Until 2009, the health system in China could be characterised as hospital-centred and lacked a solid basis of primary care as a gateway to an integrated health system. Since 2009, a new reform agenda has been implemented, in which the development of a strong primary care system is the key strategy. Great efforts have been made by the government to improve the infrastructures and workforce in primary care facilities. In her thesis, titled “Understanding Patient Choice of Health Care Facilities in China”, PhD student Yun Liu from Erasmus School of Health Policy & Management researched how patients choose healthcare facilities for their first visit.
Limitations of social health insurance
Over 96% of the population in China are covered by social health insurance. however, this insurance has limited coverage for primary care and for out-patient care. Patients have the freedom to choose any level of health care facilities, as policy does not restrict access in level or place. Congestion in higher level hospitals is therefore widespread. The desired effect of the reforms to shift patient flow to primary care is yet to be seen.
Primary care should work as the central function and the core of building an integrated health system. Directly accessing hospital care and bypassing primary care may lead to excessive costs, reduce equity, and hamper the development of an integrated care system. These undesirable consequences call for an understanding of the limited effectiveness of the reforms. A comprehensive scientific exploration and analysis to understand the health seeking behaviour have thus far not been conducted.
Patients’ trade-offs in choosing facilities
Our study provides a comprehensive picture of how patients choose healthcare facilities for their first visit. It focuses on patients’ trade-offs in the decision-making process and how the trade-offs affect patient flow between different facility levels. The results showed that tailored policies are called for as the preferences between rural and urban patients differ due to the setting and their characteristics. It highlighted the importance of better primary care to attract latent healthcare demand, as it is important for the wellbeing of the population and for the health system’s effectiveness that health problems can be identified and treated as early as possible.
In this research, we decomposed the preferences into facility attributes and investigated the preferences to the attribute levels. Therefore, our findings can be used to model and evaluate simulated effects of health policy interventions targeting to improve patient flow by changing relevant attributes of health care facilities. Our study also used tailored research methods and contributed methodological advancements to health services research.
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Want to know more about this research project? Read Yun Liu's thesis here.