Comparison of health care utilization among users of public and private community health centres in urban China

Abstract

In China, the government has encouraged the participation of private sector facilities in primary care to improve health care quality. We compare health care utilization patterns among patients who select private versus public community health centres (CHCs) for reimbursed outpatient services. This paper uses data from the Urban Employee Basic Medical Insurance scheme from 2013 to 2016 in one of the largest cities in China. We used a Poisson model and a logistic model to examine outcomes on monthly outpatient visits and the probability of hospitalization, respectively. Compared with being a user of a public CHC, being a user of a private CHC is associated with a 26.2% lower incidence rate of outpatient visits to hospitals [95% confidence interval (CI): 30.1-21.8%] and no difference in rates of visits to CHCs or hospitalization. Among patients with diabetes or hypertension, being a user of a private CHC is associated with a 12.9% lower incidence rate of outpatient visits to CHCs (95% CI: 19.8-5.4%), a 25.6% lower incidence rate of outpatient visits to hospitals (95% CI: 21.4-19.5%) and 22.3% higher odds of hospitalization (95% CI: 3.5-44.7%). Being a user of a private CHC is associated with a reduction in outpatient visits to hospitals, which aligns with the goal of reducing hospital congestion at the outpatient level. For patients with chronic diseases, being a user of a private CHC is associated with a higher probability of hospitalization. More research is needed to understand the reason for this difference.