ArticleBMC health services research2020
Synergy of policies to strengthen primary care: evidence from a national repeated cross-sectional study.
Article in BMC health services research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- Differences in healthcare institution choice among elderly cancer patients: evidence from a cross-sectional study in Shandong Province, China.BMC cancer · 2026Article
- Regional disparities in access to coordinated health care in Poland: development and application of an accessibility index.BMC health services research · 2026Article
- Strategies for enhancing PHC accessibility through mobile and capsule clinics: a spatial location allocation study in China.BMC health services research · 2025Article
- Association between health insurance cost-sharing and choice of hospital tier for cardiovascular diseases in China: a prospective cohort study.The Lancet regional health. Western Pacific · 2024Article
- Article
- Elderly people's preferences for healthcare facilities in Shanghai: gender features and influencing factor analysis.BMC public health · 2023Article
- How effective is the health promotion policy in Sichuan, China: based on the PMC-Index model and field evaluation.BMC public health · 2022Article
- How to Make Primary Healthcare More Popular: Evidence from the Middle-Aged and Elderly in China.Healthcare (Basel, Switzerland) · 2022Article
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Authors and funding
6 authors.
Funding
Abstract
backgroundPeople 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.
methodsDrawing 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.
resultsAlthough 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.
conclusionsPrimary 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.
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