Focus on vulnerable populations and promoting equity in health service utilization ––an analysis of visitor characteristics and service utilization of the Chinese community health service

BMC Public Health

Zuxun Lu¹  Yi Sun¹  Jun Xie¹  Xing Xu¹  Xiaoxu Yin¹  Yunxia Wang¹  Yanhong Gong¹  Chen Yang¹  Fujian Song²  Huajie Yang¹  Shiyi Cao¹  Ling Liu¹  Xiaoxin Dong¹ 

[1] School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Norwich, UK

关键词: Satisfaction;    Visitor characteristics;    Community health service;    Equity in health service utilization;   

Others  :  1130294
DOI  :  10.1186/1471-2458-14-503

 received in 2013-12-02, accepted in 2014-05-12,  发布年份 2014

【 摘 要 】

Background

Community health service in China is designed to provide a convenient and affordable primary health service for the city residents, and to promote health equity. Based on data from a large national study of 35 cities across China, we examined the characteristics of the patients and the utilization of community health institutions (CHIs), and assessed the role of community health service in promoting equity in health service utilization for community residents.

Methods

Multistage sampling method was applied to select 35 cities in China. Four CHIs were randomly chosen in every district of the 35 cities. A total of 88,482 visitors to the selected CHIs were investigated by using intercept survey method at the exit of the CHIs in 2008, 2009, 2010, and 2011. Descriptive analyses were used to analyze the main characteristics (gender, age, and income) of the CHI visitors, and the results were compared with that from the National Health Services Survey (NHSS, including CHIs and higher levels of hospitals). We also analyzed the service utilization and the satisfactions of the CHI visitors.

Results

The proportions of the children (2.4%) and the elderly (about 22.7%) were lower in our survey than those in NHSS (9.8% and 38.8% respectively). The proportion of the low-income group (26.4%) was apparently higher than that in NHSS (12.5%). The children group had the lowest satisfaction with the CHIs than other age groups. The satisfaction of the low-income visitors was slightly higher than that of the higher-income visitors. The utilization rate of public health services was low in CHIs.

Conclusions

The CHIs in China appears to fulfill the public health target of uptake by vulnerable populations, and may play an important role in promoting equity in health service utilization. However, services for children and the elderly should be strengthened.

