title: Health reforms in china: the public's choices for first-contact care in urban areas.
abstract: To examine the public's views towards their choice of first-contact care and its associated factors in urban China.
  
  
  
  A mixed-method study was adopted using individual interviews, focus group interviews and a cross-sectional survey. The study was conducted among the general public between September 2014 and September 2015 in Zhejiang province, China.
  
  
  
  Six focus groups and 13 individual interviews were conducted. The questionnaire was completed by 1248 respondents with a response rate of 83%. Survey results showed that 70% of the respondents preferred hospital-based services for first-contact care, it is especially the case with paediatric patients (83.3%). The qualitative data revealed that a major cause was the public distrust in the competence of primary care practitioners with lower educational qualifications. In the decision-making process, compared to cost factors like medical expenses and waiting times, participants attached greater emphasis on organizational characteristics. Respondents who rated sophisticated medical equipment, reputation of the facility, average education of doctors as important were significantly more inclined to choose hospital services. Respective adjusted odds ratios (AOR) were 2.14 (P < 0.001), 1.83 (P < 0.001) and 1.40 (P = 0.043) for their own conditions and 2.19 (P = 0.004), 1.94 (P = 0.002) and 1.86 (P = 0.003) for their children's conditions. Availability of medications and perceived severity of illness were also significantly associated with their choice of hospital services for their children.
  
  
  
  The public's preference for hospital-based services for first-contact care places a huge obstacle to promoting community-based primary care. Addressing the public's concerns about the primary care practitioners' competence is worth more efforts.
authors.affiliation: Department of Family Medicine and Primary Care, Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
authors.forename: Dan
authors.initials: D
authors.lastname: Wu
authors.affiliation: Department of Family Medicine and Primary Care, Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
authors.forename: Tai Pong
authors.initials: TP
authors.lastname: Lam
authors.affiliation: Department of Statistics and Actuarial Science, Faculty of Science, The University of Hong Kong, Hong Kong, China.
authors.forename: Kwok Fai
authors.initials: KF
authors.lastname: Lam
authors.affiliation: Institute of Social Medicine, School of Public Health, Zhejiang University, Zhejiang, China.
authors.forename: Xu Dong
authors.initials: XD
authors.lastname: Zhou
authors.affiliation: Department of Family Medicine and Primary Care, Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
authors.forename: Kai Sing
authors.initials: KS
authors.lastname: Sun
mesh_terms: D002755:Choice Behavior; D003430:Cross-Sectional Studies; D005260:Female; D017144:Focus Groups; D018166:Health Care Reform; D006761:Hospitals / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D014505:Urban Population
keywords: China; first-contact care; health reforms; primary care; service users