title: Community health centers and primary care access and quality for chronically-ill patients - a case-comparison study of urban Guangdong Province, China.
abstract: OBJECTIVE
  Reform of the health care system in urban areas of China has prompted concerns about the utilization of Community Health Centers (CHC). This study examined which of the dominant primary care delivery models, i.e., the public CHC model, the 'gate-keeper' CHC model, or the hospital-owned CHC models, was most effective in enhancing access to and quality of care for patients with chronic illness.
  
  
  METHODS
  The case-comparison design was used to study nine health care organizations in Guangzhou, Dongguan, and Shenzhen cities within Guangdong province, China. 560 patients aged 50 or over with hypertension or diabetes who visited either CHCs or hospitals in these three cities were surveyed by using face-to-face interviews. Bivariate analyses were performed to compare quality and value of care indicators among subjects from the three cities. Multivariate analyses were used to assess the association between type of primary care delivery and quality as well as value of chronic care after controlling for patients' demographic and health status characteristics.
  
  
  RESULTS
  Patients from all three cities chose their current health care providers primarily out of concern for quality of care (both provider expertise and adequate medical equipment), patient-centered care, and insurance plan requirement. Compared with patients from Guangzhou, those from Dongguan performed significantly better on most quality and value of care indicators. Most of these indicators remained significantly better even after controlling for patients' demographic and health status characteristics. The Shenzhen model (hospital-owned and -managed CHC) was generally effective in enhancing accessibility and continuity. However, coordination suffered due to seemingly duplicating primary care outpatients at the hospital setting. Significant associations between types of health care facilities and quality of care were also observed such that patients from CHCs were more likely to be satisfied with traveling time and follow-up care by their providers.
  
  
  CONCLUSIONS
  The study suggested that the Dongguan model (based on insurance mandate and using family practice physicians as 'gate-keepers') seemed to work best in terms of improving access and quality for patients with chronic conditions. The study suggested adequately funded and well-organized primary care system can play a gatekeeping role and has the potential to provide a reasonable level of care to patients.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA. lshi@jhsph.edu.
authors.forename: Leiyu
authors.initials: L
authors.lastname: Shi
authors.affiliation: Department of Information Management, Da-Yeh University, Changhua, 51591, Taiwan (ROC). dclee@mail.dyu.edu.tw.
authors.forename: De-Chih
authors.initials: DC
authors.lastname: Lee
authors.affiliation: Johns Hopkins Primary Care Policy Center, Baltimore, 624 N. Broadway, Baltimore, MD, 21205, USA. hliang16@jhu.edu.
authors.forename: Hailun
authors.initials: H
authors.lastname: Liang
authors.affiliation: School of Public Health of Sun Yat-sen University, 74, Zhongshan Road II, Guangzhou, 510275, China. zhangluwen1986@139.com.
authors.forename: Luwen
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Results for Development Institute, 1100 15th Street, NW, Washington, DC, 20005, USA. mmakinen@r4d.org.
authors.forename: Marty
authors.initials: M
authors.lastname: Makinen
authors.affiliation: Results for Development Institute, 1100 15th Street, NW, Washington, DC, 20005, USA. nblanchet@r4d.org.
authors.forename: Nathan
authors.initials: N
authors.lastname: Blanchet
authors.affiliation: Results for Development Institute, 1100 15th Street, NW, Washington, DC, 20005, USA. rkidane@r4d.org.
authors.forename: Ruth
authors.initials: R
authors.lastname: Kidane
authors.affiliation: The World Bank, 1225 Connecticut Avenue NW, Washington, DC, 20433, USA. mlindelow@worldbank.org.
authors.forename: Magnus
authors.initials: M
authors.lastname: Lindelow
authors.affiliation: Bill & Melinda Gates Foundation, 500 Fifth Avenue North, Seattle, WA, 98109, USA. Hong.Wang@gatesfoundation.org.
authors.forename: Hong
authors.initials: H
authors.lastname: Wang
authors.affiliation: School of Public Health of Sun Yat-sen University, 74, Zhongshan Road II, Guangzhou, 510275, China. wushlong@mail.sysu.edu.cn.
authors.forename: Shaolong
authors.initials: S
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002681:China; D002908:Chronic Disease / Q000628:therapy*; D003151:Community Health Centers / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data*