Comparison of health care utilization among users of public and private community health centres in urban China

2020 ◽  
Vol 37 (6) ◽  
pp. 738-743
Author(s):  
Menghan Shen ◽  
Wen He ◽  
Linyan Li ◽  
Yushan Wu
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Community Health ◽  
Incidence Rate ◽  
Lower Incidence ◽  
Care Utilization ◽  
Community Health Centres ◽  
Outpatient Visits ◽  
Health Centres ◽  
Lower Incidence Rate

Abstract Background In China, the government has encouraged the participation of private sector facilities in primary care to improve health care quality. Objective We compare health care utilization patterns among patients who select private versus public community health centres (CHCs) for reimbursed outpatient services. Methods This paper uses data from the Urban Employee Basic Medical Insurance scheme from 2013 to 2016 in one of the largest cities in China. We used a Poisson model and a logistic model to examine outcomes on monthly outpatient visits and the probability of hospitalization, respectively. Results Compared with being a user of a public CHC, being a user of a private CHC is associated with a 26.2% lower incidence rate of outpatient visits to hospitals [95% confidence interval (CI): 30.1–21.8%] and no difference in rates of visits to CHCs or hospitalization. Among patients with diabetes or hypertension, being a user of a private CHC is associated with a 12.9% lower incidence rate of outpatient visits to CHCs (95% CI: 19.8–5.4%), a 25.6% lower incidence rate of outpatient visits to hospitals (95% CI: 21.4–19.5%) and 22.3% higher odds of hospitalization (95% CI: 3.5–44.7%). Conclusion Being a user of a private CHC is associated with a reduction in outpatient visits to hospitals, which aligns with the goal of reducing hospital congestion at the outpatient level. For patients with chronic diseases, being a user of a private CHC is associated with a higher probability of hospitalization. More research is needed to understand the reason for this difference.

scholarly journals Burden of Behavioral Health Comorbidities on Outpatient Health Care Utilization by Active Duty Service Members With a First Documented mTBI

2021 ◽  
Vol 186 (Supplement_1) ◽  
pp. 567-571
Author(s):  
Lalon M Kasuske ◽  
Peter Hoover ◽  
Tim Wu ◽  
Louis M French ◽  
Jesus J Caban
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Behavioral Health ◽  
Active Duty ◽  
Service Members ◽  
Care Utilization ◽  
Men And Women ◽  
Outpatient Visits ◽  
Outpatient Utilization ◽  
Health Comorbidities

ABSTRACT Objective More than 280,000 Active Duty Service Members (ADSMs) sustained a mild traumatic brain injury (mTBI) between 2000 and 2019 (Q3). Previous studies of veterans have shown higher utilization of outpatient health clinics by veterans diagnosed with mTBI. Additionally, veterans with mTBI and comorbid behavioral health (BH) conditions such as post-traumatic stress disorder, depression, and substance use disorders have significantly higher health care utilization than veterans diagnosed with mTBI alone. However, few studies of the relationship between mTBI, health care utilization, and BH conditions in the active duty military population currently exist. We examined the proportion of ADSMs with a BH diagnosis before and after a first documented mTBI and quantified outpatient utilization of the Military Health System in the year before and following injury. Materials and Methods Retrospective analysis of 4,901,840 outpatient encounters for 39,559 ADSMs with a first documented diagnosis of mTBI recorded in the Department of Defense electronic health record, subsets of who had a BH diagnosis. We examined median outpatient utilization 1 year before and 1 year after mTBI using Wilcoxon signed rank test, and the results are reported with an effect size r. Outpatient utilization is compared by BH subgroups. Results Approximately 60% of ADSMs experience a first mTBI with no associated BH condition, but 17% of men and women are newly diagnosed with a BH condition in the year following mTBI. ADSMs with a history of a BH condition before mTBI increased their median outpatient utilization from 23 to 35 visits for men and from 32 to 42 visits for women. In previously healthy ADSMs with a new BH condition following mTBI, men more than tripled median utilization from 7 to 24 outpatient visits, and women doubled utilization from 15 to 32 outpatient visits. Conclusions Behavioral health comorbidities affect approximately one-third of ADSMs following a first mTBI, and approximately 17% of previously healthy active duty men and women will be diagnosed with a new BH condition in the year following a first mTBI. Post-mTBI outpatient health care utilization is highly dependent on the presence or absence of BH condition and is markedly higher is ADSMs with a BH diagnosis in the year after a first documented mTBI.

