I Know Some People: The Association of Social Capital With Primary Health Care Utilization of Residents in China.

Background: Primary health care (PHC) services are underused due to the unbalanced distribution of medical resources. This is especially true in developing countries where the construction of PHC systems has begun to take effect. Social capital is one of the important factors affecting primary health care utilization. Method: This study investigated the utilization of PHC services by Chinese community residents in the past year. Social capital, PHC utilization, age, health care insurance, etc., were measured. A multilevel negative binomial model was adopted to analyze the association of social capital with PHC utilization. Results: Data of 5,471 residents from 283 communities in China were collected through a questionnaire survey in 2018. The results showed that community social capital (CSC) is significantly associated with PHC utilization in China, but individual social capital (ISC) had no significant association with PHC utilization. A one-standard deviation increase in the CSC leads to a 1.9% increase in PHC utilization. Other factors like gender, education, income, health insurance, health status, etc., are significantly associated with PHC utilization in China. Conclusions: Community social capital plays a more important role in promoting PHC utilization, while ISC plays an unclear role in PHC utilization by the residents of China.

Influence of Primary Health Care Physicians' Perceived Overqualification on Turnover Intention in China.

BACKGROUND: With the aging population and increasing prevalence of chronic disease, the number of primary health care physicians in China is inadequate and physicians' turnover intention is too high. OBJECTIVE: To analyze the status of primary health care physicians' turnover intention in China and the relationship between physicians' perceived overqualification and their turnover intention. METHODS: With multistage stratified sampling, we randomly selected 1456 primary health care physicians as study subjects. Information on personal characteristics, job satisfaction, working pressure, turnover intention, and perceived overqualification was collected. The data were analyzed using descriptive statistics and multiple regression analysis. RESULTS: We found that primary health care physicians in China have high turnover intention and perceived overqualification is positively related to turnover intention. CONCLUSION: Government and primary health care may address perceived overqualification to reduce physicians' turnover intention.

Factors influencing individuals' take-up of tax-subsidized private health insurance: a cross-sectional study in China.

Aims: To identify factors influencing individuals' take-up of tax-subsidized private health insurance.Methods: A self-administered questionnaire survey was conducted to collect data in Hangzhou, China. A logistic regression analysis was applied to find factors influencing individuals' take-up of tax-subsidized private health insurance.Results: A total of 1,610 participants joined the survey, and 1,543 valid cases were obtained. The logistic regression results showed that educational level, marital status, the number of elderly people to support, types of basic medical insurance covered, disease history, reimbursement rate of outpatient visits, reimbursement rate of inpatient visits, knowledge of tax-subsidized private health insurance, and ratio of the deduction to income influenced individuals' take-up of tax-subsidized private health insurance.Limitations: Sample representativeness may be sacrificed by the fact that the data were collected from one city (Hangzhou) in a cross-sectional investigation.Conclusions: Demographic variables, such as educational level, marital status, and the number of elderly people to support, have an impact on individuals' take-up of tax-subsidized private health insurance, while age and gender are not significant. People with disease history are more likely to take out tax-subsidized private health insurance. The ratio of deduction to income is positively correlated with the take-up of tax-subsidized private health insurance. Suggestions, such as strengthening the publicity of tax-subsidized private health insurance, increasing the deduction amount, and encouraging employers to provide tax-subsidized private health insurance for employees' families are provided with the hope to promote the development of tax-subsidized private health insurance in China.

Doctor's presenteeism and its relationship with anxiety and depression: a cross-sectional survey study in China.

OBJECTIVES: The impact of presenteeism on doctors' health, quality of patient care and overall performance of health institutions has been reported. The study aimed to investigate the prevalence of presenteeism among doctors, the association between presenteeism and anxiety/depression, and aspects that can help alleviate presenteeism. DESIGN: A cross-sectional anonymous survey study was conducted between 2017 and 2018. SETTING: 30 hospitals in Hangzhou city, Zhejiang Province, China including 10 category 1 hospitals (20-99 beds), 10 category 2 hospitals (100-499 beds) and 10 category 3 hospitals (> 500 beds) which had the highest population coverage. PARTICIPANTS: At least 3 doctors from each department in the studied hospitals participated. Each participant received a gift worth around US$5 at completion of the survey. PRIMARY AND SECONDARY OUTCOME MEASURES: The prevalence of presenteeism and its relationship with anxiety or depression were evaluated as the primary outcomes. Secondary outcomes included the prevalence of abnormal cases of anxiety and depression. RESULTS: The survey was completed by 1153/1309 hospital doctors (response rate 88.1%). Presenteeism was reported by 66.4% of participants. Using the Hospital Anxiety and Depression Scale, 68.8% and 72.3% of participants had abnormal cases of anxiety and depression, respectively. Logistic regression analysis showed that participants with abnormal cases of anxiety, borderline cases of depression or abnormal cases of depression were more likely to practice presenteeism (all p<0.05). Other significant work-related contributing factors included: time working at the current hospital, management duty, monthly salary and ease of replacement (all p<0.05). CONCLUSION: Presenteeism was prevalent among doctors in China and the association of presenteeism with abnormal cases of anxiety or depression was significant. Considering the modifiable work-related contributing factors, appropriate measures at the healthcare institutions to support doctors' mental health, help them develop and reinforce management skills, and ensure appropriate manpower are important to alleviate presenteeism behaviour.

Does an economic incentive affect provider behavior? Evidence from a field experiment on different payment mechanisms.

AIMS: This study analyzed discrepancies in the quantity of medical services supplied by physicians under different payment systems for patients with different health statuses and illnesses by means of a field experiment. METHODS: Based on the laboratory experiment of Heike Hennig-Schmidt, we designed a field experiment to examine fee-for-service (FFS), capitation (CAP), and diagnosis-related group (DRG) payment systems. Medical students were replaced with 220 physicians as experimental subjects, which more closely reflected the clinical choices made by physicians in the real world. Under the three payment mechanisms, the quantity of medical services provided by physicians when they treated patients with different health statuses and illnesses were collected. Finally, relevant statistics were computed and analyzed. RESULTS: It was found that payment systems (sig. = 0.000) and patient health status (sig. = 0.000) had a stronger effect on physicians' choices regarding quantity of medical services than illness types (sig. = 0.793). Additionally, under the FFS and CAP payment systems, physicians overserved patients in good and intermediate health while underserving patients in bad health. Under the DRG payment system, physicians overserved patients in good health and underserved patients in intermediate and bad health. Correspondingly, under FFS and CAP, the proportional loss of benefits was the highest for patients in bad health and the lowest for patients in good and intermediate health; while under DRGs, patients in good and intermediate health had the largest and smallest loss of benefits, respectively. LIMITATIONS: In order to increase external effects of experiment results, we used the field experiment to replace laboratory experiment. However, the external effects still existed because of the blurring and abstraction of the parameters. CONCLUSIONS: Medical treatment cost and price affected the quantity of medical services provided by physicians. Therefore, we proposed that a mix of payment systems could address the common interests of physicians and patients, as well as influence incentives from payment systems.