Association of primary care physician supply with maternal and child health in China: a national panel dataset, 2012\u20132017

Mengping Zhou,Nan Hu,Luwen Zhang,Li Kuang

doi:10.1186/s12889-020-09220-4

Abstract

BackgroundThe Chinese government has been strengthening the primary care system since the launch of the New Healthcare System Reform in 2009. Among all endeavors, the most obvious and significant improvement lays in maternal and child health. This study was designed to explore the association of primary care physician supply with maternal and child health outcomes in China, and provide policy suggestions to the law makers.MethodsSix-year panel dataset of 31 provinces in China from 2012 to 2017 was used to conduct the longitudinal ecological study. Linear fixed effects regression model was applied to explore the association of primary care physician supply with the metrics of maternal and child health outcomes while controlling for specialty care physician supply and socio-economic covariates. Stratified analysis was used to test whether this association varies across different regions in China.ResultsThe number of primary care physicians per 10,000 population increased from 15.56 (95% CI: 13.66 to 17.47) to 16.08 (95% CI: 13.86 to 18.29) from 2012 to 2017. The increase of one primary care physician per 10,000 population was associated with 5.26 reduction in maternal mortality per 100,000 live births (95% CI: − 6.745 to − 3.774), 0.106% (95% CI: − 0.189 to − 0.023) decrease in low birth weight, and 0.419 decline (95% CI: − 0.564 to − 0.273) in perinatal mortality per 1000 live births while other variables were held constant. The association was particularly prominent in the less-developed western China compared to the developed eastern and central China.ConclusionThe sufficient supply of primary care physician was associated with improved maternal and child health outcomes in China, especially in the less-developed western region. Policies on effective and proportional allocation of resources should be made and conducted to strengthen primary care system and eliminate geographical disparities.

Highlights

The Chinese government has been strengthening the primary care system since the launch of the New Healthcare System Reform in 2009
Data source and variable Maternal and child health (MCH) outcomes was measured by three indicators: (1) maternal mortality rate (MMR) to measure maternal health, defined as the number of maternal deaths per 100,000 women of reproductive age in the population; (2) low birth weight (LBW), defined as the percentage of infant weighed less than 2500 g in all live births and (3) perinatal mortality rate (PMR), defined as the sum of neonatal deaths and fetal deaths per 1000 births, to measure child health
We found that greater Primary care physician (PCP) supply was associated with improved MCH outcomes and this association was exceptionally significant in the less-developed western region

Summary

Introduction

The Chinese government has been strengthening the primary care system since the launch of the New Healthcare System Reform in 2009. This study was designed to explore the association of primary care physician supply with maternal and child health outcomes in China, and provide policy suggestions to the law makers. Accumulating evidences show the considerable potential contribution of a strong primary care system to reduce racial and income related health disparities and provide better protection for vulnerable populations [6,7,8,9,10], and the strength of primary care system is usually measured by the supply of physicians [2], the core functions of primary care [11], and patient perceived primary care quality [12]. A literature review which has summarized most of US studies highlighted the positive effects of increased primary care physician supply on more equitable health service distribution, improved overall health and reduced gaps in health across major population groups [5]. A series of WHO reports support as well that primary care is the first choice to bridge availability gap, achieve universal coverage and eliminate health disparities among regions and subpopulations [14]

Methods

Results

Discussion

Conclusion