title: Performance comparison among the major healthcare financing systems in six cities of the Pearl River Delta region, mainland China.
abstract: BACKGROUND
  The healthcare system of mainland China is undergoing drastic reform and the optimal models for healthcare financing for provision of primary care will need to be identified. This study compared the performance indicators of the community health centres (CHCs) under different healthcare financing systems in the six cities of the Pearl River Delta region.
  
  
  METHODS
  Approximately 300 hypertensive patients were randomly recruited from the computerized chronic disease management records provided by one CHC in each of the six cities in 2011 using a multi-stage cluster random sampling method. The major outcome measures included the treatment rate of hypertension, defined as prescription of ≥ one antihypertensive agent; and the control rate of hypertension, defined as systolic blood pressure levels <140 mmHg and diastolic blood pressure levels <90 mmHg in patients without diabetes mellitus, or <130/80 mmHg among patients with concomitant diabetes. Binary logistic regression analyses were conducted with these two measures as outcome variables, respectively, controlling for patients' socio-demographic variables. The financing system (Hospital- vs. Government- vs. private-funded) was the independent variable tested for association with the outcomes.
  
  
  RESULTS
  From 1,830 patients with an average age of 65.9 years (SD 12.8), the overall treatment and control rates were 75.4% and 20.2%, respectively. When compared with hospital-funded CHCs, patients seen in the Government-funded (adjusted odds ratio [AOR] 0.462, 95% C.I. 0.325-0.656) and private-funded CHCs (AOR 0.031, 95% C.I. 0.019-0.052) were significantly less likely to be prescribed antihypertensive medication. However, the Government-funded CHC was more likely to have optimal BP control (AOR 1.628, 95% C.I. 1.157-2.291) whilst the privately-funded CHC was less likely to achieve BP control (AOR 0.146, 95% C.I. 0.069-0.310), irrespective of whether antihypertensive drugs were prescribed.
  
  
  CONCLUSIONS
  Privately-funded CHCs had the lowest rates of BP treatment and control due to a variety of potential factors as discussed.
authors.affiliation: School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China.
authors.forename: Martin C S
authors.initials: MC
authors.lastname: Wong
authors.forename: Harry H X
authors.initials: HH
authors.lastname: Wang
authors.forename: Samuel Y S
authors.initials: SY
authors.lastname: Wong
authors.forename: Xiaolin
authors.initials: X
authors.lastname: Wei
authors.forename: Nan
authors.initials: N
authors.lastname: Yang
authors.forename: Zhenzhen
authors.initials: Z
authors.lastname: Zhang
authors.forename: Haitao
authors.initials: H
authors.lastname: Li
authors.forename: Yang
authors.initials: Y
authors.lastname: Gao
authors.forename: Donald K T
authors.initials: DK
authors.lastname: Li
authors.forename: Jinling
authors.initials: J
authors.lastname: Tang
authors.forename: Jiaji
authors.initials: J
authors.lastname: Wang
authors.forename: Sian M
authors.initials: SM
authors.lastname: Griffiths
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D003151:Community Health Centers / Q000191:economics / Q000458:organization & administration; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005380:Financing, Government; D061889:Healthcare Financing; D016304:Hospitals, Private; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration; D016896:Treatment Outcome; D019037:Urban Health Services / Q000191:economics / Q000458:organization & administration
chemical_list: D000959:Antihypertensive Agents