Abstract
Urban areas usually display better health care services than rural areas, but data about suburban areas in China are lacking. Hence, this cross-sectional study compared the utilization of community basic medical services in Shanghai urban and suburban areas between 2009 and 2014. These data were used to improve the efficiency of community health service utilization and to provide a reference for solving the main health problems of the residents in urban and suburban areas of Shanghai. Using a two-stage random sampling method, questionnaires were completed by 73 community health service centers that were randomly selected from six districts that were also randomly selected from 17 counties in Shanghai. Descriptive statistics, principal component analysis, and forecast analysis were used to complete a gap analysis of basic health services utilization quality between urban and suburban areas. During the 6-year study period, there was an increasing trend toward greater efficiency of basic medical service provision, benefits of basic medical service provision, effectiveness of common chronic disease management, overall satisfaction of community residents, and two-way referral effects. In addition to the implementation effect of hypertension management and two-way referral, the remaining indicators showed a superior effect in urban areas compared with the suburbs (P<0.001). In addition, among the seven principal components, four principal component scores were better in urban areas than in suburban areas (P = <0.001, 0.004, 0.036, and 0.022). The urban comprehensive score also exceeded that of the suburbs (P<0.001). In summary, over the 6-year period, there was a rapidly increasing trend in basic medical service utilization. Comprehensive satisfaction clearly improved as well. Nevertheless, there was an imbalance in health service utilization between urban and suburban areas. There is a need for the health administrative department to address this imbalance between urban and suburban institutions and to provide the required support to underdeveloped areas to improve resident satisfaction.
Highlights
Many rural areas lack adequate medical centers and trained doctors, specialists, tend to be small in size, and have lower service offer and financial difficulties[1, 2]
We discussed the comparative results of the health service utilization quality of urban and suburban community health service centers in Shanghai to address their effectiveness and developing health service trends
The results suggested that the absolute numbers of the total serviced population, household registered population, population !60 years of age, and population of children
Summary
Many rural areas lack adequate medical centers and trained doctors, specialists, tend to be small in size, and have lower service offer and financial difficulties[1, 2]. Studies showed that imbalances between urban and rural community health services exist in the United States and Mexico[4,5,6], but data about eventual urban/suburban imbalance are lacking for China. The Douglas production function method (an econometric method) was used for the comparison of the quality of basic medical service utilization between urban and suburban community health centers. Zhang and Yong[16] focused on the community health center as their study objective They applied principal component analysis, it was solely a factor analysis of public health assessment results in 18 community health centers in Shanghai in 2011, and the quality of basic medical service utilization in urban and suburban areas of Shanghai community health centers was not compared. Studies about the urban/suburban discrepancies in China are limited and well-conducted studies are necessary to improve our knowledge and improve the health care system in China
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