title: Comparison of three models of ownership of community health centres in China: a qualitative study.
abstract: OBJECTIVE
  Community health centres are the main form of provision of primary care in China. There are three models: government managed, hospital managed and private. Our aim was to describe and compare primary care under the three ownership models.
  
  
  METHODS
  Four aspects of primary care were studied: services, organization, financing and human resources. Interviews were undertaken with 60 managerial and professional staff in 13 community health centres in the Pearl River Delta region in 2010. Three community health centres were selected in the capital city and two were selected from each of the other five cities. Thematic framework analysis was conducted.
  
  
  RESULTS
  Government-managed community health centres received the largest public funding, followed by hospital-managed community health centres, while private community health centres received the least. Private community health centres were the smallest in scale and provided lower quality public health services compared with the other two models. Patient out-of-pocket costs accounted for the majority of the revenue in all models of community health centres despite improved government funding for preventive services. General challenges such as the shortage of public funding, the exclusion of migrants in the funding for preventive services, low capacity in human resources and the separation of clinical and preventive care in community health centres were identified in all three models of community health centres.
  
  
  CONCLUSIONS
  The ownership and management of a community health centre greatly influence the service it provides. Private community health centres are in a disadvantaged position to deliver high quality clinical and preventive care.
authors.affiliation: Assistant Professor, The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, China Assistant Professor, Shenzhen Municipal Key Laboratory for Health Risk Analysis, Shenzhen Research Institute of The Chinese University of Hong Kong, China xiaolinwei@cuhk.edu.hk.
authors.forename: Xiaolin
authors.initials: X
authors.lastname: Wei
authors.affiliation: Research Assistant, The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, China.
authors.forename: Nan
authors.initials: N
authors.lastname: Yang
authors.affiliation: Assistant Professor, The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, China Assistant Professor, Department of Physical Education, the Hong Kong Baptist University, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Professor, The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, China.
authors.forename: Samuel Y S
authors.initials: SY
authors.lastname: Wong
authors.affiliation: Associate Professor, The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, China.
authors.forename: Martin C S
authors.initials: MC
authors.lastname: Wong
authors.affiliation: Professor, School of Public Health, Guangzhou Medical University, China.
authors.forename: Jiaji
authors.initials: J
authors.lastname: Wang
authors.affiliation: Lecturer, The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, China.
authors.forename: Harry H X
authors.initials: HH
authors.lastname: Wang
authors.affiliation: Chair, Bauhinia Foundation Research Centre, China.
authors.forename: Donald K T
authors.initials: DK
authors.lastname: Li
authors.affiliation: Associate Professor, The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, China Professor, Shenzhen Municipal Key Laboratory for Health Risk Analysis, Shenzhen Research Institute of The Chinese University of Hong Kong, China.
authors.forename: Jinling
authors.initials: J
authors.lastname: Tang
authors.affiliation: Professor Emeritus, The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, China.
authors.forename: Sian M
authors.initials: SM
authors.lastname: Griffiths
mesh_terms: D002681:China; D003151:Community Health Centers / Q000191:economics / Q000458:organization & administration*; D005382:Financing, Personal; D006280:Health Workforce; D006801:Humans; D010067:Ownership / Q000191:economics / Q000458:organization & administration*; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D017149:Private Sector; D017150:Public Sector; D036301:Qualitative Research
keywords: China; ownership models; primary care