SynthesisPloS one2018
Factors influencing choice of health system access level in China: A systematic review.
Synthesis in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 68 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
68 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Effects of vertical integration on the healthcare system in China: a systematic review and meta-analysis.Health policy and planning · 2024Pooled it
- Factors Influencing the Implementation of Foreign Innovations in Organization and Management of Health Service Delivery in China: A Systematic Review.Frontiers in health services · 2021Pooled it
- Urban residents' choice preferences for hospitals at different tiers and influencing factors: a study based on latent class analysis and Andersen's model of health service utilization.BMC primary care · 2026Article
- Expanding Access to Oral Contraceptive Pills: Do Consumers Prefer Over-the-Counter Availability?The patient · 2026Article
- Patient preferences for community pharmacy service models in diabetes care: a discrete choice experiment.International journal of clinical pharmacy · 2026Article
- Preference for inpatient services among the unemployed with multi-chronic conditions: a discrete choice experiment.BMC health services research · 2026Article
- Social network analysis of stakeholders in China's hierarchical medical system: toward a collaborative governance framework for enhanced integration.Frontiers in public health · 2026Article
- Socioeconomic disparities in the trends of inpatient utilization for middle-aged and older adults in China: the perspective of international comparison from four cohorts.Global health research and policy · 2025Article
- Patient Navigation Behavior in a Symptom-Based Self-Triage Mobile App for Direct-to-Consumer Urgent Care: Retrospective Observational Study.Journal of medical Internet research · 2025Observational
- Impact of initial physician contact on later-life health service utilization: a life course perspective.BMC health services research · 2025Article
- Research on the impact of family doctor contract services on the willingness of residents' first choice of medical institutions for treatment-empirical analysis based on PSM.BMC health services research · 2025Article
- Policy texts and actions: quantitative evaluation of the hierarchical medical system policy in China based on the PMC-Index model.BMC public health · 2025Article
- The impact of team functioning on the quality of care in rural hospitals: a cross-sectional survey study on similarity and multidisciplinarity.BMC health services research · 2025Article
- The impact of the hierarchical medical system on medical resource allocation in China.Scientific reports · 2025Article
- Enhancing healthcare utilization and reducing preventable hospitalizations: exploring the healthcare-seeking propensity of patients with non-communicable diseases in Rural China.BMC public health · 2025Article
- Self-referral practice among patients attending outpatient department of Northwest Comprehensive Specialized Hospital, Ethiopia: a multi-center cross-sectional study.Frontiers in public health · 2025Article
- Evaluating the equity of access to community health service centers in different regions of China based on cyclability and walkability.Frontiers in public health · 2025Article
- The effect of overuse by primary healthcare institutions on medical expenses: an empirical study from the western regions of China.Frontiers in public health · 2025Article
- Behavioral Determinants of Hospital Selection in Urological Care: Evidence From China's Hierarchical Healthcare System.Risk management and healthcare policy · 2025Article
- The impact of a deep vertical medical alliance on enhancing clinical capacity and reversing patient outflow at a Chinese county hospital: a 4-year case study.Frontiers in health services · 2025Article
8 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveIn China, patients increasingly choose to access already severely overcrowded higher level hospitals, leaving lower level facilities with low utilization rates. This situation undermines the effectiveness and efficiency of the health system. The situation tends to worsen despite policy measures aimed at improvement. We systematically review the factors affecting patient choice to synthesize scientific understanding of health system access in China. The review provides an evidence base for measures to direct patient flow towards lower level facilities.
methodsWe screened the peer-reviewed literature published from April 2009 to January 2016 that investigates Chinese patients' choice of health care facilities at different levels and assessed 45 studies in total. We applied two structured forms to extract data on each study's characteristics, methodology, and factors. RESULTS OF DATA SYNTHESIS: The results identified four factor types: 1) patient, 2) provider, 3) context and 4) composite: combined patient, provider, and/or context attributes. Patient factors are mentioned the most, but the evidence on patient factors is often inconclusive. Evidence suggests that the provider factors 'drug variety' and 'equipment', and composite factor 'perceived quality', push patients from lower levels towards higher levels.
conclusionUnderuse of primary care facilities and overcrowding of higher level facilities will likely be amplified by current demographic trends. Evidence suggests that improving drug availability, equipment and perceived quality of primary care services can improve the situation. Well-designed research that considers the interactions between factors is called for to better inform future interventions.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.