1. Synergy of policies to strengthen primary care: evidence from a national repeated cross-sectional study
- Author
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Jin Xu, Yaoguang Zhang, Qingyue Meng, Weiming Zhu, Ling Xu, and Yinzi Jin
- Subjects
Male ,China ,medicine.medical_specialty ,Health workforce availability ,Health informatics ,Health administration ,Health insurance coverage ,03 medical and health sciences ,0302 clinical medicine ,Synergic policies ,Environmental health ,Health care ,medicine ,Humans ,Health Workforce ,030212 general & internal medicine ,Reimbursement ,Insurance, Health ,Primary Health Care ,Inpatient care ,business.industry ,lcsh:Public aspects of medicine ,030503 health policy & services ,Health Policy ,Nursing research ,Public health ,lcsh:RA1-1270 ,Patient Acceptance of Health Care ,Cross-Sectional Studies ,Primary care strengthening ,Workforce ,Female ,0305 other medical science ,business ,Research Article - 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.
- Published
- 2020