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Tertiary hospitals or community clinics? An enquiry into the factors affecting patients' choice for healthcare facilities in urban China

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  • Jiang, Shan
  • Gu, Yuanyuan
  • Yang, Fan
  • Wu, Tao
  • Wang, Hui
  • Cutler, Henry
  • Zhang, Lufa

Abstract

Most Chinese patients tend to seek primary care services in tertiary hospitals rather than community clinics, which has caused the malfunction of China's multi-tiered health system. This study aimed to identify the factors that affected patients' decisions when selecting healthcare facilities and use these to design policies to redirect patient flow from tertiary hospitals back to community clinics. A cross-sectional survey was conducted in Shanghai in 2017 using the best-worst scaling experiment. A total of 202 respondents were included in the analysis, including 97 community residents, 56 tertiary hospital patients, and 49 community clinic patients. The latter two had made their choices so the three samples were analyzed separately. Seven attributes were used in the experiment with each varying across two or three levels to accommodate the features of primary care services in Shanghai. The values of attribute levels were estimated using the mixed logit model. Relative importance across attributes and attribute levels were derived and policy simulations were undertaken to examine the impact of changing attribute levels on choices. Results suggest that the three samples are composed of different types of people who presented different preference patterns. The community residents are representative of the population and to them sufficient test and examinations, doctors with expertise, and good service attitude are the most desirable features for a healthcare facility while unfriendly practitioners and lengthy visit the least attractive features. In terms of attributes, friendliness of doctors and the availability of tests and examinations are the two major drivers in selecting healthcare facilities. Our findings provide supportive evidence and useful inputs to the ongoing healthcare reform in China.

Suggested Citation

  • Jiang, Shan & Gu, Yuanyuan & Yang, Fan & Wu, Tao & Wang, Hui & Cutler, Henry & Zhang, Lufa, 2020. "Tertiary hospitals or community clinics? An enquiry into the factors affecting patients' choice for healthcare facilities in urban China," China Economic Review, Elsevier, vol. 63(C).
    • Handle: RePEc:eee:chieco:v:63:y:2020:i:c:s1043951x20301358
    DOI: 10.1016/j.chieco.2020.101538
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    3. Fang Wu & Wei Chen & Lingling Lin & Xu Ren & Yingna Qu, 2022. "The Balanced Allocation of Medical and Health Resources in Urban Areas of China from the Perspective of Sustainable Development: A Case Study of Nanjing," Sustainability, MDPI, vol. 14(11), pages 1-28, May.
    4. Chen, Qiulin & Xu, Duo & Fu, Hongqiao & Yip, Winnie, 2022. "Distance effects and home bias in patient choice on the Internet: Evidence from an online healthcare platform in China," China Economic Review, Elsevier, vol. 72(C).
    5. Jiang, Wei & Chen, Qiulin & Lou, Xuyan & Song, Lina & Chen, Zhuo, 2024. "Impact of a health system vertical integration program on patient expenditures and healthcare utilization: Evidence from county hospitals in East China," China Economic Review, Elsevier, vol. 87(C).
    6. Yu Wang & Peicong Zhai & Yue Zhang & Shan Jiang & Gang Chen & Shunping Li, 2023. "Gauging Incentive Values and Expectations (G.I.V.E.) among Blood Donors for Nonmonetary Incentives: Developing a Preference Elicitation Instrument through Qualitative Approaches in Shandong, China," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 16(6), pages 593-606, November.
    7. Meng Tian & Lei Yuan & Renzhong Guo & Yongsheng Wu & Xiaojian Liu, 2022. "Evaluations of Spatial Accessibility and Equity of Multi-Tiered Medical System: A Case Study of Shenzhen, China," IJERPH, MDPI, vol. 19(5), pages 1-18, March.

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    More about this item

    Keywords

    Best-worst scaling; China healthcare reform; Community clinics; Patient choice; Primary care; Tertiary hospital;
    All these keywords.

    JEL classification:

    • C35 - Mathematical and Quantitative Methods - - Multiple or Simultaneous Equation Models; Multiple Variables - - - Discrete Regression and Qualitative Choice Models; Discrete Regressors; Proportions
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • P35 - Political Economy and Comparative Economic Systems - - Socialist Institutions and Their Transitions - - - Public Finance

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