IDEAS home Printed from https://ideas.repec.org/a/gam/jijerp/v17y2020i18p6917-d417213.html
   My bibliography  Save this article

Association between Primary Healthcare and Medical Expenditures in a Context of Hospital-Oriented Healthcare System in China: A National Panel Dataset, 2012–2016

Author

Listed:
  • Mengping Zhou

    (Department of Health Administration, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China)

  • Jingyi Liao

    (Department of Health Administration, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China)

  • Nan Hu

    (Department of Biostatistics, FIU Robert Stempel College of Public Health and Social Work, Miami, FL 33199, USA
    Department of Family and Preventive Medicine, and Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT 84132, USA)

  • Li Kuang

    (Department of Health Administration, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China)

Abstract

Total health expenditure in China has grown considerably since a new round of health system reform was enacted in 2009. Researchers have shown that strengthening primary healthcare may be an option for countries to solve the rapid expansion of their medical expenditures. This study was designed to explore the association between the strength of primary healthcare and medical expenditures, in the context of the hospital-oriented healthcare system in China. A longitudinal ecological study was conducted using a 5-year panel dataset of 27 provinces in mainland China. The linear mixed effects regression model was used to assess the effects of primary healthcare-related metrics on medical expenditures, controlling for the provincial level specialty care physician supply and socio-economic parameters. All of the three primary healthcare-related metrics showed negative associations with the two medical expenditure parameters. Primary care physicians per 10,000 population was significantly associated with the per capita hospital medical expenditures ( p < 0.05), and the percentage of public health expenditure in total health expenditure was significantly associated with both per capita total medical expenditure and per capita hospital medical expenditures ( p < 0.01 for both). Our study found negative associations between the primary healthcare capacity and medical expenditure in the context of hospital-oriented healthcare systems in China, adding to the previous evidence that primary healthcare may play a positive role in reducing medical expenditure. Policies on increasing the primary care physician supply and the public share of total health expenditure should be conducted to strengthen the primary healthcare system. With the gradual advance of medical reform and the policy inclination to primary healthcare, this will play a more important role in controlling the rapid growth of medical expenditure.

