Abstract
BackgroundSince 2009, the Chinese government has been reforming the healthcare system and has committed to reinforcing increased use of primary care. To date, however, the Chinese healthcare system is still heavily reliant on hospital-based specialty care. Studies consistently show an association between primary care and improved health outcomes, and the same association is also found among the disadvantaged population. Due to the “hukou” system, interprovincial migrants in the urban districts are put in a weak position and become the disadvantaged. Therefore, the aim of this study is to investigate whether greater supply and utilization of primary care was associated with reduced child mortality among the entire population and the interprovincial migrants in urban districts of Guangdong province, China.MethodsAn ecological study was conducted using a 3-year panel data with repeated measurements within urban districts in Guangdong province from 2014 to 2016, with 178 observations in total. Multilevel linear mixed effects models were applied to explore the associations.ResultsHigher visit proportion to primary care was associated with reductions in the infant mortality rate and the under-five mortality rate in both the entire population and the interprovincial migrants (p < 0.05) in the full models. The association between visit proportion to primary care and reduced neonatal mortality rate was significant among the entire population (p < 0.05) while it was insignificant among the interprovincial migrants (p > 0.05).ConclusionsOur ecological study based in urban districts of Guangdong province found consistent associations between higher visit proportion to primary care and improvements in child health among the entire population and the interprovincial migrants, suggesting that China should continue to strengthen and develop the primary care system. The findings from China adds to the previously reported evidence on the association between primary care and improved health, especially that of the disadvantaged.
Highlights
Since 2009, the Chinese government has been reforming the healthcare system and has committed to reinforcing increased use of primary care
Our ecological study based in urban districts of Guangdong province found consistent associations between higher visit proportion to primary care and improvements in child health among the entire population and the interprovincial migrants, suggesting that China should continue to strengthen and develop the primary care system
This study investigated whether greater supply and utilization of primary care was associated with reduced child mortality among the entire population and among the interprovincial migrants in urban districts of Guangdong province, China
Summary
Since 2009, the Chinese government has been reforming the healthcare system and has committed to reinforcing increased use of primary care. Since the 1980s economic reform, a market-oriented healthcare system has gradually developed and hospital-based specialty care has prospered [3]. It was not until 2009 that the Chinese government launched a plan to reform the already distorted healthcare system and committed to reinforcing the primary care system [4]. People still rely on hospital-based specialty care with 41% of visits to hospitals in 2016 [7] even if primary care provides higher economic accessibility. As the first tier of the healthcare system in China, primary care institutions, provide preventive and basic health services. District hospitals provide specialized care and support the development of primary care institutions [9]. According to previous studies, building a comprehensive primary care system is the key to accessible, affordable and integrated care [2, 10,11,12,13,14]
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