【 授权许可】

   
2014 Dong et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Hall JJ, Taylor R: Health for all beyond 2000: the demise of the Alma-Ata Declaration and primary health care in developing countries. Med J Aust 2003, 178(1):17-20.
• [2]De Maeseneer J, Hjortdahl P, Starfield B: Fix what’s wrong, not what’s right, with general practice in Britain: It has provided better health than government spending deserves. BMJ 2000, 320(7250):1616.
• [3]Dahrouge S, Hogg W, Tuna M, Russell G, Devlin RA, Tugwell P, Kristjansson E: Age equity in different models of primary care practice in Ontario. Can Fam Physician 2011, 57(11):1300-1309.
• [4]Nteta TP, Mokgatle-Nthabu M, Oguntibeju OO: Utilization of the primary health care services in the Tshwane Region of Gauteng Province, South Africa. PloS one 2010, 5(11):e13909.
• [5]Xu J, Wang W, Li Y, Zhang J, Pavlova M, Liu H, Yin P, Lu Z: Analysis of factors influencing the outpatient workload at Chinese health centres. BMC Health Serv Res 2010, 10(1):151. BioMed Central Full Text
• [6]Williams A, Cookson R: Equity in health. Handb Health Econ 2000, 1:1863-1910.
• [7]Marmot M, Friel S, Bell R, Houweling TA, Taylor S: Closing the gap in a generation: health equity through action on the social determinants of health. Lancet 2008, 372(9650):1661.
• [8]Flaskerud JH, Winslow BJ: Conceptualizing vulnerable populations health-related research. Nurs Res 1998, 47(2):69.
• [9]PR China Ministry of Health: The status of national medical services in 2010. http://www.moh.gov.cn/zwgkzt/pnb/201103/50847.shtml webcite
• [10]Li Y, Xu J, Wang F, Wang B, Liu L, Hou W, Fan H, Tong Y, Zhang J, Lu Z: Overprescribing in China, driven by financial incentives, results in very high use of antibiotics, injections, and corticosteroids. Health Aff 2012, 31(5):1075-1082.
• [11]Dib HH, Sun P, Minmin Z, Wei S, Li L: Evaluating community health centers in the City of Dalian, China: how satisfied are patients with the medical services provided and their health professionals? Health Place 2010, 16(3):477-488.
• [12]Li X, Zhang T: The comparative analysis of the basic characteristics of the outpatients of the community health service institutions in a city. Chinese Health Quality Management 2008, 15(6):81-83.
• [13]Ren X, Li N, Gao B, Zhang W, Liu D: The analysis of the diseases of the community health service centers in Chengdu city. Chinese General Practice 2006, 9(17):1472-1473.
• [14]Yang C, Zheng Y, Zhai H: The situation of the medical services of the national community health service sites. Chinese General Practice 2009, 7(6):633-635.
• [15]The Statistic Center of PR China Ministry of Health: An Analysis Report of National Health Services Survey in China, 2008. Beijing: Pekin Union Medical College Press; 2009.
• [16]PR China Ministry of Health: China Health Statistics Digest of 2010. http://www.moh.gov.cn/htmlfiles/zwgkzt/ptjnj/year2010/index2010.html webcite
• [17]Scott AJ: World Development Report 2009: reshaping economic geography. J Econ Geogr 2009, 9(4):583-586.
• [18]The Statistic Center of PR China Ministry of Health: The statistic communiqué of the national health development in 2008. http://www.gov.cn/gzdt/2009-04/29/content_1299547.htm webcite
• [19]Lu Z, Li Y, Wang F, Wang B, Liu L, Zhou W, Qin G: The Development, effect and concerned issues of pilot work of National Community Health Service System Building in key contact cities–based on the Comprehensive Analysis of the Baseline Survey and Routine Monitoring Data. Chinese J Soc Med 2009, 26(006):321-325.
• [20]Mo J: The poverty and social security of Hong Kong. Hong Kong: Zhong Hua Book Company; 1993.
• [21]Bertakis KD, Azari R, Helms LJ, Callahan EJ, Robbins JA: Gender differences in the utilization of health care services. J Fam Pract 2000, 49(2):147-152.
• [22]Parslow R, Jorm A, Christensen H, Jacomb P, Rodgers B: Gender differences in factors affecting use of health services: an analysis of a community study of middle-aged and older Australians. Soc Sci Med (1982) 2004, 59(10):2121.
• [23]Margolis SA, Al-Marzouqi S, Revel T, Reed RL: Patient satisfaction with primary health care services in the United Arab Emirates. Int J Qual Health Care 2003, 15(3):241-249.
• [24]Mash B, Fairall L, Adejayan O, Ikpefan O, Kumari J, Mathee S, Okun R, Yogolelo W: A morbidity survey of South African primary care. PLoS One 2012, 7(3):e32358.
• [25]Cui M, Yin D, Jin C, Chen X, Wang L, Yang H, Wu Q, Wang B, He S, Xu Z, Cao B, Chen B: Study on the ability of child health services in primary health institutions. Chinese J Child Health Care 2012, 20(10):872-874.
• [26]Zhou Y, Qian D, Xu L, Zhang Y: Analysis on the trend of change of outpatients’ characteristics in urban community health institutions. Chinese Health Resources 2011, 14(4):259-261.
• [27]Duan X, Qin Z: The analysis of the implementation situation of the basic public health services project in city. Chinese J Pub Health 1999, 16(2):72-75.
• [28]Dunlop S, Coyte PC, McIsaac W: Socio-economic status and the utilization of physicians’ services: results from the Canadian National Population Health Survey. Soc Sci Med 2000, 51(1):123.
• [29]Xu S, Xiong G, Zhao J: The analysis of the flow and the cost of the outpatient covered by medical insurance. Chinese J Soc Med 2011, 28(2):131-132.
• [30]Mills A, Brugha R, Hanson K, McPake B: What can be done about the private health sector in low-income countries? Bull World Health Organ 2002, 80(4):325-330.
• [31]Shen T, Cheng H, Chen Z, Shi R: The survey of the utilization of the community health service and the analysis of the factors of the residents in Shanghai. J Shanghai Jiaotong University (Medical Science) 2010, 1(30):944-963.
• [32]PR China Ministry of Health: The management measures of community health facilities. http://www.gov.cn/zwgk/2006-08/10/content_359147.htm webcite
• [33]Liu Y, Li T, Xia J, Wang F, Lu Z: The Responsibility of Government in Finance of Community Health Service. Chinese J Soc Med 2008, 24(4):224-226.
• [34]Liu Y, Li T, Zou J, Huang X, Lu Z: Increasing the fund investment to promote the sustainable development of community health service. Chinese Health Economics 2007, 26(9):34-34.
• [35]Okkes I, Polderman G, Fryer G, Yamada T, Bujak M, Oskam S: The role of family practice in different health care systems. J Fam Pract 2002, 51:72-73.
• [36]Villani J, Mortensen K: Patient-provider communication and timely receipt of preventive services. Prev Med 2013, 57(5):658-663.
• [37]Gowin E, Avonts D, Horst-Sikorska W, Ignaszak-Szczepaniak M, Michalak M: Gender makes the difference: the influence of patients’ gender on the delivery of preventive services in primary care in Poland. Qual Prim Care 2009, 17(5):343-350.
• [38]Macinko J, Starfield B, Shi L: The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970–1998. Health Serv Res 2003, 38(3):831-865.
• [39]Qin J, Qin Z: The reward mechanism of the income of the British general practitioners. Foreign Med 1999, 16(2):72-75.
• [40]Bernabei R, Landi F, Gambassi G, Sgadari A, Zuccala G, Mor V, Rubenstein LZ, Carbonin P: Randomized trial of impact of model of integrated care and case management for older people living in the community. BMJ 1998, 316(7141):1348.
• [41]Miller KW, Wilder LB, Stillman FA, Becker DM: The feasibility of a street-intercept survey method in an African-American community. Am J Pub Health 1997, 87(4):655-658.