Article Text
Abstract
Objective China has been attempting to control the patients’ choice of high-level medical institutions through series measures of first point of contact at primary medical institutions, but the outcome is considered poor. We aim to analyse whether unsuccessful treatment in primary medical institutions can lead to the patients’ choice of high-level medical institutions.
Design A retrospective cluster sample study.
Setting The study setting was in Macheng city, Hubei province.
Participants The respondents are township–county (TC) patients (patients who first went to township hospitals and then county hospitals within 30 days for the same disease) who experienced unsuccessful treatment in primary medical institutions. A total of 2090 TC patients were screened out based on the New Rural Cooperative Medical System database in 2013.
Main outcome measures The choice of patients between township hospitals (primary medical institutions) and county hospitals was observed. We compared TC patients’ ratio of choosing county hospitals (RoCC) before TC experience with after TC experience. Thereafter, we compared RoCC of TC patients and non-TC patients (patients who did not experience TC) based on coarsened exact matching.
Results The ratio of TC for outpatient in township hospitals is 0.68% and that of TC for inpatient in township hospitals is 3.37%. RoCC for TC disease increased from 20.8% to 35.5% (p<0.001), RoCC for other disease increased from 35% to 37.3% (p=0.01). TC patients had significantly higher RoCC than non-TC patients (p<0.001).
Conclusions Patients’ choice of high-level medical institutions is highly associated with the experience of unsuccessful treatment in primary medical institutions. Moreover, people likely select high-level medical institutions thereafter regardless of conditions in rural China. Unsuccessful treatment in primary medical institutions is inevitable for patients. Thus, additional measures should be considered in lowering the potential risks for patients when treatments fail.
Trial registration number ChiCTR-OOR-14005563.
- choice behavior
- health policy
- primary medical institution
- rural health
- china
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Footnotes
Patient consent for publication Not required.
Contributors NY and YZ participated in conception and design and the analyses, and wrote the manuscript. NY participated in data collection and performed the statistical analysis. TY, YY and LZ helped to review the manuscript and put forward modification opinions. YZ helped to draft the manuscript, review the manuscript and make final changes. All authors have given their final approval of the version to be published.
Funding This research is supported by the National youth Natural Science Foundation of China, grant number (71603088) and National Natural Science Foundation of China, grant number (71673099).
Competing interests None declared.
Ethics approval The study protocol conformed to the guidelines of the Ethics Committee of the Tongji Medical College of Huazhong University of Science and Technology.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The anonymised dataset is available through the email of the corresponding author.