The establishment of a primary care-oriented healthcare system is crucial to enhancing the performance and sustainability of China's healthcare system. However, the relatively low utilization of primary care services remains a central barrier to the implementation of a tiered healthcare system.
Identify the institutional operational and environmental characteristics associated with the level of primary care service utilization, thereby providing policy recommendations for optimizing primary care.
A search of CNKI, Wanfang, VIP, Web of Science, and PubMed databases up to December 2022 yielded 245 Chinese and English empirical studies. These literatures were included to sort out influencing factors by referencing the WHO's six-building-block health system framework and the Andersen Behavioral Model of Health Services Use. Partial least squares structural equation modeling was used to analyze cross-sectional data from 153 primary care institutions in a case city in Shandong Province in 2021, sourced from financial reports, statistical yearbooks, and institutional questionnaires, to examine the correlations between institutional operational and environmental characteristics and the utilization of primary care services.
The review showed that primary care service utilization is influenced by four categories of factors: supply-side, demand-side, health system, and social environment. The structural equation modeling analysis showed that the model had an explanatory power (R2) of 0.489 and a predictive relevance (Q2) of 0.158. Healthcare service capacity (β=0.471, P<0.001), public health service quality (β=0.266, P=0.037), residents' health literacy (β=0.328, P<0.001), residents' health status (β=0.187, P=0.041), and geographical accessibility of primary care services (β=0.270, P=0.003) were significantly positively correlated with the utilization of primary care services, while participation in a regional medical alliance was significantly negatively correlated (β=-0.468, P=0.023).
To promote primary care utilization, rational resource allocation and improved geographical accessibility should form the foundation. Service delivery must prioritize strengthening clinical capacity for managing common diseases and advance the integration of medical and preventive care. The development of medical alliances requires the establishment of mechanisms for shared benefits and risks across institutional levels to promote the utilization of primary healthcare services. Concurrently, continuous efforts are needed to elevate residents' health literacy and overall health status.
Diabetes is a global public health issue. The county medical consortium integrates medical resources within the county to improve the efficiency of chronic disease management and service accessibility, and reduce unnecessary hospitalizations.
To evaluate the impact of establishing a compact county medical consortium on the utilization and cost control of diabetes inpatient services, providing evidence for optimizing chronic disease hierarchical diagnosis and treatment policies.
In June 2025, diabetes inpatient case data from January 2016 to June 2020 were collected from the hospital discharge summary systems of Yangxi County, Guangdong Province (which implemented medical consortium reform in November 2017) as the intervention group, and Yangchun City (which implemented the reform in April 2020) as the control group. Interrupted Time Series Analysis (ITS) was adopted, and changes in hospitalization volume, readmission volume, average length of stay, and costs were analyzed through Ordinary Least Squares (OLS) regression, Poisson regression, and Generalized Linear Model (GLM).
After the implementation of the medical community, the intervention group showed a significant decrease in hospitalization volume (immediate effect β=-52.825, P=0.008); however, no improvement was observed in readmission volume (β=-3.978, P=0.271). The control group showed a significant increase in hospitalization volume (immediate effect β=57.473, P<0.001), and readmission volume also exhibited an increasing trend (immediate effect β=5.485, P=0.033). The average hospitalization cost in the intervention group increased slightly (long-term effect β=0.039, P<0.001), whereas the control group showed a downward trend in average hospitalization cost (long-term effect β=-0.010, P<0.001). No significant changes were observed in the average length of stay in either the intervention group or the control group (P=0.256 and P=0.101, respectively).
The medical consortium effectively diverted mild diabetes cases through resource integration. reducing unnecessary hospitalization services, but no significant effects have yet been observed in terms of medical service quality and cost control. It is recommended to establish a synergistic mechanism integrating "payment reform - capacity building at the primary level - digital empowerment" to improve hierarchical management of chronic diseases.
The National Basic Public Health Service Program aims to reduce the long-term burden on patients with chronic diseases. However, whether it can effectively reduce hospitalization costs and improve long-term survival outcomes remains to be systematically evaluated.
Using hospitalized patients with diabetes as an example, to assess the impact of standardized basic public health service management on hospitalization costs and mortality outcomes.
