Abstract
BackgroundIn China, most people tend to use hospitals rather than health centers for their primary care generally due to the perception that quality of care provided in the hospital setting is superior to that provided at the health centers. No studies have been conducted in China to compare the quality of primary care provided at different health care settings. The purpose of this study is to compare the quality of primary care provided in different types of health care facilities in China.MethodsA cross-sectional survey with patients was conducted in Guangdong province of China, using the validated Chinese Primary Care Assessment Tool (PCAT). ANOVA was performed to compare the overall and 10 domains of primary care quality for patients in tertiary, secondary, and primary health care settings. Multivariate analyses were used to assess the association between types of facility and quality of primary care attributes while controlling for sociodemographic and health care characteristics.ResultsThe final number of respondents was 864 including 161 from county hospitals, 190 from rural community health centers (CHCs), 164 from tertiary hospitals, 80 from secondary hospitals, and 269 from urban CHCs. Type of health care facilities was significantly associated with total PCAT score and domain scores. CHC was associated with higher total PCAT score and scores for first contact-access, ongoing care, comprehensiveness-services available, and community orientation than secondary and/or tertiary hospitals, after controlling for patients’ demographic and health characteristics. Higher PCAT score was associated with greater satisfaction with primary care received. CHC patients were more likely to report satisfactory experiences compared to patients from secondary and tertiary facilities.ConclusionsThe study demonstrated that CHCs provided better quality primary care when compared with secondary and tertiary health care facilities, justifying CHCs as a model of primary care delivery.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1604-2) contains supplementary material, which is available to authorized users.
Highlights
In China, most people tend to use hospitals rather than health centers for their primary care generally due to the perception that quality of care provided in the hospital setting is superior to that provided at the health centers
We found that no studies had been conducted in China to compare the quality of primary care provided at different health care settings
The study affirmed community health centers (CHCs) as a model to provide better or equal quality primary care when compared with other health care facilities, which would encourage patients to seek primary care in CHCs
Summary
In China, most people tend to use hospitals rather than health centers for their primary care generally due to the perception that quality of care provided in the hospital setting is superior to that provided at the health centers. The Chinese health care system is organized as a three-tiered system, which includes tertiary medical centers (including teaching hospitals), secondary hospitals (including urban district hospitals and rural county hospitals), and community health centers (CHCs) (including rural township hospitals) [12]. Despite this classification, patients may seek medical treatment, including primary care, from all three levels without referral [13]. According to the 2012 data, more than 36 % of the outpatient services happened in the hospitals [14] Such a fragmented and uncoordinated health care delivery system leads to unaffordable access and higher cost in China [15, 16]. The annual growth rates in per capita total health care expenditures and gross domestic product were 14.9 and 10.2 %, respectively, between 2007 to 2012 [17]
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