Suggested Citation

  • Mengping Zhou & Jingyi Liao & Nan Hu & Li Kuang, 2020. "Association between Primary Healthcare and Medical Expenditures in a Context of Hospital-Oriented Healthcare System in China: A National Panel Dataset, 2012–2016," IJERPH, MDPI, vol. 17(18), pages 1-12, September.
    • Handle: RePEc:gam:jijerp:v:17:y:2020:i:18:p:6917-:d:417213
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/1660-4601/17/18/6917/pdf
    Download Restriction: no
    File URL: https://www.mdpi.com/1660-4601/17/18/6917/
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Jacob Novignon & Solomon Olakojo & Justice Nonvignon, 2012. "The effects of public and private health care expenditure on health status in sub-Saharan Africa: new evidence from panel data analysis," Health Economics Review, Springer, vol. 2(1), pages 1-8, December.
    2. Stefanini, Alessandro & Aloini, Davide & Benevento, Elisabetta & Dulmin, Riccardo & Mininno, Valeria, 2020. "A data-driven methodology for supporting resource planning of health services," Socio-Economic Planning Sciences, Elsevier, vol. 70(C).
    3. Starfield, Barbara & Shi, Leiyu, 2002. "Policy relevant determinants of health: an international perspective," Health Policy, Elsevier, vol. 60(3), pages 201-218, June.
    4. Dusheiko, Mark & Gravelle, Hugh & Martin, Stephen & Rice, Nigel & Smith, Peter C., 2011. "Does better disease management in primary care reduce hospital costs? Evidence from English primary care," Journal of Health Economics, Elsevier, vol. 30(5), pages 919-932.
    5. Mark Dusheiko & Hugh Gravelle & Stephen Martin & Nigel Rice & Peter C Smith, 2011. "Does Better Disease Management in Primary Care Reduce Hospital Costs?," Working Papers 065cherp, Centre for Health Economics, University of York.
    6. Huazhang Li & Kun Liu & Jianjun Gu & Yimin Zhang & Yun Qiao & Xiaoming Sun, 2017. "The development and impact of primary health care in China from 1949 to 2015: A focused review," International Journal of Health Planning and Management, Wiley Blackwell, vol. 32(3), pages 339-350, July.
    7. Asiskovitch, Sharon, 2010. "Gender and health outcomes: The impact of healthcare systems and their financing on life expectancies of women and men," Social Science & Medicine, Elsevier, vol. 70(6), pages 886-895, March.
    8. de Bruin, Simone R. & Versnel, Nathalie & Lemmens, Lidwien C. & Molema, Claudia C.M. & Schellevis, François G. & Nijpels, Giel & Baan, Caroline A., 2012. "Comprehensive care programs for patients with multiple chronic conditions: A systematic literature review," Health Policy, Elsevier, vol. 107(2), pages 108-145.
    9. Hansen, Paul & King, Alan, 1996. "The determinants of health care expenditure: A cointegration approach," Journal of Health Economics, Elsevier, vol. 15(1), pages 127-137, February.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Siman Yang & Mengping Zhou & Jingyi Liao & Xinxin Ding & Nan Hu & Li Kuang, 2022. "Association between Primary Care Utilization and Emergency Room or Hospital Inpatient Services Utilization among the Middle-Aged and Elderly in a Self-Referral System: Evidence from the China Health a," IJERPH, MDPI, vol. 19(19), pages 1-22, October.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Jeung-Hee Kim & Weon-Young Lee & Song Soo Lim & Young Taek Kim & Yeon-Pyo Hong, 2020. "Gender Differences in the Relationship between Type 2 Diabetes Mellitus and Employment: Evidence from the Korea Health Panel Study," IJERPH, MDPI, vol. 17(19), pages 1-11, September.
    2. Jasmin Kantarevic & Boris Kralj, 2013. "Link Between Pay For Performance Incentives And Physician Payment Mechanisms: Evidence From The Diabetes Management Incentive In Ontario," Health Economics, John Wiley & Sons, Ltd., vol. 22(12), pages 1417-1439, December.
    3. Timothy Simcoe & Maryaline Catillon & Paul Gertler, 2019. "Who benefits most in disease management programs: Improving target efficiency," Health Economics, John Wiley & Sons, Ltd., vol. 28(2), pages 189-203, February.
    4. Griebenow, Malte, 2023. "Should physicians team up to treat chronic diseases?," Journal of Health Economics, Elsevier, vol. 89(C).
    5. Islam, M. Kamrul & Kjerstad, Egil, 2017. "Is incentivizing by subsidizing a better way of managing chronic health conditions?," Working Papers in Economics 12/17, University of Bergen, Department of Economics.
    6. Clémence Bussière & Nicolas Sirven & Thomas Rapp & Christine Sevilla‐Dedieu, 2020. "Adherence to medical follow‐up recommendations reduces hospital admissions: Evidence from diabetic patients in France," Health Economics, John Wiley & Sons, Ltd., vol. 29(4), pages 508-522, April.
    7. Matteo Lippi Bruni & Irene Mammi, 2017. "Spatial effects in hospital expenditures: A district level analysis," Health Economics, John Wiley & Sons, Ltd., vol. 26(S2), pages 63-77, September.
    8. Mauro Laudicella & Paolo Li Donni, 2022. "The dynamic interdependence in the demand of primary and emergency secondary care: A hidden Markov approach," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 37(3), pages 521-536, April.
    9. David, Guy & Smith-McLallen, Aaron & Ukert, Benjamin, 2019. "The effect of predictive analytics-driven interventions on healthcare utilization," Journal of Health Economics, Elsevier, vol. 64(C), pages 68-79.
    10. Jemimah Ride & Panos Kasteridis & Nils Gutacker & Hugh Gravelle & Nigel Rice & Anne Mason & Maria Goddard & Tim Doran & Rowena Jacobs, 2023. "Impact of prevention in primary care on costs in primary and secondary care for people with serious mental illness," Health Economics, John Wiley & Sons, Ltd., vol. 32(2), pages 343-355, February.
    11. Shen, Menghan & He, Wen & Li, Linyan, 2020. "Incentives to use primary care and their impact on healthcare utilization: Evidence using a public health insurance dataset in China," Social Science & Medicine, Elsevier, vol. 255(C).
    12. Johar, Meliyanni, 2012. "Do doctors charge high income patients more?," Economics Letters, Elsevier, vol. 117(3), pages 596-599.
    13. Kongstad, L.P. & Mellace, G. & Olsen, K.R., 2016. "Can the use of Electronic Health Records in General Practice reduce hospitalizations for diabetes patients? Evidence from a natural experiment," Health, Econometrics and Data Group (HEDG) Working Papers 16/25, HEDG, c/o Department of Economics, University of York.
    14. Olorunfemi Yasiru Alimi & Kazeem Bello Ajide, 2021. "The role of institutions in environment–health outcomes Nexus: empirical evidence from sub-Saharan Africa," Economic Change and Restructuring, Springer, vol. 54(4), pages 1205-1252, November.
    15. Chuan De Foo & Shilpa Surendran & Geronimo Jimenez & John Pastor Ansah & David Bruce Matchar & Gerald Choon Huat Koh, 2021. "Primary Care Networks and Starfield’s 4Cs: A Case for Enhanced Chronic Disease Management," IJERPH, MDPI, vol. 18(6), pages 1-13, March.
    16. Iezzi, Elisa & Lippi Bruni, Matteo & Ugolini, Cristina, 2014. "The role of GP's compensation schemes in diabetes care: Evidence from panel data," Journal of Health Economics, Elsevier, vol. 34(C), pages 104-120.
    17. Olsen, Kim Rose & Laudicella, Mauro, 2019. "Health care inequality in free access health systems: The impact of non-pecuniary incentives on diabetic patients in Danish general practices," Social Science & Medicine, Elsevier, vol. 230(C), pages 174-183.
    18. Waibel, Christian & Wiesen, Daniel, 2021. "An experiment on referrals in health care," European Economic Review, Elsevier, vol. 131(C).
    19. Fiorentini, Gianluca & Lippi Bruni, Matteo & Ugolini, Cristina, 2013. "GPs and hospital expenditures. Should we keep expenditure containment programs alive?," Social Science & Medicine, Elsevier, vol. 82(C), pages 10-20.
    20. Lippi Bruni, Matteo & Mammi, Irene & Ugolini, Cristina, 2016. "Does the extension of primary care practice opening hours reduce the use of emergency services?," Journal of Health Economics, Elsevier, vol. 50(C), pages 144-155.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:gam:jijerp:v:17:y:2020:i:18:p:6917-:d:417213. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.