Community health centers and primary care access and quality for chronically-ill patients – a case-comparison study of urban Guangdong Province, China

International Journal for Equity in Health

Research

Hong Wang¹  De-Chih Lee²  Leiyu Shi³  Hailun Liang⁴  Nathan Blanchet⁵  Marty Makinen⁵  Ruth Kidane⁵  Shaolong Wu⁶  Luwen Zhang⁶  Magnus Lindelow⁷ 

[1] Bill & Melinda Gates Foundation, 500 Fifth Avenue North, 98109, Seattle, WA, USA;Department of Information Management, Da-Yeh University, 51591, Changhua, Taiwan (ROC);Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA;Johns Hopkins Primary Care Policy Center, Baltimore, 624 N. Broadway, 21205, Baltimore, MD, USA;Results for Development Institute, 1100 15th Street, NW, 20005, Washington, DC, USA;School of Public Health of Sun Yat-sen University, 74, Zhongshan Road II, 510275, Guangzhou, China;The World Bank, 1225 Connecticut Avenue NW, 20433, Washington, DC, USA;

关键词: Primary care;    Chronic disease;    Community health centers;    Integrated care;    Quality of care;   

DOI  :  10.1186/s12939-015-0222-7

 received in 2015-07-21, accepted in 2015-09-24,  发布年份 2015

来源: Springer

【 摘 要 】

ObjectiveReform of the health care system in urban areas of China has prompted concerns about the utilization of Community Health Centers (CHC). This study examined which of the dominant primary care delivery models, i.e., the public CHC model, the ‘gate-keeper’ CHC model, or the hospital-owned CHC models, was most effective in enhancing access to and quality of care for patients with chronic illness.MethodsThe case-comparison design was used to study nine health care organizations in Guangzhou, Dongguan, and Shenzhen cities within Guangdong province, China. 560 patients aged 50 or over with hypertension or diabetes who visited either CHCs or hospitals in these three cities were surveyed by using face-to-face interviews. Bivariate analyses were performed to compare quality and value of care indicators among subjects from the three cities. Multivariate analyses were used to assess the association between type of primary care delivery and quality as well as value of chronic care after controlling for patients’ demographic and health status characteristics.ResultsPatients from all three cities chose their current health care providers primarily out of concern for quality of care (both provider expertise and adequate medical equipment), patient-centered care, and insurance plan requirement. Compared with patients from Guangzhou, those from Dongguan performed significantly better on most quality and value of care indicators. Most of these indicators remained significantly better even after controlling for patients' demographic and health status characteristics. The Shenzhen model (hospital-owned and -managed CHC) was generally effective in enhancing accessibility and continuity. However, coordination suffered due to seemingly duplicating primary care outpatients at the hospital setting. Significant associations between types of health care facilities and quality of care were also observed such that patients from CHCs were more likely to be satisfied with traveling time and follow-up care by their providers.ConclusionThe study suggested that the Dongguan model (based on insurance mandate and using family practice physicians as ‘gate-keepers’) seemed to work best in terms of improving access and quality for patients with chronic conditions. The study suggested adequately funded and well-organized primary care system can play a gatekeeping role and has the potential to provide a reasonable level of care to patients.

【 授权许可】

CC BY   
© Shi et al. 2016