Factors associated with patients' healthcare-seeking behavior and related clinical outcomes under China's hierarchical healthcare delivery system

Front Public Health. 2024 Apr 12:12:1326272. doi: 10.3389/fpubh.2024.1326272. eCollection 2024.

Abstract

Introduction: The hierarchical healthcare delivery system is an important measure to improve the allocation of medical resources and promote equitable distribution of basic medical and health services. It is one of the key factors in the success or failure of China's medical reform. This study aims to analyze the factors influencing patients' healthcare-seeking behaviors, including socioeconomic and clinical outcomes, under China's hierarchical healthcare delivery system, and to provide potential solutions.

Methods: Patients receiving outpatient treatment in the past 14 days and inpatient care in the past 1 year were investigated. The multivariate logistic regression was used to analyze the influencing factors of patient's medical treatment behavior selection, and to compare whether the clinical outcomes of primary medical institutions and grade A hospitals are the same.

Results: Nine thousand and ninety-eight person-times were included in the study. Of these, 4,538 patients were outpatients, 68.27% of patients were treated in primary medical institutions; 4,560 patients were hospitalized, 58.53% chose to be hospitalized in grade A hospitals. Provinces and cities, urban and rural areas, occupation, education level, medical insurance type, income, whether there are comorbid diseases, and doctors' medical behavior are the factors affecting the choice of medical treatment behavior. Patients who choose primary medical institutions and grade A hospitals have different control levels and control rate for the blood pressure, blood lipids, blood glucose.

Conclusion: Under the hierarchical diagnosis and treatment system, the patients' choice of hospital is mainly affected by their level of education, medical insurance types, and the inpatients are also affected by whether there are comorbid conditions. Clinical outcomes of choosing different levels of hospitals were different.

Keywords: cardiovascular risk factors; hierarchical healthcare delivery system; outcomes; patients’ healthcare-seeking behavior; primary healthcare.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • China
  • Delivery of Health Care* / statistics & numerical data
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care* / statistics & numerical data
  • Socioeconomic Factors
  • Young Adult

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the National Key Research and Development Program of China (grants 2016YFC0900901, 2016YFC1301002, 2017YFC0908803, and 2018YFC1312501), the National Science Foundation of China (grant 81530016), and Biosense Webster Inc. This funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article, or the decision to submit it for publication.