Synergy of policies to strengthen primary care: evidence from a national repeated cross-sectional study

doi:10.1186/s12913-020-05695-4

. 2020 Sep 14;20(1):865.

doi: 10.1186/s12913-020-05695-4.

Synergy of policies to strengthen primary care: evidence from a national repeated cross-sectional study

Yinzi Jin^{1

2}, Jin Xu², Weiming Zhu², Yaoguang Zhang³, Ling Xu³, Qingyue Meng^{4

5}

Affiliations

¹ School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.
² China Center for Health Development Studies, Peking University, Box 505, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.
³ Center for Health Statistics and Information, National Health Commission of the People's Republic of China, 1 Hitch Man South Road, Xicheng District, Beijing, 100044, China.
⁴ School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China. qmeng@bjmu.edu.cn.
⁵ China Center for Health Development Studies, Peking University, Box 505, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China. qmeng@bjmu.edu.cn.

PMID: 32928213
PMCID: PMC7488991
DOI: 10.1186/s12913-020-05695-4

Synergy of policies to strengthen primary care: evidence from a national repeated cross-sectional study

Yinzi Jin et al. BMC Health Serv Res. 2020.

. 2020 Sep 14;20(1):865.

doi: 10.1186/s12913-020-05695-4.

Authors

Yinzi Jin^{1

2}, Jin Xu², Weiming Zhu², Yaoguang Zhang³, Ling Xu³, Qingyue Meng^{4

5}

Affiliations

¹ School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.
² China Center for Health Development Studies, Peking University, Box 505, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.
³ Center for Health Statistics and Information, National Health Commission of the People's Republic of China, 1 Hitch Man South Road, Xicheng District, Beijing, 100044, China.
⁴ School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China. qmeng@bjmu.edu.cn.
⁵ China Center for Health Development Studies, Peking University, Box 505, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China. qmeng@bjmu.edu.cn.

PMID: 32928213
PMCID: PMC7488991
DOI: 10.1186/s12913-020-05695-4

Abstract

Background: People bypass primary healthcare (PHC) institutions to seek expensive healthcare at high-level hospitals, leading to escalating medical costs and inefficient use of resources. In 2009, China launched nationwide synergic policies on primary care strengthening, to tackle access to healthcare and financial protection. This study aimed to assess the impact of the two policy areas, health insurance and health workforce, on healthcare seeking behavior.

Methods: Drawing on national survey data before (2008) and after (2013) the policies, we linked individual-level data on healthcare-seeking behavior with county-level data on health workforce and health insurance. We constructed a multilevel zero-inflated negative binomial regression to examine the impacts of average reimbursement rate (ARR) of health insurance and the density of registered physicians on outpatient/inpatient visits, and multilevel multinomial logistic regression for the impacts on choice of outpatient/inpatient care providers.

Results: Although the increase in health insurance ARR and physician density have positive impacts on individuals' healthcare use, their impacts might be weakened during 2008 and 2013, and the negative impacts of investment of those in PHC institutions on likelihood of visiting hospitals was larger. The negative impacts of ARR at PHC institutions on likelihood of visiting county-, municipal- and higher-level hospitals in 2013 was 28 percentage points, 66 percentage points and 33 percentage points larger than these in 2008.

Conclusions: Primary care strengthening requires synergic policies. Effective mechanisms for coordination across multisectoral actions are necessities for deepening those policies to ensure efficient delivery of healthcare without experiencing financial risks.

Keywords: Health insurance coverage; Health workforce availability; Primary care strengthening; Synergic policies.

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Conflict of interest statement

No conflicts of interest have been declared.

Figures

**Fig. 1**
Comparing the proportion of outpatient visits at PHC institutions to physician density at PHC institutions by GDP group, 2008 (A) and 2013 (B)

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References

1. Chrisman NJ. The health seeking process: an approach to the natural history of illness. Cult Med Psychiatry. 1997;4:351–377. - PubMed
1. Center for Health Statistics and Information, National Health and Family Planning Commission. An analysis report of national health services survey 2008. Beijing: Peking Union Medical College Press 2009.
1. Central Committee of the Communist Party of China, State Council. Opinions on deepening health system reform 2009. Available from: http://www.china.org.cn/government/sciopressconferences/200904/09/conten....
1. Meng Q, Fang H, Liu X, et al. Consolidating the social health insurance schemes in China: towards an equitable and efficient health system. Lancet. 2015;386:1484–1492. - PubMed
1. Li X, Krumholz HM, Yip W, et al. Quality of primary health care in China: challenges and recommendations. Lancet. 2020;395(10239):1802–1812. - PMC - PubMed

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[1] Chrisman NJ. The health seeking process: an approach to the natural history of illness. Cult Med Psychiatry. 1997;4:351–377. - PubMed

[2] Chrisman NJ. The health seeking process: an approach to the natural history of illness. Cult Med Psychiatry. 1997;4:351–377. - PubMed

[3] Center for Health Statistics and Information, National Health and Family Planning Commission. An analysis report of national health services survey 2008. Beijing: Peking Union Medical College Press 2009.

[4] Center for Health Statistics and Information, National Health and Family Planning Commission. An analysis report of national health services survey 2008. Beijing: Peking Union Medical College Press 2009.

[5] Central Committee of the Communist Party of China, State Council. Opinions on deepening health system reform 2009. Available from: http://www.china.org.cn/government/sciopressconferences/200904/09/conten....

[6] Central Committee of the Communist Party of China, State Council. Opinions on deepening health system reform 2009. Available from: http://www.china.org.cn/government/sciopressconferences/200904/09/conten....

[7] Meng Q, Fang H, Liu X, et al. Consolidating the social health insurance schemes in China: towards an equitable and efficient health system. Lancet. 2015;386:1484–1492. - PubMed

[8] Meng Q, Fang H, Liu X, et al. Consolidating the social health insurance schemes in China: towards an equitable and efficient health system. Lancet. 2015;386:1484–1492. - PubMed

[9] Li X, Krumholz HM, Yip W, et al. Quality of primary health care in China: challenges and recommendations. Lancet. 2020;395(10239):1802–1812. - PMC - PubMed

[10] Li X, Krumholz HM, Yip W, et al. Quality of primary health care in China: challenges and recommendations. Lancet. 2020;395(10239):1802–1812. - PMC - PubMed

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Synergy of policies to strengthen primary care: evidence from a national repeated cross-sectional study

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Synergy of policies to strengthen primary care: evidence from a national repeated cross-sectional study

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