Community Health and General Practice: The Impact of Different Cultures on the Integration of Primary Care

2001 ◽  
Vol 7 (1) ◽  
pp. 65 ◽  
Author(s):  
Hal Swerissen ◽  
Jenny Macmillan ◽  
Catuscia Biuso ◽  
Linda Tilgner
Keyword(s):  
Primary Care ◽  
Health Care ◽  
General Practice ◽  
Primary Health Care ◽  
Community Health ◽  
Community Health Centres ◽  
Care Services ◽  
Primary Health ◽  
Health Centres ◽  
The Relationship

This study examined the existing relationship between community health centres and General Practice Divisions in the State of Victoria, including the nature of joint working arrangements and the identification of barriers to greater collaboration. Improved integration of primary health care services has been advocated to improve consumer and population health outcomes and to reduce inappropriate use of acute and extended care services. General practitioners (GPs) and community health centres are two key providers of primary health care with potential for greater integration. The current study conducted telephone interviews with 20 community health centre CEOs and 18 Executive Officers of divisions, which were matched according to catchment boundaries. Results suggest, while some joint planning is occurring, especially on committees, working parties and projects, there is an overall low level of satisfaction with the relationship between community health centres and GPs and GP divisions. Major barriers to greater integration are the financial or business interests of GPs and misunderstanding and differences in perceived roles and ideology between GPs and community health centres. Improved communication, greater contact and referral and follow-up procedures are identified as a means of improving the relationship between GPs, GP divisions and community health centres. Community health centres and general practitioners (GPs) are key providers of primary care (Australian Community Health Association, 1990).

scholarly journals Effects of health insurance integration on health care utilization and its equity among the mid-aged and elderly: evidence from China

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Chaofan Li ◽  
Chengxiang Tang ◽  
Haipeng Wang
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Utilization ◽  
Concentration Index ◽  
Care Utilization ◽  
Control Group ◽  
Positive Effects ◽  
Basic Medical Insurance ◽  
Outpatient Visits ◽  
Basic Medical

Abstract Background The fragmentation of health insurance schemes in China has undermined equity in access to health care. To achieve universal health coverage by 2020, the Chinese government has decided to consolidate three basic medical insurance schemes. This study aims to evaluate the effects of integrating Urban and Rural Residents Basic Medical Insurance schemes on health care utilization and its equity in China. Methods The data for the years before (2013) and after (2015) the integration were obtained from the China Health and Retirement Longitudinal Study. Respondents in pilot provinces were considered as the treatment group, and those in other provinces were the control group. Difference-in-difference method was used to examine integration effects on probability and frequency of health care visits. Subgroup analysis across regions of residence (urban/rural) and income groups and concentration index were used to examine effects on equity in utilization. Results The integration had no significant effects on probability of outpatient visits (β = 0.01, P > 0.05), inpatient visits (β = 0.01, P > 0.05), and unmet hospitalization needs (β =0.01, P > 0.05), while it had significant and positive effects on number of outpatient visits (β = 0.62, P < 0.05) and inpatient visits (β = 0.39, P < 0.01). Moreover, the integration had significant and positive effects on number of outpatient visits (β = 0.77, P < 0.05) and inpatient visits (β = 0.49, P < 0.01) for rural residents but no significant effects for urban residents. Furthermore, the integration led to an increase in the frequency of inpatient care utilization for the poor (β = 0.78, P < 0.05) among the piloted provinces but had no significant effects for the rich (β = 0.25, P > 0.05). The concentration index for frequency of inpatient visits turned into negative direction in integration group, while that in control group increased by 0.011. Conclusions The findings suggest that the integration of fragmented health insurance schemes could promote access to and improve equity in health care utilization. Successful experiences of consolidating health insurance schemes in pilot provinces can provide valuable lessons for other provinces in China and other countries with similar fragmented schemes.

Community health services and health care utilization in rural Bangladesh

1989 ◽  
Vol 29 (12) ◽  
pp. 1343-1349 ◽  
Author(s):  
Ruhul Amin ◽  
Shifiq A. Chowdhury ◽  
G.M. Kamal ◽  
J. Chowdhury
Keyword(s):  
Health Care ◽  
Health Services ◽  
Health Care Utilization ◽  
Community Health ◽  
Community Health Services ◽  
Care Utilization ◽  
Rural Bangladesh

scholarly journals Professional support during the postpartum period: Primiparous mothers' views on professional services, their expectations, and barriers to mobilizing professional help

2020 ◽  
Author(s):  
Yiping Nan ◽  
Jingjun Zhang ◽  
Anum Nisar ◽  
Lanting Huo ◽  
Lei Yang ◽  
...  
Keyword(s):  
Health Care ◽  
Community Health ◽  
Health Care Services ◽  
Phenomenological Study ◽  
Professional Services ◽  
Professional Support ◽  
Professional Help ◽  
Community Health Centres ◽  
Care Services ◽  
Health Centres

