Patients' experiences in different models of community health centers in southern China.
OBJECTIVE
Current health care reforms in China have an overall goal of strengthening primary care through the establishment and expansion of primary care networks based on community health centers (CHCs). Implementation in urban areas has led to the emergence of different models of ownership and management. The objective of this study was to evaluate the primary care experiences of patients in the Pearl River Delta as measured by the Primary Care Assessment Tool (PCAT) and the relationships with ownership and management in the 3 different models we describe.


METHODS
This cross-sectional study was conducted on-site at CHCs in 3 cities within the Pearl River Delta, China, using a multistage cluster sampling method. A validated Mandarin Chinese version of the PCAT-Adult Edition (short version) was adopted to collect information from adult patients regarding their experiences with primary care sources. PCAT scores for individual primary care attributes and total primary care assessment scores were assessed with respect to sociodemographic characteristics, health characteristics, and health care service utilization across 3 primary care models.


RESULTS
One thousand four hundred forty (1,440) primary care patients responded to the survey, for an overall response rate of 86.1%. Respondents gave government-owned and -managed CHCs the highest overall PCAT scores when compared with CHCs either managed by hospitals (95.18 vs 90.81; P = .005) or owned by private and social entities (95.18 vs 90.69; P =.007) as a result of better first-contact care (better first-contact utilization) and coordination of care (better service coordination and information system). Factors that were positively and significantly associated with higher overall assessment scores included the presence of a chronic condition (P <.001), having medical insurance (P = .006), and a self-reported good health status (P <.001).


CONCLUSIONS
This study suggests that government-owned and -managed CHCs may be able to provide better first-contact care in terms of utilization and coordination of care, and may be better at solving the problem of underutilization of the CHCs as the first-contact point of care, one key problem facing the reforms in China.
School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
Harry H X
HH
Wang
Samuel Y S
SY
Wong
Martin C S
MC
Wong
Xiao Lin
XL
Wei
Jia Ji
JJ
Wang
Donald K T
DK
Li
Jin Ling
JL
Tang
Gemma Y
GY
Gao
Sian M
SM
Griffiths
D000328:Adult; D000368:Aged; D001294:Attitude to Health; D002681:China; D003151:Community Health Centers / Q000458:organization & administration / Q000592:standards*; D003430:Cross-Sectional Studies; D005260:Female; D006078:Government Programs / Q000458:organization & administration / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration / Q000592:standards*; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D011785:Quality Assurance, Health Care; D011795:Surveys and Questionnaires
community health center; ownership and management model; primary care assessment tool; primary health care