Abstract
BackgroundPeople bypass primary healthcare (PHC) institutions to seek expensive healthcare at high-level hospitals, leading to escalating medical costs and inefficient use of resources. In 2009, China launched nationwide synergic policies on primary care strengthening, to tackle access to healthcare and financial protection. This study aimed to assess the impact of the two policy areas, health insurance and health workforce, on healthcare seeking behavior.MethodsDrawing on national survey data before (2008) and after (2013) the policies, we linked individual-level data on healthcare-seeking behavior with county-level data on health workforce and health insurance. We constructed a multilevel zero-inflated negative binomial regression to examine the impacts of average reimbursement rate (ARR) of health insurance and the density of registered physicians on outpatient/inpatient visits, and multilevel multinomial logistic regression for the impacts on choice of outpatient/inpatient care providers.ResultsAlthough the increase in health insurance ARR and physician density have positive impacts on individuals’ healthcare use, their impacts might be weakened during 2008 and 2013, and the negative impacts of investment of those in PHC institutions on likelihood of visiting hospitals was larger. The negative impacts of ARR at PHC institutions on likelihood of visiting county-, municipal- and higher-level hospitals in 2013 was 28 percentage points, 66 percentage points and 33 percentage points larger than these in 2008.ConclusionsPrimary care strengthening requires synergic policies. Effective mechanisms for coordination across multisectoral actions are necessities for deepening those policies to ensure efficient delivery of healthcare without experiencing financial risks.
Highlights
People bypass primary healthcare (PHC) institutions to seek expensive healthcare at high-level hospitals, leading to escalating medical costs and inefficient use of resources
Individual-level data were drawn from the China National Health Service Surveys (NHSS), which covered 94 counties with 177,501 respondents before and 156 counties with 273,687 respondents after the policies on primary care strengthening
We considered the variation of services and drug packages included in the social health insurance schemes (SHI), which made the average reimbursement rate (ARR) for inpatient services more representative of the practical degree of SHI generosity
Summary
People bypass primary healthcare (PHC) institutions to seek expensive healthcare at high-level hospitals, leading to escalating medical costs and inefficient use of resources. In 2009, China launched nationwide synergic policies on primary care strengthening, to tackle access to healthcare and financial protection. This study aimed to assess the impact of the two policy areas, health insurance and health workforce, on healthcare seeking behavior. As Governments strive to progress towards the Sustainable Development Goals including Universal Health Coverage, concerted efforts are being made to strengthen primary healthcare (PHC) so that people have access to quality health services without experiencing financial risks. Healthcare seeking behavior refers to individuals’ use of health services to meet their health demands, and includes choosing from a range of services and optional healthcare providers [1]. Given that people desire good quality care at a low price, quality and price of health services are two important aspects for improving individuals’ healthcare seeking behaviors.
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