Factors associated with the choice of primary treatment at the community level among the middle‐aged and elderly in China

Background As China is still in the process of establishing the hierarchical medical system, people have full autonomy in choosing medical institutions when they need to see a doctor. The basic working of a hierarchical medical system involves four parts: primary treatment at the community level, two‐way referral, a partition of emergency and chronic disease, and a joint effort among different healthcare facilities. This study examines factors associated with primary healthcare use in a middle‐aged and elderly Chinese population. Methods Our study is a cross‐sectional and observational survey involving 1659 adults aged 45 and above. The data are from the 2015 China Health and Retirement Longitudinal Study. According to the Andersen behavioral model, we used logistic regression to analyze the influencing factors of healthcare services utilization, including predisposing, enabling, and need factors. We also compared the relative importance of factors to healthcare services utilization by analysis of variance. Results During the recently 1‐month period, 63.89% of the sample had their last visit to a primary healthcare facility. In the final logistic model, there were three predisposing characteristics (education level, children number, and work status), three enabling factors (household status, out‐of‐pocket expenses, and travel time to the healthcare facilities), and one need factor (three specific chronic diseases) were significantly associated with primary healthcare use. Having received more education, taking more travel time to the healthcare facility, paying more out‐of‐pocket expenses, and having heart problems were associated with a lower probability of choosing the primary healthcare facility. However, having more children, being still at work, with agricultural household status, diabetes, and arthritis were associated with a higher likelihood of having primary healthcare facility visits. Among all the factors, the three most powerful determinants were out‐of‐pocket expenses, travel time to the healthcare facility, and education. Conclusions Policymakers need to consider these factors when improving the system of primary treatment at the community level, including improving reimbursement policy to distinguish the payment standard between hospitals and primary healthcare facilities.