Wei Xiaolin, Yin Jia, Wong Samuel Y S, Griffiths Sian M, Zou Guanyang, Shi Leiyu
Division of Clinical Public Health and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada Centre for Health Management and Policy, Shandong University, Jinan, China JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR School of Public Health, Sun Yat-sen University, Guangzhou, China School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Medicine (Baltimore). 2017 Jan;96(1):e5755. doi: 10.1097/MD.0000000000005755.
Ownership of primary care providers varies in different cities in China. Shanghai represented the full public ownership model of primary providers; Shenzhen had public-owned but private-operated providers; and Hong Kong represented the full private ownership. The study aims to assess the association of primary care ownership and patient perceived quality of care in 3 Chinese megacities.We conducted multistage stratified random surveys in 2013 in the 3 cities. Quality scores of primary care were measured using the validated primary care assessment tools. Multivariate linear regression models were used to compare quality scores after controlling potential confounders of patient demographic, socioeconomic, and healthcare utilization factors.Overall, 797 primary care users in Shanghai, 802 in Shenzhen, and 1325 in Hong Kong participated in the study. The mean total quality scores were reported the highest in Shanghai (28.39), followed by Shenzhen (25.82) and then Hong Kong (25.21) (P < 0.001). Shanghai participants reported the highest scores for 1st contact accessibility, coordination of information, comprehensiveness of service availability, and culture competence, while Hong Kong participants reported the lowest for these domains (P < 0.001). Hong Kong participants from rich households reported higher total scores than those from poor households (P < 0.05); however, this was not found in Shanghai and Shenzhen.The study suggests that private primary care ownership may be associated with lower quality and less equitable care distribution. In China, it suggests that it may be beneficial to promote public-owned and nonprofit providers. Promoting privatization in primary care may be at the cost of quality and equity of primary care.
在中国，不同城市的基层医疗服务提供者的所有制形式各不相同。上海代表了基层医疗服务提供者完全公有制的模式；深圳的基层医疗服务提供者是公有民营；而香港则代表了完全私有制。本研究旨在评估中国三个特大城市基层医疗服务所有制与患者感知的医疗服务质量之间的关联。
2013年，我们在这三个城市开展了多阶段分层随机调查。使用经过验证的基层医疗评估工具来衡量基层医疗服务的质量得分。在控制了患者人口统计学、社会经济和医疗服务利用因素等潜在混杂因素后，采用多元线性回归模型比较质量得分。
总体而言，上海的797名基层医疗服务使用者、深圳的802名以及香港的1325名参与了本研究。报告的平均总质量得分在上海最高（28.39），其次是深圳（25.82），然后是香港（25.21）（P<0.001）。上海参与者在首次接触的可及性、信息协调性、服务可及性的全面性以及文化能力方面的得分最高，而香港参与者在这些方面的得分最低（P<0.001）。香港富裕家庭的参与者报告的总得分高于贫困家庭的参与者（P<0.05）；然而，在上海和深圳未发现这种情况。
该研究表明，私立基层医疗服务所有制可能与较低的质量以及医疗服务分配缺乏公平性有关。在中国，这表明推广公有和非营利性的医疗服务提供者可能是有益的。在基层医疗服务领域推行私有化可能会以牺牲基层医疗服务的质量和公平性为代价。
