PT  - JOURNAL ARTICLE
AU  - Haitao Li
AU  - Zhu Wu
AU  - Xia Hui
AU  - Yanhong Hu
TI  - Impact of local health insurance schemes on primary care management and control of hypertension: a cross-sectional study in Shenzhen, China
AID  - 10.1136/bmjopen-2019-031098
DP  - 2019 Oct 01
TA  - BMJ Open
PG  - e031098
VI  - 9
IP  - 10
4099  - http://bmjopen.bmj.com/content/9/10/e031098.short
4100  - http://bmjopen.bmj.com/content/9/10/e031098.full
SO  - BMJ Open2019 Oct 01; 9
AB  - Background In China, the local health insurance coverage is usually related to timely reimbursement of hypertensive care in primary care settings, while health insurance that is not local could represent an obstacle for accessibility and affordability of primary care for hypertensive patients.Objective To investigate whether local health insurance schemes have a positive impact on hypertension management and control.Design We performed an on-site, face-to-face, patients survey in community health centres (CHCs) in Shenzhen, China.Setting and participants Hypertensive patients seeking healthcare from CHCs were selected as study participants using a systematic sampling design.Main measures We obtained information about insurance status, social capital, drug treatment and control of hypertension. Multivariable stepwise logistic regression models were constructed to test the associations between insurance status and hypertension management, as well as insurance status and social capital.Results A total of 867 participants were included in the final study analysis. We found that the participants covered by local insurance schemes were more likely to be managed in primary care facilities (61.1% vs 81.9%; OR=2.58, 95% CI: 1.56 to 4.28), taking antihypertensive drugs (77.2% vs 88.0%; OR=2.23, 95% CI: 1.37 to 3.62) and controlling blood pressure (43.0% vs 52.4%; OR=1.46, 95% CI: 1.03 to 2.07) when compared with those with insurance coverage that is not local. The participants covered by local insurance schemes reported a higher score of perceived generalised trust than those without (4.23 vs 3.97; OR=0.74, 95% CI: 0.53 to 0.86).Conclusion Our study demonstrates that local health insurance coverage could help improve management and control of hypertension in a primary care setting. Policymakers suggest initiating social interventions for better management and control of hypertension at the primary care level, although the causal pathways across insurance status, social capital and control of hypertension deserve further investigations.