Abstract
BackgroundResidents’ preference for primary health care (PHC) determined their utilization of PHC. This study aimed to assess the determinants of PHC service preference among the residents and the trend in PHC service preference over time in China.MethodsWe employed the nationally representative longitudinal data from 2012 to 2018 based on the China Family Panel Studies. The analysis framework was guided by the Andersen model of health service utilization. We included a total of 12,508 individuals who have been successfully followed up in the surveys of 2012, 2014, 2016, and 2018 without any missing data. Logistic regressions were performed to analyze potential predictors of PHC preference behavior.ResultsThe results indicated that individuals’ socio-economic circumstances and their health status factors were statistically significant determinants of PHC preference. Notably, over time, the residents’ likelihood of choosing PHC service represented a decreasing trend. Compare to 2012, the likelihood of PHC service preference decreased by 18.6% (OR, 0.814; 95% CI, 0.764–0.867) in 2014, 30.0% (OR, 0.700; 95% CI, 0.657–0.745) in 2016, and 34.9% (OR, 0.651; 95% CI, 0.611–0.694) in 2018. The decrease was significantly associated with the changes in residents’ health status.ConclusionsThe residents’ likelihood of choosing PHC service represented a decreasing trend, which was contrary to the objective of China’s National Health Reform in 2009. We recommend that policymakers adjust the primary service items in PHC facilities and strengthen the coordination of service between PHC institutions and higher-level hospitals.
Highlights
Residents’ preference for primary health care (PHC) determined their utilization of PHC
About 40.4% of the individuals were from the eastern region of China, and more than half of the study sample lived in rural areas (59.5%)
Most of the individuals were at work (61.1%), and 43.5% of the individuals reported that their household income in the last year was between 30,000 and 90,000 RMB
Summary
Residents’ preference for primary health care (PHC) determined their utilization of PHC. During the past decade of healthcare reform, China has made great efforts to improve the Primary Health Care (PHC) system [1], especially to strengthen the construction of PHC delivery system. Health Statistics Yearbook 2019, the number of PHC institutions in mainland China was 943,639 in 2018, with an increase of 41,930 since 2010. Those facilities improved the access to primary health care to residents [5]. Patients’ preference for different types of medical institutions determined the PHC utilization in China [8]. Studies on the PHC preference can help optimize the PHC service delivery system, but it was far from sufficient
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