Adam Smith Business School, University of Glasgow , Glasgow, UK.
Department of Health Policy, London School of Economics and Political Science , London, UK.
Health Syst Reform. 2020 Dec 1;6(1):e1846844. doi: 10.1080/23288604.2020.1846844.
As China's health system is faced with challenges of overcrowded hospitals, there is a great need to better understand the recent patterns and determinants of people's choice between primary care facilities and hospitals for outpatient care. Based on recent individual-level data from the China Health and Retirement Longitudinal Survey (CHARLS) and official province-level data from China health statistical yearbooks, we examine the patterns of outpatient visits to primary care facilities versus hospitals among middle-aged and older individuals and explore both supply- and demand-side correlates that explain these patterns. We find that 53% of outpatient visits were paid to primary care facilities as opposed to hospitals in 2015, compared to 60% in 2011. Both supply and demand factors were associated with this decline. On the supply side, we find that the density of primary care facilities did not account for this decline, but higher densities of hospitals and licensed doctors were associated with lower use of primary care facilities. On the demand side, we find that individuals with higher socioeconomic status and greater health care needs were less likely to use primary health care facilities. Our findings suggest that a high concentration of health care professionals in hospitals diverts patients away from primary care facilities. Staffing the primary care facilities with a well-trained health care workforce is the key to a well-functioning primary care system. The findings also suggest a need to address demand-side inequality issues.
由于中国的医疗体系面临着医院人满为患的挑战，因此非常有必要更好地了解人们在基层医疗机构和医院之间选择门诊服务的最新模式和决定因素。本研究基于中国健康与养老追踪调查（CHARLS）的近期个体层面数据和中国卫生统计年鉴的官方省级数据，考察了中年及以上人群到基层医疗机构和医院就诊的门诊模式，并探讨了解释这些模式的供需双方相关因素。我们发现，2015 年有 53%的门诊就诊是在基层医疗机构，而不是医院，而 2011 年这一比例为 60%。供给和需求两方面的因素都与这一下降有关。在供给方面，我们发现基层医疗机构的密度并不能解释这一下降，而医院和执业医生的密度较高与基层医疗机构就诊率较低有关。在需求方面，我们发现社会经济地位较高和医疗保健需求较大的人不太可能使用基层医疗保健机构。我们的研究结果表明，医院中大量的医疗保健专业人员将患者从基层医疗机构转移走。为基层医疗保健系统配备训练有素的医疗保健人员是其良好运作的关键。这些发现还表明，需要解决需求方面的不平等问题。
