Feng Shanshan, Shi Leiyu, Zeng Jiazhi, Chen Wen, Ling Li
Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.
Sun yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China.
PLoS One. 2017 Jan 5;12(1):e0169241. doi: 10.1371/journal.pone.0169241. eCollection 2017.
In order to improve the quality of services at village clinics (VCs), which are important primary care service providers in rural China, the Chinese government has encouraged the township hospitals to own and manage VCs. There are currently three models of ownership and management of VCs: township hospital-owned and -managed (HVC), village committee-owned and -managed (VVC), and private-owned and -managed (PVC). This study aims to examine the association between these ownership models of VCs and patients' primary care experiences.
Villagers were selected by multistage stratified sampling and their experiences with primary care were measured using the Primary Care Assessment Tool-Adult Edition (PCAT-AS). Data were collected through face-to-face interviews and the questionnaires administered by investigators in the cross-sectional study from February to April 2015. The PCAT scores were compared among the three models by covariance analysis, and multiple linear regression was used to analyze factors associated with the PCAT total scores.
A total of 1491 questionnaires were collected. After controlling for covariates, HVCs reported the highest PCAT scores and satisfaction rate. In terms of the domains, HVC reported the highest scores in the coordination and comprehensiveness domains, while PVC had the highest scores in the first contact-accessibility domain. Multivariate linear regression showed that HVC, married participants, aged 60 and older, satisfied with the services, receiving six or more visits, and those with medical expenditures over 20% of their total family expenditures, were also positively associated with better primary care quality.
This study demonstrates that villagers receiving medical care at HVCs perceived better primary care than those at PVCs and VVCs. In order to improve the quality of primary care at VCs, it is necessary to increase government subsidies for public service packages, tighten the township hospital's supervision of PVCs and VVCs, and develop performance-based incentive plans to motivate improvements in the accessibility of HVCs.
为提高作为中国农村重要基层医疗服务提供者的村卫生室（VC）的服务质量，中国政府鼓励乡镇卫生院对村卫生室进行拥有和管理。目前村卫生室有三种所有权和管理模式：乡镇卫生院所有并管理（HVC）、村委会所有并管理（VVC）和私人所有并管理（PVC）。本研究旨在探讨村卫生室的这些所有权模式与患者基层医疗体验之间的关联。
通过多阶段分层抽样选取村民，并使用成人版基层医疗评估工具（PCAT-AS）来衡量他们的基层医疗体验。在2015年2月至4月的横断面研究中，通过面对面访谈和调查员发放问卷来收集数据。通过协方差分析比较三种模式下的PCAT得分，并使用多元线性回归分析与PCAT总分相关的因素。
共收集到1491份问卷。在控制协变量后，HVC报告的PCAT得分和满意度最高。在各个领域方面，HVC在协调和全面性领域得分最高，而PVC在首次接触可及性领域得分最高。多元线性回归显示，HVC、已婚参与者、60岁及以上、对服务满意、接受六次或更多次就诊以及医疗支出占家庭总支出超过20%的人群，也与更好的基层医疗质量呈正相关。
本研究表明，在HVC接受医疗服务的村民比在PVC和VVC接受医疗服务的村民感受到更好的基层医疗服务。为提高村卫生室的基层医疗服务质量，有必要增加政府对公共服务包的补贴，加强乡镇卫生院对PVC和VVC的监管，并制定基于绩效的激励计划，以促进HVC提高可及性。
