Bypassing primary care facilities: health-seeking behavior of middle age and older adults in China

• Published in: BMC health services research 2021-08, Vol.21 (1), p.1-895, Article 895
• Main Authors: Li, Changle, Chen, Zhuo, Khan, M. Mahmud
• Format: Article
• Language: English
• Subjects: Analysis; Bypassing; China; Chronic illnesses; Demographic aspects; Gender; Health behavior; Health care expenditures; Health facilities; Health insurance; Health planning; Health services; Health-seeking behavior; Insurance coverage; Middle age; Monetary incentives; Older adults; Older people; Patient-centered care; Patients; Primary care; Primary health care; Rural areas; Social aspects; Socioeconomic factors; Urban areas
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-021-06908-0

Background With economic development, aging of the population, improved insurance coverage, and the absence of a formal referral system, bypassing primary healthcare facilities appear to have become more common. Chinese patients tend to visit the secondary or tertiary healthcare facilities directly leading to overcrowding at the higher-level facilities. This study attempts to analyze the factors associated with bypassing primary care facilities among patients of age 45 years or older in China. Methods Random effects logistic models were used to examine bypassing of primary health facilities among rural-urban patients. Data from 2011 to 2015 waves of the China Health and Retirement Longitudinal Study were used. Results Two in five older patients in China bypass primary health centers (PHC) to access care from higher-tier facilities. Urban patients were nearly twice as likely as rural patients to bypass PHC. Regardless of rural-urban residence, our analysis found that a longer travel time to primary facilities compared to higher-tier facilities increases the likelihood of bypassing. Patients with higher educational attainment were more likely to bypass PHCs. In rural areas, patients who reported their health as poor or those who experienced a recent hospitalization had a higher probability of bypassing PHC. In urban areas, older adults (age 65 years or older) were more likely to bypass PHC than the younger group. Patients with chronic conditions like diabetes also had a higher probability of bypassing. Conclusions The findings indicate the importance of strengthening the PHCs in China to improve the efficiency and effectiveness of the health system. Significantly lower out-of-pocket costs at the PHC compared to costs at the higher tiers had little or no impact on increasing the likelihood of utilizing the PHCs. Improving service quality, providing comprehensive person-centered care, focusing on family health care needs, and providing critical preventive services will help increase utilization of PHCs as well as the effectiveness and efficiency of the health system. Keywords: Health-seeking behavior, Bypassing, Primary care, Older adults, China