Association between Primary Healthcare and Medical Expenditures in a Context of Hospital-Oriented Healthcare System in China: A National Panel Dataset, 2012-2016.

Mengping Zhou,Nan Hu,Jingyi Liao,Li Kuang

doi:10.3390/ijerph17186917

Abstract

Total health expenditure in China has grown considerably since a new round of health system reform was enacted in 2009. Researchers have shown that strengthening primary healthcare may be an option for countries to solve the rapid expansion of their medical expenditures. This study was designed to explore the association between the strength of primary healthcare and medical expenditures, in the context of the hospital-oriented healthcare system in China. A longitudinal ecological study was conducted using a 5-year panel dataset of 27 provinces in mainland China. The linear mixed effects regression model was used to assess the effects of primary healthcare-related metrics on medical expenditures, controlling for the provincial level specialty care physician supply and socio-economic parameters. All of the three primary healthcare-related metrics showed negative associations with the two medical expenditure parameters. Primary care physicians per 10,000 population was significantly associated with the per capita hospital medical expenditures (p < 0.05), and the percentage of public health expenditure in total health expenditure was significantly associated with both per capita total medical expenditure and per capita hospital medical expenditures (p < 0.01 for both). Our study found negative associations between the primary healthcare capacity and medical expenditure in the context of hospital-oriented healthcare systems in China, adding to the previous evidence that primary healthcare may play a positive role in reducing medical expenditure. Policies on increasing the primary care physician supply and the public share of total health expenditure should be conducted to strengthen the primary healthcare system. With the gradual advance of medical reform and the policy inclination to primary healthcare, this will play a more important role in controlling the rapid growth of medical expenditure.

Highlights

To maintain the sustainable growth of medical expenditure has become an important issue facing the health system reform in all countries since the health sector continues to expand faster than the economy [1]
Our study found negative associations between the primary healthcare capacity and medical expenditure in the context of hospital-oriented healthcare systems in China, adding to the previous evidence that primary healthcare may play a positive role in reducing medical expenditure
The proportion of public health expenditure among total health expenditure increased from 65.51% to 71.34%, and the popularity rate of sanitary toilets in rural areas rose from 68.83% to 77.82%

Summary

Introduction

To maintain the sustainable growth of medical expenditure has become an important issue facing the health system reform in all countries since the health sector continues to expand faster than the economy [1]. Between 2000 and 2017, global health spending in real terms grew by 3.9% a year while the economy grew by 3.0% a year and this trend was even more serious in middle-income countries (expenditure 6.3% vs GDP 5.9%) [2]. As one of the middle-income countries, China is rapidly converging towards higher levels of spending since the new round of health system reforms was. Res. Public Health 2020, 17, 6917; doi:10.3390/ijerph17186917 www.mdpi.com/journal/ijerph

Methods

Results

Discussion

Conclusion