Abstract
BackgroundAlthough the community health service system is now established in China, the utilisation of the community health service institutions is low due to the lack of a gate-keeping role of the primary health service providers and referrals among the three-tiered health service institutions. In addition to this, patients who can afford to pay, often seek best services in big hospitals to guarantee the quality of care. Thus, the need of guiding the patients to the community health services and increasing the utilisation of the community health service institutions is becoming an urgent problem, which hinders the future development of community health services. This study focuses on the question of how to increase the utilisation of Chinese community health centres (HCs).MethodsA cross-sectional Base-line Survey of Chinese City Community Health Service System Building using the multi-staged cluster sampling was conducted to collect data from all HCs in 28 key contact cities. Relevant indicators of totally 1790 HCs were analysed. The statistical methods included ANONVA and logistic regression.Results and ConclusionsThe analysis suggested several key factors for increasing the outpatient workload (OW) at the HCs: establishing an adequate referral system among the different levels of the health system; enhancing the qualification of health personnel and increasing the compensation by the health insurance for services provided at HCs. Other key factors with a positive effect on the OW included: the government ownership of the HCs, the scale of the institutions, the medical equipment used, the mix of health services provided, and the women in childbearing age in the residence.
Highlights
The community health service system is established in China, the utilisation of the community health service institutions is low due to the lack of a gate-keeping role of the primary health service providers and referrals among the three-tiered health service institutions
Among the categorical indicators with a significant difference between the two groups of health centre (HC), the mean values for high outpatient workload group (HOWG) were higher than these for low outpatient workload group (LOWG) in case of "government-owned HC, outpatient designated, inpatient designated, house is used for free, house is rented by HC, and rent is raised by HC itself"
The comparison between the two groups of HCs in numerical indicators Table 2 suggests a significant difference between the two groups of HCs for all numerical indicators except for "health station (HS) owned by HC" in policy and management, "percentage of drug income and total income" in financing, "percentage of children aged in 0 to 6 in total population, percentage of pregnant women in total population, percentage of mental patient in total population served" in continuum of care, and "drug kinds, current observation beds, physician with postgraduate certificate, new physician with education certificate enrolled into in 3 year, nurse with postgraduate certificate, and the family medicine and community nursing training" in quality of care
Summary
The community health service system is established in China, the utilisation of the community health service institutions is low due to the lack of a gate-keeping role of the primary health service providers and referrals among the three-tiered health service institutions. The two of the main measures adopted by the government to establish a competitive health service market, included the introduction of a competition among the three-tiered health service institutions and the introduction of patients' out-of-pocket payment directly to the health service providers. There is a concentration of superior health resources and patients at the third-tiered health service institutions as well as a decline in the use of primary and secondary health service institutions This results in a serious equity problem, especially with regard to patients without high income, who cannot afford to pay directly to physicians. The Chinese government endeavoured to develop a convenient and affordable primary health services - community health service - for the city residents This mainly involved a transformation of the former health service institutions at the primary level and some health service institutions at the secondary level at the end of 1990s [1]
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