Abstract
BackgroundWith economic development, aging of the population, improved insurance coverage, and the absence of a formal referral system, bypassing primary healthcare facilities appear to have become more common. Chinese patients tend to visit the secondary or tertiary healthcare facilities directly leading to overcrowding at the higher-level facilities. This study attempts to analyze the factors associated with bypassing primary care facilities among patients of age 45 years or older in China.MethodsRandom effects logistic models were used to examine bypassing of primary health facilities among rural-urban patients. Data from 2011 to 2015 waves of the China Health and Retirement Longitudinal Study were used.ResultsTwo in five older patients in China bypass primary health centers (PHC) to access care from higher-tier facilities. Urban patients were nearly twice as likely as rural patients to bypass PHC. Regardless of rural-urban residence, our analysis found that a longer travel time to primary facilities compared to higher-tier facilities increases the likelihood of bypassing. Patients with higher educational attainment were more likely to bypass PHCs. In rural areas, patients who reported their health as poor or those who experienced a recent hospitalization had a higher probability of bypassing PHC. In urban areas, older adults (age 65 years or older) were more likely to bypass PHC than the younger group. Patients with chronic conditions like diabetes also had a higher probability of bypassing.ConclusionsThe findings indicate the importance of strengthening the PHCs in China to improve the efficiency and effectiveness of the health system. Significantly lower out-of-pocket costs at the PHC compared to costs at the higher tiers had little or no impact on increasing the likelihood of utilizing the PHCs. Improving service quality, providing comprehensive person-centered care, focusing on family health care needs, and providing critical preventive services will help increase utilization of PHCs as well as the effectiveness and efficiency of the health system.
Highlights
With economic development, aging of the population, improved insurance coverage, and the absence of a formal referral system, bypassing primary healthcare facilities appear to have become more common
The propensity to bypass primary health centers (PHC) remained almost static in urban areas over the years – 62.4% in Wave 1, 61.1% in Wave 2, and 60.1% in Wave 3
The results indicate that bypassers differed from non-bypassers in terms of their residence, educational attainment, household income, medical insurance coverage, specific chronic conditions, and the incidence of hospitalization
Summary
With economic development, aging of the population, improved insurance coverage, and the absence of a formal referral system, bypassing primary healthcare facilities appear to have become more common. Many local level primary centers (PHCs) are not ready to offer chronic disease management [5]. Another significant change was the adoption of a universal health insurance scheme that has provided coverage to 95% of the population since 2011 [6]. With rapid economic development, aging of the population, improved insurance coverage, and lack of formal referral structure, bypassing PHCs to seek care from secondary and tertiary healthcare facilities (STFs) have increased, leading to overcrowding at the highertier facilities [7]
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