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Hu L, Cai S. Spatial Allocation Rationality Analysis of Medical Resources Based on Multi-Source Data: Case Study of Taiyuan, China. Healthcare (Basel) 2024; 12:1669. [PMID: 39201227 PMCID: PMC11353343 DOI: 10.3390/healthcare12161669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 08/05/2024] [Accepted: 08/09/2024] [Indexed: 09/02/2024] Open
Abstract
Reasonably allocating medical resources can effsectively optimize the utilization efficiency of such resources. This paper took Taiyuan City as an example and established a model to evaluate the rationality of medical resource spatial allocation, incorporating two key dimensions: the spatial layout and the supply and demand of medical resources. In terms of the spatial layout, three indexes were included: Firstly, the service coverage rates of different levels of medical institutions, based on residents' medical orientations, were calculated using network analysis methods. Secondly, the Huff-2SFCA method was improved to calculate the accessibility of medical resources for four different modes of transportation. Then, the Health Resource Agglomeration Degree (HRAD) and Population Agglomeration Degree (PAD) were used to quantify the equity of medical resources. In terms of the supply and demand of medical resources, one index was included: the supply-demand ratio of medical resources during sudden public health events, which was calculated using the number of beds per thousand people as an indicator. These four indexes were weighted using the entropy weight method to obtain the rationality grade of medical resource spatial allocation in Taiyuan City. The study found that the rationality evaluation level of medical resource allocation in the central urban area of Taiyuan City followed a "concentrically decreasing" pattern. The rating ranged from "very reasonable" to "less reasonable", with the area of each level expanding gradually. The areas rated within the top two categories only accounted for 19.92% of the study area, while the area rated as "less reasonable" occupied 38.73% of the total area. These results indicate that the model accounted for residents' travel for various medical orientations and the availability of resources during public health emergencies. It considered both the spatial layout and supply and demand of medical resources, offering recommendations for the precise allocation of urban medical resources.
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Affiliation(s)
- Lujin Hu
- School of Geomatics and Urban Spatial Informatics, Beijing University of Civil Engineering and Architecture, Beijing 102616, China;
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Peng Y, Zhai S, Zhang Z, Zhang R, Zhang J, Jin Q, Zhou J, Chen J. People-centered primary care measures in health equity: a perspective of urban-rural comparison in Beijing, China. Int J Qual Health Care 2024; 36:mzae067. [PMID: 39005076 DOI: 10.1093/intqhc/mzae067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 06/20/2024] [Accepted: 07/13/2024] [Indexed: 07/16/2024] Open
Abstract
Person-centered primary care measures (PCPCM) facilitate high-quality and culturally appropriate primary care. Access to PCPCM remains unequal between rural and urban areas, and the available evidence on rural PCPCM is still lacking. A cross-sectional survey was conducted with stratified sampling by regions, and four districts (Xicheng, Fengtai, Huairou, and Daxing) in Beijing were selected to test the performance of PCPCM in both urban and rural areas. Descriptive statistical methods were used to compare the urban-rural differences in the demographic characteristics of PCPCM. Correlation and regression analyses were performed to determine the associations between PCPCM in demographics and utilization of primary care. The PCPCM showed good reliability and validity in both urban and rural areas (P < .001), slightly lower in rural areas, but scores of rural PCPCM (R-PCPCM) in all items were lower than urban PCPCM (U-PCPCM). Patients in either the preferred urban or rural health centers all showed the highest PCPCM scores, with U-PCPCM= 3.31 for CHCs and R-PCPCM= 3.10 for RHCs, respectively. Patients in urban areas were more likely to receive higher-quality primary care than in rural areas (P < .001). Patients who preferred hospitals (β = 2.61, P < .001) or CHCs (β = 0.71, P = .003) as providers was a significant positive predictor of U-PCPCM but it was the preference for hospitals (β = 2.95, P < .001) for R-PCPCM. Urban-rural differences existed in the performance of PCPCM, with rural areas typically more difficult to access better PCPCM. To promote health equity in rural areas, healthcare providers should strive to minimize urban-rural differences in the quality and utilization of primary care services as much as feasible.
