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Determinants of initial utilization of community healthcare services among patients with major non-communicable chronic diseases in South China.

ABSTRACT: BACKGROUND: Although expected to act as gate-keeping primary care providers, as community health service (CHS) facilities are severely under-utilized; Chinese people in both rural and urban areas used predominantly higher-tier facilities for primary care purpose, with significant financial and outcome consequences. This study intends to explore the determinants of initial utilization of CHS among patients with major non-communicable chronic diseases (NCDs) in order to understand the care-seeking behavior among urban and rural residents in South China. METHODS: A multi-stage cluster random sampling methodology was adopted to create a sample of 19,466 adults with NCDs from 7,970 urban households and 32,035 adults with NCDs from 3,860 rural households in Guangdong, China. Interviews and physical examinations were conducted in 2010 to collect data on patient characteristics, medical conditions, and awareness and utilization of healthcare. Descriptive analysis and logistic regression analysis were performed to study utilization patterns and the factors associated with the patterns. RESULTS: Prevalence of major NCDs in urban areas was significantly higher than that in rural areas (12.55% vs. 8.70%; p<0.001). Second-tier district hospitals were most preferred for initial consultation (46.05% in rural areas vs. 45.32% in urban areas; p<0.001), followed by tertiary general or specialized hospitals (28.39% in rural areas vs. 33.89% in urban areas; p<0.001). The proportion of patients who had initial use of CHS was relatively low (25.56% in rural areas vs. 20.79% in urban areas; p<0.001). Awareness of self-care and the presence of medical insurance were leading factors associated with first contact of CHS facilities in both urban and rural areas. CONCLUSION: The study suggests that CHS facilities are not often used as the first contact for patients in both rural and urban areas in south China. Much effect must be made to enhance the gatekeeper system and improve medical insurance coverage in future healthcare reforms.

SUBMITTER: Yang H

PROVIDER: S-EPMC4278805 | biostudies-other | 2014

REPOSITORIES: biostudies-other

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Project description:BackgroundThe burden of chronic diseases has become a major public health concern, and high-efficiency use of community health services is essential in combating chronic diseases. This study described the status of chronic diseases in southern China and explored the determinants of health service utilization among adult residents.MethodsData were obtained from one part of community survey data from four counties in Ganzhou City, southern China. A multistage, stratified random sampling method was used to conduct a cross-sectional survey between 2018 and 2020. Overall, 7430 valid questionnaires were collected. A lasso-linear regression analysis was performed to explore the determinants of community health service utilization.ResultsAccording to the study, most participants (44.6%) reported having relatively good health, while 42.1% reported having moderate health. Chronic diseases were reported by 66.9% of the respondents. The three most prevalent self-reported chronic diseases were hypertension (22.6%), hyperlipidemia (5.9%), and diabetes (5.9%). Among residents with chronic diseases, 72.1% had one chronic disease, while the rest had multiple. Only 13.9% of residents frequently utilized community health services, while 18.9% never used them. Additionally, among residents who reported having chronic diseases, 14.1% had never attended community health services. Four categories of factors were the key determinants of community health service utilization: (1) personal characteristics, age, and sex; (2) health-related factors, such as family history, self-reported health conditions, and the number of chronic diseases; (3) community health service characteristics, such as satisfaction with and accessibility to community health services; and (4) knowledge of chronic diseases. Specifically, women tend to utilize healthcare services more frequently than men. Additionally, residents who are advanced in age, have a family history of chronic diseases, suffer from multiple chronic conditions, rate their self-reported health condition as poor, have a better knowledge about chronic diseases, have better accessibility to community health services, and have higher the satisfaction with community health services, tend to utilize them more frequently.ConclusionsGiven the limited healthcare resources, the government should promote the effective utilization of community health facilities as a critical community-based strategy to combat the growing threat of chronic diseases in southern China. The priority measures involve enhancing residents' access to and satisfaction with community health services and raising awareness of chronic illnesses among older individuals with poor health status.

Project description:BackgroundPeople with chronic non-communicable diseases (NCD) are particularly vulnerable to socioeconomic inequality due to their long-term expensive health needs. This study aimed to assess socioeconomic-related inequality in health service utilization among NCD patients in China and to analyze factors associated with this disparity.MethodsData were taken from the 2008 Chinese National Health Survey, in which a multiple stage stratified random sampling method was employed to survey 56,456 households. We analyzed the distribution of actual use, need-expected use, and need-standardized usage of outpatient services (over a two-week period) and inpatient services (over one-year) across different income groups in 27,233 adult respondents who reported as having a NCD. We used a concentration index to measure inequality in the distribution of health services, which was expressed as HI (Horizontal Inequity Index) for need-standardized use of services. A non-linear probit regression model was employed to detect inequality across socio-economic groups.ResultsPro-rich inequity in health services among NCD patients was more substantial than the average population. A higher degree of pro-rich inequity (HI = 0.253) was found in inpatient services compared to outpatient services (HI = 0.089). Despite a greater need for health services amongst those of lower socio-economic status, their actual use is much less than their more affluent counterparts. Health service underuse by the poor and overuse by the affluent are evident. Household income disparity was the greatest inequality factor in NCD service use for both outpatients (71.3%) and inpatients (108%), more so than health insurance policies. Some medical insurance schemes, such as the MIUE, actually made a pro-rich contribution to health service inequality (16.1% for outpatient and 12.1% for inpatient).ConclusionsInequality in health services amongst NCD patients in China remains largely determined by patient financial capability. The current insurance schemes are insufficient to address this inequity. A comprehensive social policy that encompasses a more progressive taxation package and redistribution of social capital as well as pro-poor welfare is needed.

Project description:Along with three years implementation of health reform in China, this study aimed at providing the up-to-date evidence about the accessibility of essential public health services (EPHS) among adults with chronic diseases (CDs) in both urban and rural areas, as well as determinants in access to EPHS.The data were collected from a cross-sectional survey conducted in 2013, which used a multistage stratified random sampling method to select 54 urban communities and 54 rural villages. Hypertension patients and diabetes patients were the target population who are the main beneficiaries of EPHS. Single factor analysis of influencing factors on difference access to EPHS was performed by Chi-Square analysis. Logistic regression analysis was used to determine the predictors of effective management and effective control.Patients with hypertension or diabetes were predominantly middle-aged or older persons and had a mean age of 65.26 year. People with CDs in China have a higher basic accessibility rate in EPHS with more than 90% of them having experience in receiving EPHS. And those who are willing to receive services from doctors have the most positive influence on effective management and control in blood pressure or blood glucose. But unsatisfied quality and equity of EPHS still exist in primary health system. 90% of participants could receive EPHS, but just 44% of them could control their diseases effectively. And participants from cities had the higher rates in effective management (urban: rural = 57%: 50.6%) and effective control (urban: rural = 39.5%: 27.8%).People with CDs have a high level in geography and economic accessibility to EPHS, but the effectiveness of health management also needs to be improved, especially for those living in rural areas. Our study highlights the continuing need for improving ability to provide EPHS and the equality among regions. Meanwhile, strengthen health education and promotion for patients with CDs to improve their willingness to receive EPHS is also highlighted.

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Determinants of initial utilization of community healthcare services among patients with major non-communicable chronic diseases in South China.

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