title: Experiences with primary healthcare in Fuzhou, urban China, in the context of health sector reform: a mixed methods study.
abstract: China has recently placed increased emphasis on the provision of primary healthcare services through health sector reform, in response to inequitably distributed health services. With increasing funding for community level facilities, now is an opportune time to assess the quality of primary care delivery and identify areas in need of further improvement. A mixed methodology approach was adopted for this study. Quantitative data were collected using the Primary Care Assessment Tool-Chinese version (C-PCAT), a questionnaire previously adapted for use in China to assess the quality of care at each health facility, based on clients' experiences. In addition, qualitative data were gathered through eight semi-structured interviews exploring perceptions of primary care with health directors and a policy maker to place this issue in the context of health sector reform. The study found that patients attending community health and sub-community health centres are more likely to report better experiences with primary care attributes than patients attending hospital facilities. Generally low scores for community orientation, family centredness and coordination in all types of health facility indicate an urgent need for improvement in these areas. Healthcare directors and policy makers perceived the need for greater coordination between levels of health providers, better financial reimbursement, more formal government contracts and recognition/higher status for staff at the community level and more appropriate undergraduate and postgraduate training.
authors.affiliation: Liverpool School of Tropical Medicine, International Public Health, Liverpool, UK.
authors.forename: Rosalind
authors.initials: R
authors.lastname: McCollum
authors.forename: Lieping
authors.initials: L
authors.lastname: Chen
authors.forename: Tang
authors.initials: T
authors.lastname: ChenXiang
authors.forename: Xiaoyun
authors.initials: X
authors.lastname: Liu
authors.forename: Barbara
authors.initials: B
authors.lastname: Starfield
authors.forename: Zheng
authors.initials: Z
authors.lastname: Jinhuan
authors.forename: Rachel
authors.initials: R
authors.lastname: Tolhurst
mesh_terms: D002681:China; D018166:Health Care Reform / Q000458:organization & administration*; D006801:Humans; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D011787:Quality of Health Care / Q000458:organization & administration; D019037:Urban Health Services / Q000458:organization & administration* / Q000592:standards
keywords: China; primary care assessment tool; primary health care; quality