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Affiliation(s)
- Yingchun Peng
- School of Medical Humanities, Capital Medical University, No. 10, Xitoutiao, You An Men Wai, Fengtai District, Beijing 100069, China
| | - Shaoqi Zhai
- School of Medical Humanities, Capital Medical University, No. 10, Xitoutiao, You An Men Wai, Fengtai District, Beijing 100069, China
| | - Zhiying Zhang
- Outpatient Office, Beijing Luhe Hospital, Capital Medical University, No. 82, Xinhua South Street, Tongzhou District, Beijing 101100, China
| | - Ruyi Zhang
- Ethics Committee Office, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshun East Street, Chaoyang District, Beijing 100015, China
| | - Jiaying Zhang
- School of Medical Humanities, Capital Medical University, No. 10, Xitoutiao, You An Men Wai, Fengtai District, Beijing 100069, China
| | - Qilin Jin
- Cardiac Surgery Department, People's Hospital of Beijing Daxing District, No. 26, Huangcun West Street, Daxing District, Beijing 102600, China
| | - Jiaojiao Zhou
- Department of Medical Administration, Fengtai District Xiluoyuan Community Health Service Center, Building 26, Xiluoyuan 1, Fengtai District, Beijing 100077, China
| | - Jingjing Chen
- Dean's office, Huairou District Liulimiao Community Health Service Center, No. 17, Liulimiao Village, Liulimiao Town, Huairou District, Beijing 101400, China
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Xu T, Loban E, Wei X, Zhou Z, Wang W. Comparison of Health Care Utilization in Different Usual Sources of Care Among Older People With Cardiovascular Disease in China: Evidence From the Study on Global Ageing and Adult Health. Int J Public Health 2024; 68:1606103. [PMID: 38234446 PMCID: PMC10792126 DOI: 10.3389/ijph.2023.1606103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/14/2023] [Indexed: 01/19/2024] Open
Abstract
Objectives: To compare the health care utilization in different usual sources of care (USCs) among the elderly population with cardiovascular disease in China. Methods: Cross-sectional data for 3,340 participants aged ≥50 years with cardiovascular disease from Global AGEing and Adult Health (2010)-China were used. Using the inverse probability of treatment weighting on the propensity score with survey weighting, combined with negative binomial regression and logistic regression models, the correlation between USCs and health care utilization was assessed. Results: Patients using primary care facilities as their USC had fewer hospital admissions (IRR = 0.507, 95% CI = 0.413, 0.623) but more unmet health needs (OR = 1.657, 95% CI = 1.108, 2.478) than those using public hospitals. Patients using public clinics as their USC had higher outpatient visits (IRR = 2.188, 95% CI = 1.630, 2.939) than the private clinics' group. Conclusion: The difference in inpatient care utilization and unmet health care needs between public hospitals and primary care facilities, and the difference in outpatient care utilization between public and private clinics were significant. Using primary care facilities as USCs, particularly public ones, appeared to increase care accessibility, but it still should be strengthened to better address patients' health care needs.
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Affiliation(s)
- Tiange Xu
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Ekaterina Loban
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Wenhua Wang
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
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Xue Q, Xu DR, Cheng TC, Pan J, Yip W. The relationship between hospital ownership, in-hospital mortality, and medical expenses: an analysis of three common conditions in China. Arch Public Health 2023; 81:19. [PMID: 36765426 PMCID: PMC9911958 DOI: 10.1186/s13690-023-01029-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 01/21/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Private hospitals expanded rapidly in China since 2009 following its national health reform encouraging private investment in the hospital sector. Despite long-standing debates over the performance of different types of hospitals, empirical evidence under the context of developing countries remains scant. We investigated the disparities in health care quality and medical expenses among public, private not-for-profit, and private for-profit hospitals. METHODS A total of 64,171 inpatients (51,933 for pneumonia (PNA), 9,022 for heart failure (HF) and 3,216 for acute myocardial infarction (AMI)) who were admitted to 528 secondary hospitals in Sichuan province, China, during the fourth quarters of 2016, 2017, and 2018 were selected for this study. Multilevel logistic regressions and multilevel linear regressions were utilized to assess the relationship between hospital ownership types and in-hospital mortality, as well as medical expenses for PNA, HF, and AMI, after adjusting for relevant hospital and patient characteristics, respectively. RESULTS The private not-for-profit (adjusted OR, 1.69; 95% CI, 1.08, 2.64) and for-profit (adjusted OR, 1.67; 95% CI, 1.06, 2.62) hospitals showed higher in-hospital mortality than the public ones for PNA, but not for AMI and HF. No significant differences were found in medical expenses across hospital ownership types for AMI, but the private not-for-profit was associated with 9% higher medical expenses for treating HF, while private not-for-profit and for-profit hospitals were associated with 10% and 11% higher medical expenses for treating PNA than the public hospitals. No differences were found between the private not-for-profit and private for-profit hospitals both in in-hospital mortality and medical expenses across the three conditions. CONCLUSION The public hospitals had at least equal or even higher healthcare quality and lower medical expenses than the private ones in China, while private not-for-profit and for-profit hospitals had similar performances in these aspects. Our results added evidences on hospitals' performances among different ownership types under China's context, which has great potential to inform the optimization of healthcare systems implemented among developing countries confronted with similar challenges.
