Comparison of health care utilization among users of public and private community health centres in urban China.

ABSTRACT

BACKGROUND: In China, the government has encouraged the participation of private sector facilities in primary care to improve health care quality. OBJECTIVE: We compare health care utilization patterns among patients who select private versus public community health centres (CHCs) for reimbursed outpatient services. METHODS: This paper uses data from the Urban Employee Basic Medical Insurance scheme from 2013 to 2016 in one of the largest cities in China. We used a Poisson model and a logistic model to examine outcomes on monthly outpatient visits and the probability of hospitalization, respectively. RESULTS: Compared with being a user of a public CHC, being a user of a private CHC is associated with a 26.2% lower incidence rate of outpatient visits to hospitals [95% confidence interval (CI) 30.1-21.8%] and no difference in rates of visits to CHCs or hospitalization. Among patients with diabetes or hypertension, being a user of a private CHC is associated with a 12.9% lower incidence rate of outpatient visits to CHCs (95% CI 19.8-5.4%), a 25.6% lower incidence rate of outpatient visits to hospitals (95% CI 21.4-19.5%) and 22.3% higher odds of hospitalization (95% CI 3.5-44.7%). CONCLUSION: Being a user of a private CHC is associated with a reduction in outpatient visits to hospitals, which aligns with the goal of reducing hospital congestion at the outpatient level. For patients with chronic diseases, being a user of a private CHC is associated with a higher probability of hospitalization. More research is needed to understand the reason for this difference.