The effect of the latest health care reforms on the quality of community health services in China.

Abstract

The Chinese government initiated a new round health care reform in 2009 to provide universal primary health care to the country's population. The aim of this study was to evaluate and compare the quality of community health services before and after the latest health care reforms in China. A series of nationwide surveys were conducted in 2008 and in 2011to assess the development of the community health services. A total of 2274 and 2501 community health centers, 38200 and 42200 prescriptions, and 12163 and 12386 outpatients visited community health centers (CHCs) were investigated in 2008 and in 2011, respectively. Multivariable regressions and Kruskal-Wallis tests were applied to analyze the differences before and after health care reforms. Quality of community health services has been improved significantly at the first stage of health care reforms in China. CHCs were larger and better equipped after health care reforms in terms of average building area and average number of medical equipment. Patient satisfaction increased, and patient payments per visit decreased after health care reforms. But there was no significant improvement in health human resource, and overuse of injections remains prevalent, pointing to the need for further reforms to improve quality of community health services, such as general practitioner cultivation and supervision over prescribing behaviors.