Underuse of Primary Care in China: The Scale, Causes, and Solutions

Wu, Dan; Lam, Tai Pong

doi:10.3122/jabfm.2016.02.150159

Cited by 119 publications

(124 citation statements)

References 27 publications

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“…These findings are in accordance with other studies from Kenya, Papua New Guinea, China and Nepal [27][28][29][30][31]. Even though, the association was not statistically significant, other caretakers socio-demographic factors also positively affected bypassing behavior especially age and education.…”

Section: Discussionsupporting

confidence: 82%

Bypassing Primary Health Care Facilities for Common Childhood Illnesses in Sharg-Alneel Locality in Khartoum State, Sudan 2015

Ahmed¹

2017

SJPH

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Abstract:In Sudan despite the current implementation of universal health coverage policy, routine monitoring reports highlight that patients frequently bypass Primary Health Care (PHC) facilities in favor of higher-level hospitals, though hospitals are costly and time consuming. The main objective of this study was to study the extent of bypassing the public PHC facilities and factors associated with the decision of caretakers to bypass such facilities seeking care for their under-five year's children with common illnesses in Sharg-Alneel locality, 2015. The study proposed strategies and interventions to the Sudan government -Federal Ministry of Health (FMoH) -to improve PHC service utilization The study was cross-sectional comparative study, interviewer administered questionnaires and facility assessment checklist was used for data collection. The data was analysed using SPSS. The study interviewed 497 caretakers, 87% of them pursued health care for their children directly from secondary hospitals. The main reasons for bypassing the closest public health facilities were unavailability of doctors, lack of health insurance services and higher cost of services. The proportion of bypassing a PHC facility for child care is significantly associated with child sex, child age, presenting symptoms of diarrhea, fever, difficult breathing and severe vomiting, caretakers' occupation as well as the economic status. In a resource limited country, health policy to achieve universal health coverage is better to focus on quality of care as well as quantity. Community mobilization and interventions to improve access and utilization of quality PHC services are all recommended. Furthermore, more research on bypassing behaviour is also recommended.

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Section: Discussionsupporting

confidence: 82%

Bypassing Primary Health Care Facilities for Common Childhood Illnesses in Sharg-Alneel Locality in Khartoum State, Sudan 2015

Ahmed¹

2017

SJPH

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“…Primary care facilities (community health facilities in urban areas, and township health centres and village clinics in rural areas) provide preventive and basic medical services, while the secondary and tertiary-care institutions provide specialized care (1). Outpatient services are available at all tiers of facilities.…”

Section: Introductionmentioning

confidence: 99%

“…Freedom of choice of health care is embraced by the public and walk-in medical consultations are readily available. Hospital-based services have been abused (1) and one of the goals of the health reforms launched in 2009 was to encourage the utilization of community-based primary care (2). Enormous resources have been poured into the primary care infrastructure establishments such as buildings, manpower, and basic medical equipment.…”

Section: Introductionmentioning

confidence: 99%

Health reforms in china: the public’s choices for first-contact care in urban areas

Lam

et al. 2017

FAMPRJ

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Purpose. To examine the public's views towards their choice of first-contact care and its associated factors in urban China. Methods. A mixed-method study was adopted using individual interviews, focus group interviews and a cross-sectional survey. The study was conducted among the general public between September 2014 and September 2015 in Zhejiang province, China. Results. Six focus groups and 13 individual interviews were conducted. The questionnaire was completed by 1248 respondents with a response rate of 83%. Survey results showed that 70% of the respondents preferred hospital-based services for first-contact care, it is especially the case with paediatric patients (83.3%). The qualitative data revealed that a major cause was the public distrust in the competence of primary care practitioners with lower educational qualifications. In the decision-making process, compared to cost factors like medical expenses and waiting times, participants attached greater emphasis on organizational characteristics. Respondents who rated sophisticated medical equipment, reputation of the facility, average education of doctors as important were significantly more inclined to choose hospital services. Respective adjusted odds ratios (AOR) were 2.14 (P < 0.001), 1.83 (P < 0.001) and 1.40 (P = 0.043) for their own conditions and 2.19 (P = 0.004), 1.94 (P = 0.002) and 1.86 (P = 0.003) for their children's conditions. Availability of medications and perceived severity of illness were also significantly associated with their choice of hospital services for their children. Conclusion. The public's preference for hospital-based services for first-contact care places a huge obstacle to promoting community-based primary care. Addressing the public's concerns about the primary care practitioners' competence is worth more efforts.

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“…At present, major factors causing chronic diseases such as heart diseases, cancers, and diabetes, include unhealthy diet, the lack of physical exercises, and the use of tobacco [15]. To deal with these challenges, some measures recommended by scholars include the utilization of primary care [16] and reform the medical insurance system [17]. It is believed that the public health approach and medical health insurance can minimize the impacts of factors causing chronic diseases.…”

Section: China's Policy On the Control Of Chronic Diseases Of The Agementioning

confidence: 99%

The Role of Medical Insurance in the Chinese Elders’ Behaviors of Smoking and Quit Smoking

Zhi-Lei¹,

Wang²,

Kin-Sun³

et al. 2017

UCMS

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PURPOSE: In the midst of rapid ageing population and rising medical cost, smoking cessation policy is more emphasized by the governments in China than ever. They have taken a public health approach to reform their medical care system, in which policy under an innovative public health reform process is hammered out to reduce the impact of ageing population and rising prevalence rates of chronic diseases on medical expenditure. However, there are very limited studies on the relationship between China's medical care system and elderly smoking behaviors. DESIGN/METHODOLOGY/APPROACH: The study adopts national elderly data, namely the China Health and Retirement Longitudinal Study (CHARLS), to investigate into the relationship between medical care system and elderly smoking behaviors with control variables, including socio-economic background, disability status and chronic diseases. FINDINGS: According to the results of logistics regression model, there is no significant relationship between smoking behavior and the medical insurance for urban residents and urban employees, whereas new rural cooperative medical insurance is positively correlated to the likelihood of smoking and negatively correlated to the likelihood to quit smoking among the elderly population. Besides, aged above 75, having chronic diseases and visual disability increase the likelihood to quit smoking, but no formal education and hearing disability decrease the likelihood to quit smoking. Aged above 75 and married lower the likelihood of smoking, but male, having hearing disability and respiratory disease enhance the likelihood of smoking. ORIGINALITY/VALUE: China's medical care system has not yet fully utilized its role in public health approach and the governments may modify their smoking cessation policies and practices to become preventive rather than reactive by taking reference to the findings of this paper.

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Underuse of Primary Care in China: The Scale, Causes, and Solutions

Cited by 119 publications

References 27 publications

Bypassing Primary Health Care Facilities for Common Childhood Illnesses in Sharg-Alneel Locality in Khartoum State, Sudan 2015

Bypassing Primary Health Care Facilities for Common Childhood Illnesses in Sharg-Alneel Locality in Khartoum State, Sudan 2015

Health reforms in china: the public’s choices for first-contact care in urban areas

The Role of Medical Insurance in the Chinese Elders’ Behaviors of Smoking and Quit Smoking

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