Medical record homepage data, Basic Public Health Service Program data, and mortality registration data from 10 counties in Henan Province from 2019 to 2024 were selected using cluster random sampling. A comparable cohort was constructed using propensity score matching (PSM). In the matched sample, multiple linear regression was used to analyze the effect of inclusion in standardized basic public health service management on hospitalization costs among patients with diabetes. Kaplan-Meier (KM) curves and time-stratified Cox regression were used to evaluate its impact on all-cause mortality, diabetes-related mortality, and cardiovascular and cerebrovascular mortality.
A total of 121 869 patients with diabetes were included, including 52 329 patients who were enrolled in standardized basic public health service management (management group) and 69 540 who were not (non-management group); 14 027 patients were in the death group and 107 842 in the survival group. Before matching, baseline characteristics differed between the management group and non-management group. After PSM, each group contained 52 329 patients, and all covariates were well balanced. Multiple linear regression analysis of factors affecting hospitalization costs in patients with diabetes showed that hospitalization costs in the management group were reduced by 2.86% compared with the non-management group (95%CI=2.08%-3.63%, P<0.001); sensitivity analysis yielded consistent results. The KM curves showed that the all-cause mortality rate, diabetes-related mortality rate, and cardiovascular and cerebrovascular mortality rate were all lower in the management group than in the non-management group (P<0.001). Time-stratified Cox regression showed that during follow-up <1 year, the HRs for all-cause mortality, diabetes mortality, and cardiovascular and cerebrovascular mortality in the management group were 0.19, 0.20, and 0.19, respectively, corresponding to mortality risk reductions of 81%, 80%, and 81%; during follow-up 1-2 years, the HRs for the three mortality outcomes were 0.22, 0.26, and 0.22, respectively, corresponding to risk reductions of 78%, 74%, and 78%; during follow-up >2 years, the HRs for the three mortality outcomes were 0.41, 0.43, and 0.41, respectively, corresponding to risk reductions of 59%, 57%, and 59%.
Inclusion in basic public health service management is associated with lower hospitalization costs and lower risks of all-cause mortality, diabetes mortality, and cardiovascular and cerebrovascular mortality among county-level hospitalized patients with diabetes, and the association with mortality risk varies across follow-up stages. It is recommended to continuously promote basic public health service management, pay attention to patients with a higher hospitalization economic burden and a higher risk of diabetes complications, and strengthen early identification, standardized referral, and continuous follow-up of high-risk diabetic complications at the primary care level, so as to further consolidate its benefits in reducing hospitalization economic burden and improving survival outcomes.
The tiered healthcare delivery system is a crucial component in deepening healthcare reform. Analyzing the healthcare-seeking choices of outpatients and their influencing factors from the demand-side perspective, based on real-world data, holds significant practical importance for advancing the tiered healthcare system and promoting the high-quality development of healthcare services.
To identify outpatient healthcare-seeking behavior and influencing factors among residents of Guangdong Province in the context of tiered healthcare system. The report is for supporting policies on rational healthcare utilization.
Data were obtained from the Seventh National Health Service Survey, which was completed in september-october 2023, covering eight sampled counties (districts/cities) of Guangdong Province. The study population consisted of residents who reported experiencing an illness within two weeks and sought medical care at a healthcare institution (n=2 213). Taking "whether patients choose first contact at primary care facilities for sickness within two-weeks" as the dependent variable, a multivariate Logistic regression analysis was conducted to identify the influencing factors.
Of the residents who reported an illness within the two-week period, 1 597 individuals [accounting for 72.16%] sought their initial medical consultation at a primary healthcare institution. Patients in rural areas (OR=1.561, 95%CI=1.170-2.082), proximity to a primary care facility (OR=3.870, 95%CI=2.915-5.136), enrollment in urban-rural resident basic medical insurance (OR=2.209, 95%CI=1.695-2.879), and perceived mild illness (OR=3.458, 95%CI=2.449-4.883) were more likely to choose primary care facility, while those with education levels above high school (OR=0.498, 95%CI=0.293-0.847) and didn't contract with a family doctor (OR=0.671, 95%CI=0.504-0.894) were more likely to seek care at non-primary healthcare institutions.
The majority of Guangdong residents preferred primary care facility for first contact, but there is still a space of improvement. Both environmental and individual factors significantly influence healthcare-seeking choices. Efforts should focus on optimizing the distribution and accessibility of primary care facilities, strengthening service capacity and management efficiency, to promote rational healthcare utilization of residences.