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Affiliation(s)
- Qingping Xue
- School of Public Health, Chengdu Medical College, Chengdu, China
- Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
| | - Dong Roman Xu
- Center for World Health Organization Studies and Department of Health Management, School of Health Management of Southern Medical University, Guangzhou, China
- Acacia Lab for Implementation Research, SMU Institute for Global Health (SIGHT), Dermatology Hospital of Southern Medical University (SMU), Guangzhou, China
| | | | - Jay Pan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
- School of Public Administration, Sichuan University, Chengdu, China.
| | - Winnie Yip
- Harvard TH Chan School of Public Health, Boston, USA
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Lu J, Yang H, Shi L, Sheng X, Huo Y, Liu R, Hu R. Associations between Primary Healthcare Experiences and Glycemic Control Status in Patients with Diabetes: Results from the Greater Bay Area Study, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1120. [PMID: 36673874 PMCID: PMC9859184 DOI: 10.3390/ijerph20021120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/29/2022] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
Primary healthcare (PHC) plays an important role in diabetes management; community health centers (CHCs) serve as the main providers of PHC. However, few studies have discussed the association between the service quality of PHC and the effects of diabetes management. In this study, we explored the associations between experiences of PHC in CHCs and glycemic control status in patients with diabetes mellitus. This study was conducted in six CHCs in the Greater Bay Area of China. In total, 418 patients with diabetes mellitus (44% males and 56% females) were recruited between August and October 2019. We evaluated their PHC experiences using the Primary Care Assessment Tool (PCAT) developed by Johns Hopkins and assessed their glycemic control status by measuring their fasting plasma glucose levels. Binary logistic regression analyses were conducted to assess the associations between the patients’ PHC experiences and glycemic control status, adjusting for covariates. The patients with good glycemic control had significantly higher total and dimensional PCAT scores compared with those with poor glycemic control (p < 0.05). Higher PCAT scores were significantly associated with a greater adjusted odds ratios (aORs) of good glycemic control for total and dimensional PCAT scores. For example, compared to those with poor glycemic control, the aORs for those with good glycemic control was 8.82 (95% CI = 4.38−17.76) per total PCAT score increasing. Especially, the aORs for those with good glycemic control were 3.92 (95% CI = 2.38−6.44) and 4.73 (95% CI = 2.73−8.20) per dimensional PCAT score of family-centeredness and community orientation increasing, respectively. Better PHC experiences were associated with better diabetes management. In particular, family-centered and community-oriented CHCs may help improve diabetes management in China and other low- and middle-income countries.
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Affiliation(s)
- Junfeng Lu
- Department of Health Management, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Hui Yang
- Department of Biostatistics, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China
| | - Leiyu Shi
- John Hopkins School of Public Health, Baltimore, MD 21205, USA
| | - Xia Sheng
- Department of Health Management, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yongjun Huo
- Department of Health Management, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Ruqing Liu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Ruwei Hu
- Department of Health Management, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
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Xu T, Loban K, Wei X, Wang W. Determinants of choice of usual source of care among older people with cardiovascular diseases in China: evidence from the Study on Global Ageing and Adult Health. BMC Public Health 2022; 22:1970. [PMID: 36303176 PMCID: PMC9615328 DOI: 10.1186/s12889-022-14352-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 10/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular diseases (CVD) are emerging as the leading contributor to death globally. The usual source of care (USC) has been proven to generate significant benefits for the elderly with CVD. Understanding the choice of USC would generate important knowledge to guide the ongoing primary care-based integrated health system building in China. This study aimed to analyze the individual-level determinants of USC choices among the Chinese elderly with CVD and to generate two exemplary patient profiles: one who is most likely to choose a public hospital as the USC, the other one who is most likely to choose a public primary care facility as the USC. METHODS This study was a secondary analysis using data from the World Health Organization's Study on Global AGEing and Adult Health (SAGE) Wave 1 in China. 3,309 individuals aged 50 years old and over living with CVD were included in our final analysis. Multivariable logistic regression was built to analyze the determinants of USC choice. Nomogram was used to predict the probability of patients' choice of USC. RESULTS Most of the elderly suffering from CVD had a preference for public hospitals as their USC compared with primary care facilities. The elderly with CVD aged 50 years old, being illiterate, residing in rural areas, within the poorest income quintile, having functional deficiencies in instrumental activities of daily living and suffering one chronic condition were found to be more likely to choose primary care facilities as their USC with the probability of 0.85. Among those choosing primary care facilities as their USC, older CVD patients with the following characteristics had the highest probability of choosing public primary care facilities as their USC, with the probability of 0.77: aged 95 years old, being married, residing in urban areas, being in the richest income quintile, being insured, having a high school or above level of education, and being able to manage activities living. CONCLUSIONS Whilst public primary care facilities are the optimal USC for the elderly with CVD in China, most of them preferred to receive health care in public hospitals. This study suggests that the choice of USC for the elderly living with CVD was determined by different individual characteristics. It provides evidence regarding the choice of USC among older Chinese patients living with CVD.
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Affiliation(s)
- Tiange Xu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Katya Loban
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Canada
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Wenhua Wang
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.
