Can Health Disparity Be Eliminated? The Role of Family Doctor Played in Shanghai, China

Abstract

Background: Globally, the elimination of health disparity is a significant policy target. Primary health care has been implemented as a strategy to achieve this target in China for almost 10 years. This study examined whether family doctor (FD) policy in Shanghai contributed to eliminating health disparity as expected.

Methods: System dynamics modeling was performed to construct and simulate a system of health disparity formation (business-as-usual (BAU) scenario, without any interventions), a system with FD intervention (FD scenario), and three other systems with supporting policies (Policy 1/Policy 2/Policy hybrid scenario) from 2013 to 2050. Health disparities were simulated in different scenarios, making it possible to compare the BAU results with those of FD intervention and with other policy interventions.

Findings: System dynamics models showed that the FD policy would play a positive role in reducing health disparities in the initial stage, and medical price control-rather than health management-was the dominant mechanism. However, in this model, the health gap was projected to expand again around 2039. The model examined the introduction of two intervention policies, with findings showing that the policy focused on socioeconomic status improvement would be more effective in reducing health disparities, suggesting that socioeconomic status is the fundamental cause of these disparities.

Conclusions: The results indicate that health disparities could be optimized, but not eliminated, as long as differences in socioeconomic status persists.

Keywords: China; family doctor; health disparity; socioeconomic status; system dynamics modeling.

Figure A1

System dynamic model of the FD intervention.

Figure 1

Causal loop of socioeconomic status (SES)–health disparity.

Figure 2

Causal loop of SES–family doctor (FD)–health disparity.

Figure 3

Causal loop of SES–FD–health disparity with policy interventions.

Figure 4

(a) Health status (business-as-usual (BAU) scenario); (b) health status (FD scenario); (c) health gap (FD scenario). Note: BAU scenario: SES–health disparity scenario; FD scenario: SES–FD–health disparity scenario; Policy 1 scenario: scenario with intervention policy of lower drug prices; Policy 2 scenario: scenario with intervention policy of higher income promotion for the low-SES group; Policy hybrid scenario: scenario with two intervention policies.

Figure 5

(a) Tier-3 hospital-visiting rate (BAU scenario); (b) community health service center (CHSC)-visiting rate (BAU scenario); (c) tier-2/tier-3 hospital-visiting rate (FD scenario); (d) CHSC-visiting rate (FD scenario). Note: BAU scenario: SES–health disparity scenario; FD scenario: SES–FD–health disparity scenario; Policy 1 scenario: scenario with intervention policy of lower drug prices; Policy 2 scenario: scenario with intervention policy of higher income promotion for the low-SES group; Policy hybrid scenario: scenario with two intervention policies.

Figure 6

(a) Medical costs as a proportion of income (BAU scenario); (b) medical costs as a proportion of income (FD scenario). Note: BAU scenario: SES–health disparity scenario; FD scenario: SES–FD–health disparity scenario; Policy 1 scenario: scenario with intervention policy of lower drug prices; Policy 2 scenario: scenario with intervention policy of higher income promotion for the low-SES group; Policy hybrid scenario: scenario with two intervention policies.

Figure 7

(a) Medical costs as a proportion of income (Policy Scenario 1); (b) doctor-visiting rate (Policy Scenario 1); (c) health gap (Policy Scenario 1). Note: BAU scenario: SES–health disparity scenario; FD scenario: SES–FD–health disparity scenario; Policy 1 scenario: scenario with intervention policy of lower drug prices; Policy 2 scenario: scenario with intervention policy of higher income promotion for the low-SES group; Policy hybrid scenario: scenario with two intervention policies.

Figure 8

(a) Medical costs as a proportion of income (Policy Scenario 2); (b) doctor-visiting rate (Policy Scenario 2); (c) health gap (Policy Scenario 2). Note: BAU scenario: SES–health disparity scenario; FD scenario: SES–FD–health disparity scenario; Policy 1 scenario: scenario with intervention policy of lower drug prices; Policy 2 scenario: scenario with intervention policy of higher income promotion for the low-SES group; Policy hybrid scenario: scenario with two intervention policies.

Figure 9

(a) Health status (Hybrid Scenario); (b) medical costs as a proportion of income (Hybrid Scenario); (c) doctor-visiting rate (Hybrid Scenario). Note: BAU scenario: SES–health disparity scenario; FD scenario: SES–FD–health disparity scenario; Policy 1 scenario: scenario with intervention policy of lower drug prices; Policy 2 scenario: scenario with intervention policy of higher income promotion for the low-SES group; Policy hybrid scenario: scenario with two intervention policies.

Figure 10

Health gap under different scenarios. Note: BAU scenario: SES–health disparity scenario; FD scenario: SES–FD–health disparity scenario; Policy 1 scenario: scenario with intervention policy of lower drug prices; Policy 2 scenario: scenario with intervention policy of higher income promotion for the low-SES group; Policy hybrid scenario: scenario with two intervention policies.