School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China.
PLoS One. 2012;7(9):e46309. doi: 10.1371/journal.pone.0046309. Epub 2012 Sep 28.
The healthcare system of mainland China is undergoing drastic reform and the optimal models for healthcare financing for provision of primary care will need to be identified. This study compared the performance indicators of the community health centres (CHCs) under different healthcare financing systems in the six cities of the Pearl River Delta region.
Approximately 300 hypertensive patients were randomly recruited from the computerized chronic disease management records provided by one CHC in each of the six cities in 2011 using a multi-stage cluster random sampling method. The major outcome measures included the treatment rate of hypertension, defined as prescription of ≥ one antihypertensive agent; and the control rate of hypertension, defined as systolic blood pressure levels <140 mmHg and diastolic blood pressure levels <90 mmHg in patients without diabetes mellitus, or <130/80 mmHg among patients with concomitant diabetes. Binary logistic regression analyses were conducted with these two measures as outcome variables, respectively, controlling for patients' socio-demographic variables. The financing system (Hospital- vs. Government- vs. private-funded) was the independent variable tested for association with the outcomes.
From 1,830 patients with an average age of 65.9 years (SD 12.8), the overall treatment and control rates were 75.4% and 20.2%, respectively. When compared with hospital-funded CHCs, patients seen in the Government-funded (adjusted odds ratio [AOR] 0.462, 95% C.I. 0.325-0.656) and private-funded CHCs (AOR 0.031, 95% C.I. 0.019-0.052) were significantly less likely to be prescribed antihypertensive medication. However, the Government-funded CHC was more likely to have optimal BP control (AOR 1.628, 95% C.I. 1.157-2.291) whilst the privately-funded CHC was less likely to achieve BP control (AOR 0.146, 95% C.I. 0.069-0.310), irrespective of whether antihypertensive drugs were prescribed.
Privately-funded CHCs had the lowest rates of BP treatment and control due to a variety of potential factors as discussed.
中国大陆的医疗体系正在经历重大改革，需要确定提供初级保健的最佳医疗保健融资模式。本研究比较了珠江三角洲地区六个城市中不同医疗融资系统下社区卫生服务中心（CHC）的绩效指标。
2011 年，采用多阶段聚类随机抽样方法，从每个城市的一个 CHC 的计算机化慢性病管理记录中随机招募了大约 300 名高血压患者。主要观察指标包括高血压治疗率，定义为处方≥一种降压药；以及高血压控制率，定义为无糖尿病患者的收缩压<140mmHg 和舒张压<90mmHg，或合并糖尿病患者的收缩压<130/80mmHg。分别以这两个指标为因变量进行二元逻辑回归分析，控制患者的社会人口统计学变量。以融资系统（医院、政府、私营）为自变量，检验与结果的关系。
在 1830 名平均年龄为 65.9 岁（SD 12.8）的患者中，总体治疗和控制率分别为 75.4%和 20.2%。与医院资助的 CHC 相比，政府资助的 CHC（调整后的优势比[OR]0.462，95%置信区间[CI]0.325-0.656）和私营资助的 CHC（OR0.031，95%CI0.019-0.052）接受降压药物治疗的可能性明显降低。然而，政府资助的 CHC 更有可能实现最佳血压控制（OR1.628，95%CI1.157-2.291），而私营资助的 CHC 实现血压控制的可能性较低（OR0.146，95%CI0.069-0.310），无论是否开了降压药。
私营资助的 CHC 由于各种潜在因素导致血压治疗和控制率最低，具体原因如下所述。