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Cheng X, Li Y, Zhang Y, Lu J. The characteristics of and responses to the two COVID-19 outbreak waves in Hebei Province of China, January 2020 to February 2021. Epidemiol Infect 2021; 149:e212. [PMID: 35285437 PMCID: PMC8485049 DOI: 10.1017/s0950268821002089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/06/2021] [Indexed: 11/29/2022] Open
Abstract
Hebei Province was affected by two coronavirus disease 2019 (COVID-19) outbreak waves during the period 22 January 2020 through 27 February 2020 (wave 1) and 2 January 2021 through 14 February 2021 (wave 2). To evaluate and compare the epidemiological characteristics, containment delay, cluster events and social activity, as well as non-pharmaceutical interventions of the two COVID-19 outbreak waves, we examined real-time update information on all COVID-19-confirmed cases from a publicly available database. Wave 1 was closely linked with the COVID-19 pandemic in Wuhan, whereas wave 2 was triggered, to a certain extent, by the increasing social activities such as weddings, multi-household gatherings and church events during the slack agricultural period. In wave 2, the epidemic spread undetected in the rural areas, and people living in the rural areas had a higher incidence rate than those living in the urban areas (5.3 vs. 22.0 per 1 000 000). Furthermore, Rt was greater than 1 in the early stage of the two outbreak waves, and decreased substantially after massive non-pharmaceutical interventions were implemented. In China's 'new-normal' situation, development of targeted and effective intervention remains key for COVID-19 control in consideration of the potential threat of new coronavirus strains.
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Affiliation(s)
- Xiaomin Cheng
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong Province510080, China
| | - Yifan Li
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong Province510080, China
| | - Yali Zhang
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong Province510080, China
| | - Jiahai Lu
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong Province510080, China
- One Health Center of Excellence for Research & Training, Sun Yat-Sen University, Guangzhou510080, China
- Key Laboratory for Tropical Disease Control of Ministry of Education, Sun Yat-Sen University, Guangzhou510080, China
- NMPA Key Laboratory for Quality Monitoring and Evaluation of Vaccines and Biological Products, Sun Yat-Sen University, Guangzhou510080, China
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Li C, Chen Z, Khan MM. Bypassing primary care facilities: health-seeking behavior of middle age and older adults in China. BMC Health Serv Res 2021; 21:895. [PMID: 34461884 PMCID: PMC8406824 DOI: 10.1186/s12913-021-06908-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With economic development, aging of the population, improved insurance coverage, and the absence of a formal referral system, bypassing primary healthcare facilities appear to have become more common. Chinese patients tend to visit the secondary or tertiary healthcare facilities directly leading to overcrowding at the higher-level facilities. This study attempts to analyze the factors associated with bypassing primary care facilities among patients of age 45 years or older in China. METHODS Random effects logistic models were used to examine bypassing of primary health facilities among rural-urban patients. Data from 2011 to 2015 waves of the China Health and Retirement Longitudinal Study were used. RESULTS Two in five older patients in China bypass primary health centers (PHC) to access care from higher-tier facilities. Urban patients were nearly twice as likely as rural patients to bypass PHC. Regardless of rural-urban residence, our analysis found that a longer travel time to primary facilities compared to higher-tier facilities increases the likelihood of bypassing. Patients with higher educational attainment were more likely to bypass PHCs. In rural areas, patients who reported their health as poor or those who experienced a recent hospitalization had a higher probability of bypassing PHC. In urban areas, older adults (age 65 years or older) were more likely to bypass PHC than the younger group. Patients with chronic conditions like diabetes also had a higher probability of bypassing. CONCLUSIONS The findings indicate the importance of strengthening the PHCs in China to improve the efficiency and effectiveness of the health system. Significantly lower out-of-pocket costs at the PHC compared to costs at the higher tiers had little or no impact on increasing the likelihood of utilizing the PHCs. Improving service quality, providing comprehensive person-centered care, focusing on family health care needs, and providing critical preventive services will help increase utilization of PHCs as well as the effectiveness and efficiency of the health system.
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Affiliation(s)
- Changle Li
- Department of Health Economics, School of Health Management, Inner Mongolia Medical University, Hohhot, China.,Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Rd, Wright Hall 116, Athens, GA, 30602, USA
| | - Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Rd, Wright Hall 116, Athens, GA, 30602, USA.,Centre for Health Economics, School of Economics, University of Nottingham Ningbo China, Ningbo, China
| | - M Mahmud Khan
- Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Rd, Wright Hall 116, Athens, GA, 30602, USA.
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Gabrani J, Schindler C, Wyss K. Perspectives of Public and Private Primary Healthcare Users in Two Regions of Albania on Non-Clinical Quality of Care. J Prim Care Community Health 2021; 11:2150132720970350. [PMID: 33243061 PMCID: PMC7705804 DOI: 10.1177/2150132720970350] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Aiming to tackle the rise of non-communicable diseases and an ageing population, Albania is engaged in boosting primary healthcare services and quality of care. The patients’ perspectives on their experience with public and private providers are, however, missing, although their viewpoints are critical while shaping the developing services. Consequently, we analyze perceptions of users of primary healthcare as it relates to non-clinical quality of care and the association to sociodemographic characteristics of patients and the type of provider. Methods: A facility-based survey was conducted in 2018 using the World Health Organization responsiveness questionnaire which is based on a 4-point scale along with 8 non-clinical domains of quality of care. The data of 954 patients were analyzed through descriptive statistics and linear mixed regression models. Results: Similar mean values were reported on total scale of the quality of care for private and public providers, also after sociodemographic adjustments. The highest mean score was reported for the domain “communication” (3.75) followed by “dignity” (3.65), while the lowest mean scores were given for “choice” (2.89) and “prompt attention” (3.00). Urban governmental PHC services were rated significantly better than private outpatient clinics in “coordination of care” (2.90 vs 2.12, P < .001). In contrast, private outpatient clinics were judged significantly better than urban PHC clinics in “confidentiality” (3.77 vs 3.38, P = .04) and “quality of basic amenities” (3.70 vs 3.02, P < .001). “Autonomy” was reported as least important attribute of quality. Conclusion: While the perception of non-clinical care quality was found to be high and similar for public and private providers, promptness and coordination of care require attention to meet patient’s expectations on good quality of care. There is a need to raise the awareness on autonomy and the involvement of patients’ aspects concerning their health.
