Does having a usual primary care provider reduce patient self-referrals in rural China's rural multi-tiered medical system? A retrospective study in Qianjiang District, China

• Type of Material: Article
• Authors: Da Feng, Huazhong University of Science and Technology; Donglan Zhang, University of Georgia; Boyang Li, Huazhong University of Science and Technology; Yan Zhang, Huazhong University of Science and Technology; Ray Serrano, Emory University; Danxiang Shi, Shanghai First Maternity and Infant Hospital; Yuan Liu, Emory University; Liang Zhang, Huazhong University of Science and Technology
• Language: English
• Date: 2017-11-28
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © 2017 The Author(s).
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12913-017-2673-6
• Title of Journal or Parent Work: BMC Health Services Research
• ISSN: 1472-6963
• Volume: 17
• Issue: 1
• Start Page: 778
• End Page: 778
• Grant/Funding Information: This study was supported by grants from the Natural Science Foundation of China: Research of rural medical service vertical integration management model based on CAS theory (71273099).; This study was supported by grants from the rural medical service vertical integration management model based on CAS theory (71273099).
• Keywords: COUNTRIES; Life Sciences & Biomedicine; HEALTH-CARE; Multi-tiered medical system; QUALITY; Health Care Sciences & Services; Science & Technology; Self-referral; CANCER; DELIVERY; ACCESS; Usual primary care provider; SERVICES; PATIENTS PERCEPTIONS; REFORM; SEEKING
• Research Categories: Health Sciences, Public Health; Health Sciences, Health Care Management

Abstract

Introduction: Within China's multi-tiered medical system, many patients seek care in higher-tiered hospitals without a referral by a primary-care provider. This trend, generally referred to as patient self-referral behavior, may reduce the efficiency of the health care system. This study seeks to test the hypothesis that having a usual primary care provider could reduce patients' self-referral behavior. Methods: We obtained medical records of 832 patients who were hospitalized for common respiratory diseases from township hospitals in Qianjiang District of Chongqing City during 2012-2014. Logit regressions were performed to examine the association between having a township hospital as a usual provider and self-referring to a county hospital after being discharged from a township hospital, while controlling for patients' gender, age, income, education, severity of disease, distance to the nearest county hospital and the general quality of the township hospitals in their community. A propensity score weighting approach was applied. Results: We found that having a usual primary care provider was associated with a lower likelihood of self-referral (odds ratio = 0.58, 95% confidence interval [CI] =0.41-0.82), and a 9% (95% CI: -14%, - 3%) reduction in the probability of patients' self-referral behavior. Discussion/conclusion: The results suggest that establishing a long-term relationship between patients and primary care providers may enhance the patient-physician relationship and reduce patients' tendency for unnecessary use of medical resources.