Social determinants of community health services utilization among the users in China: a 4-year cross-sectional study.

Yanhong Gong,Zuxun Lu,Xiaoxv Yin,Shiyi Cao,Geng Qin,Junan Liu,Yongbin Li,Xiaoxin Dong,Chen Yang,Yunxia Wang,Fujian Song,Huajie Yang,Liqun Liu,Jun Xie,Wei Zhou,David W Dowdy

doi:10.1371/journal.pone.0098095

Abstract

BackgroundTo identify social factors determining the frequency of community health service (CHS) utilization among CHS users in China.MethodsNationwide cross-sectional surveys were conducted in 2008, 2009, 2010, and 2011. A total of 86,116 CHS visitors selected from 35 cities were interviewed. Descriptive analysis and multinomial logistic regression analysis were employed to analyze characteristics of CHS users, frequency of CHS utilization, and the socio-demographic and socio-economic factors influencing frequency of CHS utilization.ResultsFemale and senior CHS clients were more likely to make 3–5 and ≥6 CHS visits (as opposed to 1–2 visits) than male and young clients, respectively. CHS clients with higher education were less frequent users than individuals with primary education or less in 2008 and 2009; in later surveys, CHS clients with higher education were the more frequent users. The association between frequent CHS visits and family income has changed significantly between 2008 and 2011. In 2011, income status did not have a discernible effect on the likelihood of making ≥6 CHS visits, and it only had a slight effect on making 3–5 CHS visits.ConclusionCHS may play an important role in providing primary health care to meet the demands of vulnerable populations in China. Over time, individuals with higher education are increasingly likely to make frequent CHS visits than individuals with primary school education or below. The gap in frequency of CHS utilization among different economic income groups decreased from 2008 to 2011.

Highlights

The primary health care (PHC) system was once inexpensive to the users of the PHC and played an important role in improving the population’s health in China [1,2]
Approximately one-third required more than 15 minutes to get to the visited community health service (CHS) facilities on foot
In 2011, income status did not have a discernible effect on the likelihood of making $6 visits, and it only has a slight effect on making 3–5 CHS visits

Summary

Introduction

The primary health care (PHC) system was once inexpensive to the users of the PHC and played an important role in improving the population’s health in China [1,2]. The economic reforms that have transformed China since 1978 unleashed a boom in economic changes, but they had negative effects on the PHC system [3,4]. In order to resolve this problem and supply affordable and equitable PHC for all, the latest round of healthcare reform was initiated in 2009 [7,8]. About 30% of the government funds are allocated to the building of supply-side infrastructure and training of PHC providers [7]. The number of community healthcare service (CHS) institutions increased dramatically between 2008 and 2011. Total number of CHS institutions was 24,260 in 2008, 27,308 in 2009, 32,739 in 2010, and 32,860 in 2011 [9]. To identify social factors determining the frequency of community health service (CHS) utilization among CHS users in China

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