Whither the roads lead to? Estimating association between urbanization and primary healthcare service use with chinese prefecture-level data in 2014.

Sheng Nong,Zhuo Chen

doi:10.1371/journal.pone.0234081

Abstract

With the rapid economic development across China over recent decades, examining how urbanization may affect healthcare service use and its implications is more than urgent. This study estimates the association between urbanization and primary healthcare services use in China. We construct a prefecture-level dataset on healthcare services utilization and urbanization. We regress the proportion of residents using healthcare services in primary healthcare centers versus secondary or tertiary hospitals on a set of prefecture-level control variables. Results suggest that use of primary healthcare centers outpatient service is positively associated with being in the proximity of a provincial capital, but negatively correlated with the percentage of the urban population and the availability of public transportation. Higher likelihood of seeking care in major hospitals instead of primary healthcare centers is associated with urbanization, justifying a need for primary care physicians as gatekeepers in China’s healthcare delivery system.

Highlights

Primary healthcare services are often provided by local community health centers for convenience and efficiency
Rural residents have much higher usage than their urban counterparts, with 35% of outpatient services being within rural primary healthcare center (PHC) facilities and 23% of inpatient services
Prefectures near provincial capitals tend to be wealthier than prefectures that far away from the capital, rural PHCs in these prefectures may be more competent in retaining local patients

Summary

Introduction

Primary healthcare services are often provided by local community health centers for convenience and efficiency. At times patients may seek care at major hospitals away from where they live, even for conditions treatable at local community health centers–commonly known as bypassing. In countries where primary care physicians serve as gatekeepers, bypassing is less likely to be an issue for their healthcare systems. Patients in China have more latitude in choosing a provider within their home province than most other healthcare systems bypassing is more common in China. Major Chinese hospitals are motivated to compete for patients, leading to wide-spread bypassing and a significant economic burden and inefficiencies in the healthcare system. Bypassing causes congestion in major hospitals and underutilized resources in lower-tiered providers, resulting in wasted resources, low patient satisfaction, and medical malpractice disputes [1]

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Results

Discussion

Conclusion