Impact of patient-perceived quality of primary health care on the patients' bypass behaviour in China
Abstract Background: Bypass behaviour is a phenomenon that an individual visits an higher-level and farther health institution instead of one with an acceptable quality of care that is closer. Patient bypass often occurs under the loose rules of first diagnosis. Additionally, patients’ perceived quality of primary health care is one of the important factors affecting their bypass behaviours. Objective: to explore individuals’ bypass behaviour in China and the impact of patients’ perceived quality of primary health care on their bypass behaviour. Method: in 2019, a national wide sampling survey was conducted to collect data of Chinese residents’ bypass behaviours and its potential influencing factors. The questionnaire that was used assessed the following: the perceived quality of primary care using the Primary Care Assessment Tool; bypass experience; age; health insurance; and other factors. A logit regression model was used to analyse the impact of perceived quality of PHC on bypass behaviour. Results: the data of 2070 residents sampled in 706 secondary/tertiary hospitals in China were collected. The results show that perceived quality of PHC is significantly associated with bypass behaviour in China. Per increase of one the PCAT mean score had an odds ratio of 0.98 (p<0.05) for bypass behaviour. Gender, household registration and cold fee for PHC were negatively associated with bypass behaviour. Conclusion: patients' perceived quality of primary health care plays an active role in reducing their bypass behaviours, which may provide a new perspective for the design of primary health care policies.