Changes in Beijing Residents' Primary Care Utilization during the New Round of Healthcare Reform：a Study Based on 2013 and 2018 Waves of the National Health Service Survey

Abstract

BackgroundBeijing has taken a series of measures to promote patients to use primary healthcare since the implementation of the new round of healthcare reform in 2009, especially after the comprehensive reform of separating medical treatment and drug sales, but there is a lack of evidence on the improvement in Beijing residents' use of primary healthcare. The features of users of primary healthcare are still unclear, and if the majority of them have low socioeconomic status, which may bring about the issue of inequity in healthcare use.ObjectiveTo examine the features of Beijing residents choosing a healthcare institution for treatment between 2013 and 2018, and analyze the changes over the period, to provide evidence for promoting the development of tiered diagnosis and treatment system.MethodsThis study was carried out from July to September 2020 using the data of Beijing part of the Fifth National Health Service Survey (2013) and Sixth National Health Service Survey (2018) , involving residents≥15 years old with medical experience in the two weeks prior to the survey. Residents' healthcare utilization behaviors were analyzed using Andersen's behavioral model of healthcare utilization, and the changes over the period were analyzed using multiple logistic regression and the Chow test.ResultsThe rate of using primary healthcare in the residents increased to 64.40% (4 125/6 405) in 2018 from 60.89% (1 527/2 508) in 2013, showing a statistical difference (χ2=9.61, P=0.002) . Compared to the year 2013, the year 2018 witnessed increased rates of primary healthcare utilization in females, those≥60 years old, living in urban areas, having non-low income, urban employee basic medical insurance, or two or more chronic diseases (P<0.05) . Multiple Logistic regression analysis showed that age, residential area, type of medical insurance and prevalence of chronic diseases were the influencing factors for the selection of medical institutions in Beijing in 2013 (P<0.05) , and gender, age, per capita income level of family, type of medical insurance and prevalence of chronic diseases were the influencing factors for the selection of medical institutions in Beijing in 2018 (P<0.05) . The Chow test demonstrated that increased rates of primary healthcare utilization were found mainly in residents with urban employee basic medical insurance〔OR (95%CI) =1.56 (1.24, 1.97) 〕 and those living in urban areas〔OR (95%CI) =1.27 (1.01, 1.58) 〕 (P<0.05) .ConclusionIn general, the primary healthcare utilization behaviors of Beijing residents showed an increase trend from 2013 to 2018, and the majority of them were those living in urban areas and/or having urban employee basic medical insurance.

Keywords

• |hierarchical diagnosis and treatment|community health services|health care reform|beijing