scholarly journals Synergy of policies to strengthen primary care: evidence from a national repeated cross-sectional study

2020 ◽  
Author(s):  
Yinzi Jin ◽  
Jin Xu ◽  
Weiming Zhu ◽  
Yaoguang Zhang ◽  
Ling Xu ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Insurance ◽  
Health Workforce ◽  
Healthcare Seeking ◽  
Percentage Points ◽  
Level Data ◽  
Seeking Behavior ◽  
Healthcare Seeking Behavior ◽  
Negative Impacts ◽  
The Impact

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.

scholarly journals Synergy of policies to strengthen primary care: evidence from a national repeated cross-sectional study

2020 ◽  
Author(s):  
Yinzi Jin ◽  
Jin Xu ◽  
Weiming Zhu ◽  
Yaoguang Zhang ◽  
Ling Xu ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Insurance ◽  
Health Workforce ◽  
Healthcare Seeking ◽  
Percentage Points ◽  
Level Data ◽  
Seeking Behavior ◽  
Healthcare Seeking Behavior ◽  
Negative Impacts ◽  
The Impact

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.

scholarly journals Synergy of policies to strengthen primary care: evidence from a national repeated cross-sectional study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yinzi Jin ◽  
Jin Xu ◽  
Weiming Zhu ◽  
Yaoguang Zhang ◽  
Ling Xu ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Insurance ◽  
Health Workforce ◽  
Healthcare Seeking ◽  
Percentage Points ◽  
Level Data ◽  
Seeking Behavior ◽  
Healthcare Seeking Behavior ◽  
Negative Impacts ◽  
The Impact

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.

scholarly journals Synergy of policies to strengthen primary care: evidence from a national repeated cross-sectional study

2020 ◽  
Author(s):  
Yinzi Jin ◽  
Jin Xu ◽  
Weiming Zhu ◽  
Yaoguang Zhang ◽  
Ling Xu ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Insurance ◽  
Health Workforce ◽  
Negative Binomial ◽  
Healthcare Seeking ◽  
Use Of Resources ◽  
Percentage Points ◽  
Level Data ◽  
Negative Impacts ◽  
The Impact

Abstract Objective 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.Conclusion 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.

scholarly journals How Can One Strengthen a Tiered Healthcare System through Health System Reform? Lessons Learnt from Beijing, China

2020 ◽  
Vol 17 (21) ◽  
pp. 8040
Author(s):  
Shuduo Zhou ◽  
Jin Xu ◽  
Xiaochen Ma ◽  
Beibei Yuan ◽  
Xiaoyun Liu ◽  
...  
Keyword(s):  
Primary Care ◽  
Ambulatory Care ◽  
Healthcare System ◽  
Primary Healthcare ◽  
Healthcare Facilities ◽  
Healthcare Seeking ◽  
Seeking Behavior ◽  
Tertiary Hospitals ◽  
Healthcare Seeking Behavior ◽  
The Impact

How one can reshape the current healthcare sector into a tiered healthcare system with clarified division of functions between primary care facilities and hospitals, and improve the utilization of primary care, is a worldwide problem, especially for the low and middle-income countries (LMICs). This paper aimed to evaluate the impact of the Beijing Reform on healthcare-seeking behavior and tried to explain the mechanism of the change of patient flow. In this before and after study, we evaluated the changes of outpatient visits and inpatient visits among different levels of health facilities. Using the monitored and statistical data of 373 healthcare institutions 1-year before and 1-year after the Beijing Reform, interrupted time series analysis was applied to evaluate the impact of the reform on healthcare-seeking behavior. Semi-structured interviews were used to further explore the mechanisms of the changes. One year after the reform, the flow of outpatients changed from tertiary hospitals to community health centers with an 11.90% decrease of outpatients in tertiary hospitals compared to a 15.01% increase in primary healthcare facilities. The number of ambulatory care visits in primary healthcare (PHC) showed a significant upward trend (P < 0.10), and the reform had a significant impact on the average number of ambulatory care visits per institution in Beijing’s tertiary hospitals (p < 0.10). We concluded that the Beijing Reform has attracted a substantial number of ambulatory care visits from hospitals to primary healthcare facilities in the short-term. Comprehensive reform policies were necessary to align incentives among relative stakeholders, which was a critical lesson for other provinces in China and other LMICs.

scholarly journals Effect of Health Education on Healthcare-Seeking Behavior of Migrant Workers in China

2020 ◽  
Vol 17 (7) ◽  
pp. 2344 ◽  
Author(s):  
Xuefeng Li ◽  
Han Yang ◽  
Hui Wang ◽  
Xujun Liu
Keyword(s):  
Health Education ◽  
Online Education ◽  
Migrant Workers ◽  
Public Consultation ◽  
Healthcare Seeking ◽  
Bulletin Boards ◽  
Seeking Behavior ◽  
Effective Role ◽  
Healthcare Seeking Behavior ◽  
The Impact

Health education is considered to be an effective way to improve the healthcare-seeking behavior of migrant workers. This study examined the impact of health education on healthcare-seeking behavior of migrant workers in China and explored the differences in different health education methods. This paper used the 2017 China Migrants Dynamic Survey (CMDS) to analyze the relationship between health education and healthcare-seeking behavior. Our results indicated that health education could significantly improve the healthcare-seeking behavior of migrant workers, but there was still ample space for improvement. From the perspective of different health education methods, lectures, public consultation, and online education were positively correlated to healthcare-seeking behavior, while publicity materials and bulletin boards were not. Although the effects of publicity materials and bulletins were limited, these two health education methods were still the most widely used. Our results emphasized the necessity of increasing investment in lectures, public consultation, online education, and other similar health education methods. This change in health education methods can play an effective role in the spread of health education to improve the healthcare-seeking behavior of migrant workers.

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