a timely manner, and they devise less-effective interventions. Recently, massive electronic trip records have been widely used to infer people’s health-seeking trips. With health-seeking trips inferred from smart card data, this paper mainly answers two questions: (i) how do public hospital reforms affect the hospital choices of patients? (ii) What are the spatial differences of the effects of public hospital reforms? To achieve these goals, tertiary hospital preferences, hospital bypass, and the efficiency of the health-seeking behaviors of patients, before and after Beijing’s public hospital reform in 2017, were compared. The results demonstrate that the effects of this reform on the hospital choices of patients were spatially different. In subdistricts with (or near) hospitals, the reform exerted the opposite impact on tertiary hospital preference compared with core and periphery areas. However, the reform had no significant effect on the tertiary hospital preference and hospital bypass in subdistricts without (or far away from) hospitals. Regarding the efficiency of the health-seeking behaviors of patients, the reform positively affected patient travel time, time of stay at hospitals, and arrival time. This study presents a time-efficient method to evaluate the effects of the recent public hospital reform in Beijing on a fine scale.

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Tertiary hospitals or community clinics? An enquiry into the factors affecting patients' choice for healthcare facilities in urban China

Cited by 28 publications

References 29 publications

Stated preferences for family doctor contract services: a survey of the rural elderly in Anhui Province, China

Stated preferences for family doctor contract services: a survey of the rural elderly in Anhui Province, China

Evaluations of Spatial Accessibility and Equity of Multi-Tiered Medical System: A Case Study of Shenzhen, China

Whether Public Hospital Reform Affects the Hospital Choices of Patients in Urban Areas: New Evidence from Smart Card Data

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