Abstract Background: Primiparous mothers who lack experience and knowledge of child caring, are usually overwhelmed with multifarious stressors and challenges. Although support from professionals is needed for new mothers, there is indeed a gap between the necessary high-quality service and the currently provided poor services. This study aimed to explore Chinese primiparous mothers' views on professional services, identify barriers to mobilizing professional support, and further understand mothers' expectations of and preferences for the delivery of professional services. Method: A descriptive phenomenological study design was utilized in this study, and semi-structured interviews were conducted with 28 primiparous mothers selected from two community health centres in Xi' an city, Shannxi province, northwest part of China and who had given birth within one year before the interview. Each conversation lasted between 20-86 minutes. Colaizzi' s seven-step phenomenological approach was used for data analysis. Results: Three major themes were identified: (a) dissatisfying with current professional services for postpartum mothers, (b) likelihood of health care professional help- seeking behaviour, (c) highlighting demands for new health care services. Seven related subthemes including disappointment with hospital services, distrusting services provided by community health centres, private institutes and online platforms; seeking help from professional was not the first choice, hesitating to express their inner discourse to professionals, and considering practical factors prohibited mothers from seeking professional help; urgent needs for new baby-care-related services, and importance of mothers' self-needs. The necessity of professional support in the first month of confinement was highly emphasized by participants. Online professional guidance and support were perceived to be the best way to receive services in this study. Conclusion: The results of this descriptive phenomenological study suggested that the current maternal and child health care services were insufficient and could not meet the needs of primiparous mothers. The identified barriers should be analysed and highlighted by enhancing education and eliminating stigma. The results also indicated that providing service focused on mothers' needs may be an effective strategy to enhance primiparous mothers' well-being, and also suggested that feasibility, convenience, and the cultural adaptability of health care service should be considered during the delivery of postpartum interventions.

scholarly journals HEALTH LITERACY AND HEALTH CARE UTILIZATION PATTERNS IN MIDDLE AGE ADULTS IN PAKISTAN

1969 ◽  
Vol 6 (2) ◽  
pp. 821-826
Author(s):  
UMAR ALEEM ◽  
NOOR KHAN ◽  
ZAKRIA ZAKAR ◽  
ROBEENA ZAKAR ◽  
SHAMAILA
Keyword(s):  
Health Care ◽  
Health Literacy ◽  
Health Care Utilization ◽  
Community Health ◽  
Health Center ◽  
Middle Age ◽  
Community Health Center ◽  
Functional Health ◽  
Care Utilization ◽  
Inadequate Health Literacy

OBJECTIVES: No practical and theoretical pattern for identifying health literacy and its utilizationpatterns exist. Health literacy is referring to the ability to read and perform numerical tasks'. Thisstudy’s objective was to recognize useful clinically questions that might be effective for theidentification of marginal and inadequate health literacy in adults.MATERIAL AND METHODS: In person interviews from a sample of n=332 middle age adults (28-40years) completed. A 5 point likert scale questionnaire include 16 literacy screening questionsadministered, followed by a validated health measure, the Short Test of Functional Health Literacy inAdults (STOHFLA). Grounded on the STOHFLA men were categorized as having inadequate,marginal, and adequate health literacy. Health care utilization pattern were identified in a separatequestionnaire through 10 close ended questions.RESULTS: Inadequate health literacy accounts for 42%, marginal health literacy 14% and adequatehealth literacy for 44% of the participants. 23% of the participants do not go to visit the hospital anddoctor in minor health related issues. 29% of the participants use over the counter drugs, and only 48%of the participants visit health facilities (Community Health Center, BHU, RHCs, THQ, DHQ) for theirhealth related issues.CONCLUSION:Health literacy and health care utilization are not so common in middle age adults inPakistan. The need of health literacy must be addressed in middle age adults, and it is possible when thehealth care facilities are fully utilized.KEYWORDS:Heallh Literacy, Healthcare Utilization, Community Health Center, Basic health Unit,Rural Health Center

scholarly journals Burden of Active Tuberculosis in an Integrated Health Care System, 1997–2016: Incidence, Mortality, and Excess Health Care Utilization

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Paul Y Wada ◽  
Christian Lee-Rodriguez ◽  
Yun-Yi Hung ◽  
Jacek Skarbinski
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Active Tuberculosis ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
First Year ◽  
Potential Value ◽  
Outpatient Visits ◽  
Integrated Health Care System ◽  
Over Time

Abstract Active tuberculosis (TB) is preventable. To quantify the potential value of prevention, we assessed active TB burden in a large health system from 1997 to 2016. Compared with a matched non-TB cohort, patients with active TB had higher mortality (8.4% vs 1.3%), mean number of hospitalizations (0.55 vs 0.10), emergency department visits (0.78 vs 0.28), and outpatient visits (14.6 vs 5.9) in the first year. TB-associated hospital use (mean number of hospitalizations and total length of stay) increased from 1997–2000 compared with 2013–2016 despite decreasing active TB incidence. Active TB is associated with high mortality and health care utilization and has remained stable or increased over time.

scholarly journals Cost of Delivering Health Care Services in Public Sector Primary and Community Health Centres in North India

PLoS ONE ◽  
2016 ◽  
Vol 11 (8) ◽  
pp. e0160986 ◽  
Author(s):  
Shankar Prinja ◽  
Aditi Gupta ◽  
Ramesh Verma ◽  
Pankaj Bahuguna ◽  
Dinesh Kumar ◽  
...  
Keyword(s):  
Health Care ◽  
Public Sector ◽  
Community Health ◽  
Health Care Services ◽  
North India ◽  
Community Health Centres ◽  
Care Services ◽  
Health Centres
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