Elsevier

China Economic Review

Volume 20, Issue 4, December 2009, Pages 620-624
China Economic Review

Community health service centers in China, not always trusted by the populations they serve?

https://doi.org/10.1016/j.chieco.2009.04.004Get rights and content

Abstract

Based on the idea that healthcare needs to be managed by individuals and that basic health services should be provided by the community, this paper examines the factors that impact urban outpatients' preferences for particular community health service centers (CHSCs) and hospitals. Rational consumption of healthcare is influenced by a patient's beliefs, beyond simple demographics and social structure. Ignorance of basic health issues leads to non-rational patient behavior, which also explains the confusion in Chinese health reform regarding people's mistrust of CHSCs. Health education in the form of self-managed care may increase personal health knowledge and encourage individuals to make use of the basic health services that are supplied by CHSCs.

Introduction

During the early stages of the Chinese economic reform in 1978, rural collective economies collapsed, destroying the framework of rural cooperative healthcare. In urban areas before economic reform, most individuals were employees of state-owned enterprises or other government institutions whose healthcare provisions were at their employer's expense. In the 1990s, along with urban economic reform, state-owned enterprises became financially independent and were downsized. State enterprises and other government organizations had difficulty financing their employees' healthcare needs. In general, government spending on the health industry throughout China has declined since the 1990s. Human and material resources have become increasingly concentrated in big cities and large hospitals, and a vicious cycle of non-adoption of costly preventive care, which can lead to unnecessarily severe illnesses that require expensive treatment, has merged.

For a long time, patients had to travel long distances to seek the advice of clinical experts in China. Since 2005, the Chinese government has encouraged a debate in society based on a draft proposal for reform of the country's struggling healthcare system. The current exchange focuses on strategic behavior involving several related entities, including different departments of the state government, medical centers, health-care beneficiaries, doctors, and other sectors of the healthcare industry. Before the release of the health system reform plan, critics debated whether to tighten government control of medical services or to convert to a market-oriented healthcare system.

However, today there is general agreement that it is important to develop basic medical services for everyone; the overall goal of the reform policy is to implement a universal healthcare plan by 2020, as proposed in the report to the 17th National Congress of the Communist Party of China. Recently, the Chinese government has been paying more attention to a plan for Community Health System Centers (CHSCs) supported by major financing from both central and local governments. The aim of the plan is to make basic health services more accessible and cheaper for everyone at the community level and to discourage visits to large hospitals for minor ailments.

The concerns about the implementation of the CHSC policies have received much attention. Self-management programs for chronic diseases can improve overall health at community-based sites (Lorig et al., 1999, Lorig et al., 2004). The program is a workshop that lasts two and a half hours, once a week, for six weeks in community settings such as senior centers, churches, libraries and hospitals. People with different chronic health problems attend these group sessions. Workshops are facilitated by trained leaders. The programs have been adopted by certain urban community health centers in China, including those in Beijing, Shanghai, Chengdu, and Liaoning (Li & Chen, 2005). People are increasingly aware of the services provided by these CHSCs.

However, a patient's belief systems regarding factors that affect their health is one of the key elements at play when they choose to go to a CHSC or a hospital. This article discusses the belief systems adopted by Chinese health consumers and explains how such beliefs lead to non-rational behavior when seeking medical care.

The purpose of the paper is to empirically evaluate the behavior of Chinese patients with regard to CHSCs. The paper is structured as follows. The second section describes related theories and the basic model used in this paper. The data and variables are discussed in the third section. Our estimation results from a binary logistic regression are presented in the fourth section. The last section offers concluding remarks.

Section snippets

Theories and model specification

Research on health behavior not only explains individual health actions but may also contribute to improving the quality and efficiency of the services offered by medical institutions. This provides a theoretical basis for appropriate government involvement. Health behavior scholars have applied, criticized, and even revised the popular Behavioral Model of Health Services Use (HSU) (Andersen, 1968). The model has evolved into the Expanded Behavioral Model of Health Services Utilization (

Data and variables

This research is based on a cross-sectional dataset taken from five cities in China in 2006, including Shanghai, Dalian, Shenzhen, Chengdu and Xi'an. Data were collected through a collaboration between Tsinghua University and the World Bank. Results from 4802 families (15,009 people) are reported in this survey. We selected 3251 people from the sample. Our goal was to examine the behavior of outpatients who represented the individual who most recently sought healthcare within their families.

We

Results

This paper focuses on the relationship between each independent variable and an individual's decision to use the CHSC (Table 4).

We found a significant association between age and the use of community health services (p = 0.001 < 0.05, B =  0.011). Patients are more likely to choose hospitals as their first choice as they get older. Elderly patients tend to avoid CHSCs. Elderly patients in China have increasingly become major players in terms of their demand for medical services, particularly in the

Conclusion

The function of CHSCs is mainly to treat common, routine and chronic diseases. Patients have access to effective treatment and rehabilitation at CHSCs; therefore, more than 50% of patients could potentially be triaged out from hospitals to ease overcrowding. To achieve this policy objective, the Chinese government has worked to improve CHSCs and has increased the level of capital investment and training of medical care staff. Meanwhile, the first-contact care through general practitioners and

Acknowledgements

We thank Yongheng YANG of Tsinghua University for his guidance. The study was supported by a grant (No.70403009) from the National Natural Science Foundation of China.

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