Patients’ Experiences in Different Models of Community Health Centers in Southern China

Harry H. X. Wang; Samuel Y. S. Wong; Martin C. S. Wong; Xiao Lin Wei; Jia Ji Wang; Donald K. T. Li; Jin Ling Tang; Gemma Y. Gao; Sian M. Griffiths

doi:10.1370/afm.1545

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Shaping delivery of primary health care through China's CHCs
Sabrina T. Wong

Published on: 23 December 2013
Author response: Emerging and Evolving Role of Privately Owned Community Health Centres in China
Samuel YS Wong

Published on: 29 November 2013
Emerging and Evolving Role of Privately Owned Community Health Centers (CHCs) in China
Susan X Lin

Published on: 26 November 2013

Published on: (23 December 2013)
Page navigation anchor for Shaping delivery of primary health care through China's CHCs
Shaping delivery of primary health care through China's CHCs
Sabrina T. Wong, Associate Professor
We would agree with the comments provided by the authors of previous letters and those of the Wang, et al manuscript that more work is needed to examine the association between models of primary health care delivery and patients' experiences of quality of care. Wang, et al's study provides important information on the increasingly important role that community health centres (CHCs) are playing in the delivery of primary h...
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We would agree with the comments provided by the authors of previous letters and those of the Wang, et al manuscript that more work is needed to examine the association between models of primary health care delivery and patients' experiences of quality of care. Wang, et al's study provides important information on the increasingly important role that community health centres (CHCs) are playing in the delivery of primary health care. In 2010, 37% of CHCs were G-CHCs, 34% were H-CHCs, and 29% were P-CHCs1. Certainly the role of government in owning and managing CHCs continues to increase, boding well for urban and suburban residents in China. At the same time, the number of privately owned and managed CHCs is increasing at a faster rate than G-CHCs. Monitoring the rate of increase in number of P- CHCs and their ability to provide the same or higher quality primary health care compared to G-CHCs is needed. Too many P-CHCs or other models that are not publicly funded could lead to further health and health care inequities.
A comparison of primary care assessment scores by CHC model doesn't show any one outstanding performer across all areas of measured by the PCAT (see Table 2). Moreover, the overall lower PCAT scores for the P-CHCs compared to the G-CHCs could also be due to lower trust of patients attending P-CHCs; Patients may believe that P-CHCs are motivated mainly in making a profit and not working to provide the highest quality care to them (personal communication, Community health association of China; Dec. 2013). In those attending H-CHCs, patient reported experiences are significantly lower for the uninsured. In addition to the authors' interpretation for these lower PCAT scores, we would suggest that with less government input into the operation of the H-CHCs there is more emphasis on medical care particularly for those who are insured and less priority given to population health interventions (e.g., prevention and public health services) delivered within a primary care setting.
To address potential health and health inequity among patients attending the different types of CHCs, the Chinese government will gradually modify their operation through slowing the growth of some types of CHCs, innovations in funding and financing, and improving their operating systems for eventual performance reporting. The time is ripe for conducting research that would influence policy decisions on how CHCs could be improved in order to strengthen primary health care in China.
1. Chinese Health Statistics Summary. Ministry of Health of the People's Republic of China. Beijing, China, 2011.
Sabrina T. Wong, Associate Professor University of British Columbia, School of Nursing and Centre for Health Services and Policy Research
Delu Yin, Assistant Professor Capital Institute of Pediatrics and Community Health Association of China
Competing interests: ?? None declared
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Competing Interests: None declared.
Published on: (29 November 2013)
Page navigation anchor for Author response: Emerging and Evolving Role of Privately Owned Community Health Centres in China
Author response: Emerging and Evolving Role of Privately Owned Community Health Centres in China
Samuel YS Wong, Professor
As suggested by Lin S, more evidence based studies are needed to provide more micro-level data to help policy makers to understand various factors that could potentially explain the differences we found with respect to primary care experiences between the privately owned and government owned CHCs in China. In another study conducted in Hong Kong (1), our group has shown that primary care services provided by the privat...
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As suggested by Lin S, more evidence based studies are needed to provide more micro-level data to help policy makers to understand various factors that could potentially explain the differences we found with respect to primary care experiences between the privately owned and government owned CHCs in China. In another study conducted in Hong Kong (1), our group has shown that primary care services provided by the private sector in Hong Kong were more accessible and had better continuity of care (interpersonal) as compared to those provided by the government although patients in the lower socioeconomic status tended to have poorer primary care experiences. As limited research has been conducted on the models of primary care delivery and patient oriented outcomes in China, it would be important to have further discussions and debates as well as further studies to explore the relationships between various models of care and quality of care and primary care experiences, as well as the relationship between models of care and health inequality in the future.
1. Wong SYS, Kung K, Griffiths SM, Carthy T, Wong MCS, Lo SV, Chung VCH, Goggins W, Starfield B. Comparison of primary care experiences among adults in general outpatient clinics and private general practice clinics in Hong Kong. BMC Public Health. 2010;10:397.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (26 November 2013)
Page navigation anchor for Emerging and Evolving Role of Privately Owned Community Health Centers (CHCs) in China
Emerging and Evolving Role of Privately Owned Community Health Centers (CHCs) in China
Susan X Lin, Assistant Professor
This study reported that patients who seek care in government owned and managed CHCs had better primary care experiences than did patients from hospital and private owned CHCs in the more economically developed regions in Southern China. The same research team also compared outcomes of treating hypertension in different models of CHCs in the same areas and found that patients treated in the privately owned CHCs had lowest...
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This study reported that patients who seek care in government owned and managed CHCs had better primary care experiences than did patients from hospital and private owned CHCs in the more economically developed regions in Southern China. The same research team also compared outcomes of treating hypertension in different models of CHCs in the same areas and found that patients treated in the privately owned CHCs had lowest rates of BP control1.
As China continues to carry out health care reforms and is experimenting with different service delivery models, these study findings have important policy implications. More evidence based studies like these ones are needed to provide micro-level data for policy makers to fully understand the underlying factors that can account for the differences associated with the performance of providing primary care and patient outcomes in different models of CHCs.
China has a short history of developing CHCs to provide community based primary care. CHCs have great potentials to provide affordable, accessible and equal primary care to people in both urban and rural areas. The majority of CHCs in 2008 were owned by government and only 9% of them had private ownership 2. While privately owned CHCs exist and may continue to increase, it is important to evaluate the role of privately owned CHCs in the current and future development of CHCs in China. The study findings with a focus on comparing the performance of providing primary care in different models can lead to more discussions and debates on (1) how CHCs with private ownership can improve patient care quality and outcomes; (2) whether various service delivery models will create more disparities or close the gaps between the poor and rich; (3) whether privately owned CHCs can become a viable model to meet the needs of patients and the society; (4) whether privately owned CHCs best function in urban or in rural areas. Regardless of ownership type, further development of CHCs in China needs to address issues of standardizing education and training programs of primary care providers, improving patient trust through providing affordable, accessible and good primary care, and developing efficient referral systems to meet care needs of patients.
1. Wong MC, Wang HH, Wong SY, et al. Performance comparison among the major healthcare financing systems in six cities of the Pearl River Delta region, mainland China. PloS one. 2012;7(9):e46309.
2. Bhattacharyya O, Delu Y, Wong ST, Bowen C. Evolution of primary care in China 1997-2009. Health policy (Amsterdam, Netherlands). May 2011;100(2-3):174-180.
Competing interests: ?? None declared
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Competing Interests: None declared.