Synergy of policies to strengthen primary care: evidence from a national repeated cross-sectional study
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RESEARCH ARTICLE
Open Access
Synergy of policies to strengthen primary care: evidence from a national repeated cross-sectional study Yinzi Jin1,2, Jin Xu2, Weiming Zhu2, Yaoguang Zhang3, Ling Xu3 and Qingyue Meng1,2*
Abstract Background: People bypass primary healthcare (PHC) institutions to seek expensive healthcare at high-level hospitals, leading to escalating medical costs and inefficient use of resources. In 2009, China launched nationwide synergic policies on primary care strengthening, to tackle access to healthcare and financial protection. This study aimed to assess the impact of the two policy areas, health insurance and health workforce, on healthcare seeking behavior. Methods: Drawing on national survey data before (2008) and after (2013) the policies, we linked individual-level data on healthcare-seeking behavior with county-level data on health workforce and health insurance. We constructed a multilevel zero-inflated negative binomial regression to examine the impacts of average reimbursement rate (ARR) of health insurance and the density of registered physicians on outpatient/inpatient visits, and multilevel multinomial logistic regression for the impacts on choice of outpatient/inpatient care providers. Results: Although the increase in health insurance ARR and physician density have positive impacts on individuals’ healthcare use, their impacts might be weakened during 2008 and 2013, and the negative impacts of investment of those in PHC institutions on likelihood of visiting hospitals was larger. The negative impacts of ARR at PHC institutions on likelihood of visiting county-, municipal- and higher-level hospitals in 2013 was 28 percentage points, 66 percentage points and 33 percentage points larger than these in 2008. Conclusions: Primary care strengthening requires synergic policies. Effective mechanisms for coordination across multisectoral actions are necessities for deepening those policies to ensure efficient delivery of healthcare without experiencing financial risks. Keywords: Health insurance coverage, Health workforce availability, Synergic policies, Primary care strengthening
Background As Governments strive to progress towards the Sustainable Development Goals including Universal Health Coverage, concerted efforts are being made to strengthen primary healthcare (PHC) so that people have access to quality health services without experiencing financial risks. * Correspondence: [email protected] 1 School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China 2 China Center for Health Development Studies, Peking University, Box 505, 38 Xue Yuan Road, Haidian District, Beijing 100191, China Full list of author information is available at the end of the article
Synergy of policies on interrelated health systems function are warranted to strengthen PHC, especially for low- and middle-income countries (LMICs). Health financing and health workforce are two important policy areas. Healthcare seeking behavior refers to individuals’ use of health servi
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