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Affiliation(s)
- Jonila Gabrani
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Kaspar Wyss
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Fang Y, Zhang F, Zhou C, Chen M. Governance Capability of the Public Health System: A Comparative Analysis of the Control of COVID-19 in the Different Provinces of China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4210. [PMID: 33921152 PMCID: PMC8071522 DOI: 10.3390/ijerph18084210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 11/25/2022]
Abstract
At the beginning of 2020, the global outbreak of the novel coronavirus COVID-19 posed a huge challenge to the governance capabilities of public health in various countries. In this paper, the SEIR model is used to fit the number of confirmed cases in each province in China, and the reduction rate of the basic reproduction number is used to measure the actual score of the control effect of COVID-19. The potential capacity of prevention and control of epidemics, in theory, is constructed, and we use the difference between theoretical ability and actual score to measure the ability of governance of public health. We found that there were significant differences between actual effect and theoretical ability in various regions, and governance capabilities were an important reason leading to this difference, which was not consistent with the level of economic development. The balance of multiple objectives, the guiding ideology of emphasizing medical treatment over prevention, the fragmentation of the public health system, and the insufficiency of prevention and control ability in primary public health systems seriously affected the government's ability to respond to public health emergencies.
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Affiliation(s)
- Yingfeng Fang
- School of Economics and Management, Wuhan University, Wuhan 430072, China; (F.Z.); (C.Z.); (M.C.)
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Žvinakis P, Kalibataitė R, Kalibatas V. Patients’ Shift from Public to Private Primary Health Care Providers in Lithuania: Analysis of the Main Reasons. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2021; 58:469580211060304. [PMID: 34928184 PMCID: PMC8724985 DOI: 10.1177/00469580211060304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Aims Lithuania is one of the countries where public and private primary health care (PHC) providers compete for patients. Patients continuously shift from public to PHC providers, but an analysis of the main reasons was never performed. This study aimed to analyze the reasons why patients shift from public to private PHC providers and identify the associations between the reasons and demographic characteristics of the patients. Methods A cross-sectional study based on a phone questionnaire was conducted among patients who shifted from public to private primary health care (PHC) providers. A total of 810 phone calls were made, and 572 telephone surveys were completed. The response rate was 70.49%. The difference between the proportions was assessed using the Z-test. The association between categorical variables was assessed using the chi-square test. Results The study identified the following main reasons: long queues to obtain family physician appointments (23.6%), inconvenient location of public’s institution department (20.1%), patients relocating (19.2%), enrolment at a former family physician who transitioned from a public to private PHC institution (10.5%), and long waiting time at the family physician’s office for the appointment (9.4%). Some statistically significant correlations were found between the specific reasons for shifting from public to private PHC organizations and patients' demographic characteristics. Conclusions Personal reasons are the most common reasons for shifting from public to private PHC providers (43.36% of the respondents), following the reasons related exclusively to the family physician (25.17%) and related PHC institutions only (24.9%).
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Affiliation(s)
- Paulius Žvinakis
- Department of Health Management, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Roberta Kalibataitė
- Department of Dental and Oral Pathology, Faculty of Odontology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vytenis Kalibatas
- Department of Health Management, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Zhang A, Nikoloski Z, Albala SA, Yip W, Xu J, Mossialos E. Patient Choice of Health Care Providers in China: Primary Care Facilities versus Hospitals. Health Syst Reform 2020; 6:e1846844. [PMID: 33314985 DOI: 10.1080/23288604.2020.1846844] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
As China's health system is faced with challenges of overcrowded hospitals, there is a great need to better understand the recent patterns and determinants of people's choice between primary care facilities and hospitals for outpatient care. Based on recent individual-level data from the China Health and Retirement Longitudinal Survey (CHARLS) and official province-level data from China health statistical yearbooks, we examine the patterns of outpatient visits to primary care facilities versus hospitals among middle-aged and older individuals and explore both supply- and demand-side correlates that explain these patterns. We find that 53% of outpatient visits were paid to primary care facilities as opposed to hospitals in 2015, compared to 60% in 2011. Both supply and demand factors were associated with this decline. On the supply side, we find that the density of primary care facilities did not account for this decline, but higher densities of hospitals and licensed doctors were associated with lower use of primary care facilities. On the demand side, we find that individuals with higher socioeconomic status and greater health care needs were less likely to use primary health care facilities. Our findings suggest that a high concentration of health care professionals in hospitals diverts patients away from primary care facilities. Staffing the primary care facilities with a well-trained health care workforce is the key to a well-functioning primary care system. The findings also suggest a need to address demand-side inequality issues.
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Affiliation(s)
- Anwen Zhang
- Adam Smith Business School, University of Glasgow , Glasgow, UK
| | - Zlatko Nikoloski
- Department of Health Policy, London School of Economics and Political Science , London, UK
| | - Sarah Averi Albala
- UCL Institute for Innovation and Public Purpose, University College London , London, UK
| | - Winnie Yip
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University , Boston, Massachusetts, USA
| | - Jin Xu
- China Center for Health Development Studies, Peking University , Beijing, China
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science , London, UK
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13
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Zhang H, Wang W, Haggerty J, Schuster T. Predictors of patient satisfaction and outpatient health services in China: evidence from the WHO SAGE survey. Fam Pract 2020; 37:465-472. [PMID: 32064515 PMCID: PMC7474531 DOI: 10.1093/fampra/cmaa011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Patient satisfaction is an essential indicator in medical practise and research. To monitor the health and well-being of adult populations and the ageing process, the World Health Organization (WHO) has initiated the Study on Global AGEing and Adult Health (SAGE), compiling longitudinal information in six countries including China as one major data source. OBJECTIVE The objective of this study was to identify potential predictors for patient satisfaction based on the 2007-10 WHO SAGE China survey. METHODS Data were analysed using random forests (RFs) and ordinal logistic regression models based on 5774 responses to predict overall patient satisfaction on their most recent outpatient health services visit over the last 12 months. Potential predictor variables included access to care, costs of care, quality of care, socio-demographic and health care characteristics and health service features. Increase of the mean-squared error (incMSE) due to variable removal was used to assess relative importance of the model variables for accurately predicting patient satisfaction. RESULTS The survey data suggest low frequency of dissatisfaction with outpatient services in China (1.8%). Self-reported treatment outcome of the respective visit of a care facility demonstrated to be the strongest predictor for patient satisfaction (incMSE +15%), followed by patient-rated communication (incMSE +2.0%), and then income, waiting time, residency and patient age. Individual patient satisfaction in the survey population was predicted with 74% accuracy using either logistic regression or RF. CONCLUSIONS Patients' perceived outcomes of health care visits and patient communication with health care professionals are the most important variables associated with patient satisfaction in outpatient health services settings in China.
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Affiliation(s)
- Hao Zhang
- Department of Family Medicine, McGill University, Montréal, Canada
| | - Wenhua Wang
- Department of Family Medicine, McGill University, Montréal, Canada
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Montréal, Canada
| | - Tibor Schuster
- Department of Family Medicine, McGill University, Montréal, Canada
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14
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Comparison of Patients' Perceived Quality of Primary Care Between Urban and Rural Community Health Centers in Guangdong, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134898. [PMID: 32646063 PMCID: PMC7369941 DOI: 10.3390/ijerph17134898] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/28/2020] [Accepted: 07/03/2020] [Indexed: 12/18/2022]
Abstract
Background: A series of reforms were implemented to improve the quality of primary care services in China. This study aims to assess patients’ perceived quality of primary healthcare between rural and urban community health centers in Guangdong. Methods: A cross-sectional survey was conducted from July to December 2015 in Guangdong. We surveyed 1010 respondents who visited either community health centers/stations (CHCs/CHSs) in urban areas or township health centers/rural health stations (THCs/RHSs) in rural areas. A validated Chinese version of the Primary Care Assessment Tool-Adult Short Version (PCAT-AS), representing ten primary care domains, was used to collect information on patients’ primary care experiences. A t-test was used for comparison on domain scores and total scores between patients from CHCs/CHSs and THCs/RHSs. An analysis of covariance was employed to compare the adjusted PCAT domain scores and total scores. Multilevel models were used to explore factors associated with PCAT total scores. Results: Overall, patients reported a lower level of experience of community orientation and family centeredness compared to other primary care domains. Patients from THCs/RHSs settings in the rural area reported better primary care experience in four domains, including first contact, accessibility, ongoing care, and community orientation. Higher education background and those with a chronic disease were associated with better primary care experience, after controlling for confounding factors. Patients who preferred primary care institutions when getting sick or used health services more frequently reported better primary care experiences. Conclusion: Continued efforts are needed to strengthen primary care performances, particularly in a community orientation and family centeredness. Primary care delivery in CHCs/CHSs settings should be improved in four domains, including first contact, accessibility, ongoing care, and community orientation.
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15
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Jin K, Zhang H, Seery S, Fu Y, Yu S, Zhang L, Sun F, Tian L, Xu J, Yue XZ. Comparing public and private emergency departments in China: Early evidence from a national healthcare quality survey. Int J Health Plann Manage 2019; 35:581-591. [PMID: 31721297 DOI: 10.1002/hpm.2968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 10/28/2019] [Accepted: 11/01/2019] [Indexed: 11/11/2022] Open
Abstract
The number of private healthcare facilities has rapidly increased since the progressive open market policies, which began in the 1980s; however, little is known about the development of private emergency departments (EDs). This cross-sectional study was part of the National Control Information System (NCIS) project, which collects data annually from hospitals across China. Emergency services data were extracted and included location, infrastructure, human resources, beds, and number of patients; 4529 hospitals across 31 provinces in mainland China were eventually included, consisting of 988 private and 3541 public EDs. Evidence shows that most private EDs are located in central China, where local economies are relatively developed. Most private EDs (91.6%) are found in secondary hospitals but have significantly fewer beds and smaller workforces compared with public EDs. An imbalance of emergency medical resources was observed across China, and this disparity becomes even more profound in rural hospitals. These findings may initiate collaborative, public-private partnerships in emergency health services provision and suggest there is a need to offer tax breaks to incentivize investors, but further research is required. We may also need to rethink health insurance policies, which could enable more equitable access to private emergency care. Future planning and health policies must be based upon the strongest available evidence, if we are to address imbalanced health services distribution and growing demand.
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Affiliation(s)
- Kui Jin
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hui Zhang
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Sam Seery
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,Department of Humanities and Social Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yangyang Fu
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shanshan Yu
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lili Zhang
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Feng Sun
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Liyuan Tian
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jun Xu
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xue Zhong Yue
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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16
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Yip W, Fu H, Chen AT, Zhai T, Jian W, Xu R, Pan J, Hu M, Zhou Z, Chen Q, Mao W, Sun Q, Chen W. 10 years of health-care reform in China: progress and gaps in Universal Health Coverage. Lancet 2019; 394:1192-1204. [PMID: 31571602 DOI: 10.1016/s0140-6736(19)32136-1] [Citation(s) in RCA: 513] [Impact Index Per Article: 102.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/20/2019] [Accepted: 08/23/2019] [Indexed: 01/23/2023]
Abstract
In 2009, China launched a major health-care reform and pledged to provide all citizens with equal access to basic health care with reasonable quality and financial risk protection. The government has since quadrupled its funding for health. The reform's first phase (2009-11) emphasised expanding social health insurance coverage for all and strengthening infrastructure. The second phase (2012 onwards) prioritised reforming its health-care delivery system through: (1) systemic reform of public hospitals by removing mark-up for drug sales, adjusting fee schedules, and reforming provider payment and governance structures; and (2) overhaul of its hospital-centric and treatment-based delivery system. In the past 10 years, China has made substantial progress in improving equal access to care and enhancing financial protection, especially for people of a lower socioeconomic status. However, gaps remain in quality of care, control of non-communicable diseases (NCDs), efficiency in delivery, control of health expenditures, and public satisfaction. To meet the needs of China's ageing population that is facing an increased NCD burden, we recommend leveraging strategic purchasing, information technology, and local pilots to build a primary health-care (PHC)-based integrated delivery system by aligning the incentives and governance of hospitals and PHC systems, improving the quality of PHC providers, and educating the public on the value of prevention and health maintenance.
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Affiliation(s)
- Winnie Yip
- Harvard School of Public Health, Boston, MA, USA.
| | - Hongqiao Fu
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Angela T Chen
- China Health Partnership, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Tiemin Zhai
- China National Health Development Center, Beijing, China
| | - Weiyan Jian
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Roman Xu
- Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, China
| | - Jay Pan
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Min Hu
- School of Public Health, Fudan University, Shanghai, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Qiulin Chen
- Institute of Population and Labor Economics, Chinese Academy of Social Sciences, Beijing, China
| | - Wenhui Mao
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Qiang Sun
- School of Health Care Management and Key Laboratory of Health Economic and Policy Research of National Health Commission, Shandong University, Jinan, China
| | - Wen Chen
- School of Public Health, Fudan University, Shanghai, China
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17
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Evaluating Primary Health Care Performance from User Perspective in China: Review of Survey Instruments and Implementation Issues. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16060926. [PMID: 30875833 PMCID: PMC6466226 DOI: 10.3390/ijerph16060926] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/04/2019] [Accepted: 03/11/2019] [Indexed: 12/28/2022]
Abstract
This review aims to summarize the progress of patient evaluation studies focusing on primary health care (PHC) in China, specifically in relation to survey instruments and implementation issues. Eligible studies published in English or Chinese were obtained through online searches of PubMed and China National Knowledge Infrastructure. A descriptive reporting approach was used due to variations in the measurements and administration methods between studies. A total of 471 articles were identified and of these articles; of those 91 full-text articles were included in the final analysis. Most studies used author-developed measurements with five-point Likert response scales and many used the Chinese translations of validated tools from other countries. Most instruments assessed the physical environment, medical equipment, clinical competency and convenience aspects of PHC using a satisfaction rating instead of care experience reporting. Many studies did not report the sampling approach, patient recruitment procedures and survey administration modes. The patient exit survey was the most commonly used survey implementation method. The focus on the structural dimensions of PHC, inconsistent wording, categories of response options that use satisfaction rating, and unclear survey implementation processes are common problems in patient evaluation studies of PHC in China. Further studies are necessary to identify population preferences of PHC in China in order to move towards developing Chinese value-based patient experience measurements.
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18
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Wang W, Maitland E, Nicholas S, Haggerty J. Determinants of Overall Satisfaction with Public Clinics in Rural China: Interpersonal Care Quality and Treatment Outcome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050697. [PMID: 30818750 PMCID: PMC6427360 DOI: 10.3390/ijerph16050697] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/08/2019] [Accepted: 02/22/2019] [Indexed: 01/17/2023]
Abstract
The primary health care quality factors determining patient satisfaction will shape patient-centered health reform in China. While rural public clinics performed better than hospitals and private clinics in terms of patient perceived quality of primary care in China, there is little information about which quality care aspects drove patients’ satisfaction. Using a World Health Organization database on 1014 rural public clinic users from eight provinces in China, our multiple linear regression model estimated the association between patient perceived quality aspects, one treatment outcome, and overall primary health care satisfaction. Our results show that treatment outcome was the strongest predictor of overall satisfaction (β = 0.338 (95% CI: 0.284 to 0.392); p < 0.001), followed by two interpersonal care quality aspects, Dignity (being treated respectfully) (β = 0.219 (95% CI: 0.117 to 0.320); p < 0.001) and Communication (clear explanation by the physician) (β = 0.103 (95% CI: 0.003 to 0.203); p = 0.043). Prompt attention (waiting time before seeing the doctor) and Confidentiality (talking privately to the provider) were not correlated with overall satisfaction. The treatment outcome focus, and weak interpersonal primary care aspects, in overall patient satisfaction, pose barriers towards a patient-centered transformation of China’s primary care rural clinics, but support the focus of improving the clinical competency of rural primary care workers.
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Affiliation(s)
- Wenhua Wang
- Department of Family Medicine, McGill University, Montreal, QC H3T 1M5, Canada.
| | - Elizabeth Maitland
- University of Liverpool Management School, University of Liverpool, Liverpool L697ZH, UK.
| | - Stephen Nicholas
- School of Management and School of Commerce, Tianjin Normal University, Tianjin 300074, China.
- Guangdong Research Institute for International Strategies, Guangdong University of Foreign Studies, Guangzhou 510420, China.
- TOP Education Institute, Sydney, NSW 2015, Australia.
- University of Newcastle Business School, Newcastle, NSW 2308, Australia.
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Montreal, QC H3T 1M5, Canada.
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Alavi M, Khodaie Ardakani MR, Moradi-Lakeh M, Sajjadi H, Shati M, Noroozi M, Forouzan AS. Responsiveness of Physical Rehabilitation Centers in Capital of Iran: Disparities and Related Determinants in Public and Private Sectors. Front Public Health 2018; 6:317. [PMID: 30488030 PMCID: PMC6247717 DOI: 10.3389/fpubh.2018.00317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 10/16/2018] [Indexed: 11/23/2022] Open
Abstract
Background: Responsiveness as a non-medical, non-financial goal of the health system is of special importance to people with physical disability. The current study assessed the experiences of people with physical disabilities when they encounter rehabilitation centers in Tehran. Methods: This cross-sectional study was conducted in Tehran, the capital of Iran. The sample consisted of 610 people with physical disabilities referred to 10 comprehensive rehabilitation centers (CRCs) selected by Quota sampling. Data were collected by a standard responsiveness questionnaire proposed by the World Health Organization (WHO) and were analyzed by a standard protocol. Blinder-Oaxaca analysis was done to explain the inequality in performance of public and private sectors. Results: Study participants included 298 (48.7%) women and 312 (51.3%) men. The mean age of the respondents was 46.3 (SD = 14.3) for women and 45.6 (SD = 15.4) for men. Prompt attention (33.3%) and confidentiality (1.3%) were the most and least important reported domains, respectively. Overall poor responsiveness was reported by 20.9% of respondents. Private rehabilitation centers showed significantly better performance in communication, basic amenities and autonomy compared to public centers (P ≤ 0.05). Perceived social class explained 76% of the inequality in autonomy in the private and public sector (P ≤ 0.05). Conclusion: Improving overall responsiveness in domains that are of high importance from the respondents' viewpoint but are performing poorly—areas such as prompt attention and basic amenities—is essential. Additionally, interventions are needed to improve the performance of the public centers and providers in the areas of participation of service users in all social classes in their rehabilitation decisions and procedures, clear communication, and basic amenities.
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Affiliation(s)
- Manijeh Alavi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Research and Technology Department, Ministry of Health and Medical Education, Tehran, Iran
| | | | - Maziar Moradi-Lakeh
- Department of Community and Family Medicine, Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Homeira Sajjadi
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohsen Shati
- Department of Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehdi Noroozi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ameneh Setareh Forouzan
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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