Affiliation:
1. China Centre for Health Development Studies Peking University Beijing China
2. School of Management Beijing University of Chinese Medicine Beijing China
3. Australian National Institute of Management and Commerce Sydney New South Wales Australia
4. Research Institute for International Strategies Guangdong University of Foreign Studies Guangdong China
5. School of Economics and School of Management Tianjin Normal University Tianjin China
6. Newcastle Business School University of Newcastle University Drive Newcastle New South Wales Australia
Abstract
AbstractBackgroundStronger primary health care (PHC) is critical to achieving the United Nations' Sustainable Development Goals. However, there is scarce evidence on the impact of PHC on health system performance in developing countries. Since 2009, China has implemented an ambitious health system reform, among which PHC has received unprecedented attention. This study investigates the role of PHC resource in improving health status, financial protection and health equity.MethodsWe obtained province‐level and individual‐level data to conduct a longitudinal study across the period of China's health system reform. The dependent variables included health outcomes and financial protection. The independent variables were the number of PHC physicians and share of PHC physicians in all physicians. Mixed‐effect models were used for adjusted associations.ResultsFrom 2003 to 2017, the number of PHC physicians slightly increased by 31.75 per 100,000 persons and the share of PHC physicians in all physicians increased by 3.62 percentage points. At the province level, greater PHC physician density was positively associated with life expectancy, negatively associated with age‐standardized excess mortality, infectious disease mortality, perinatal mortality low birth weight, as well as the share of health expenses in total consumption expenses. At the individual and household level, greater PHC physician density was positively associated with self‐assessed health, and negatively associated with incidence of catastrophic health expenditures. Compared to other quintiles, the poorest quintile benefited more from PHC physician density.ConclusionsIn China, an increased PHC physician supply was associated with improved health system performance. While China's PHC system has been strengthened in the context of China's health system reforms, further effective incentives should be developed to attract more qualified PHC workers.
Reference43 articles.
1. Why strengthening primary health care is essential to achieving universal health coverage
2. Geneva: World Health Organization.Primary Health Care on the Road to Universal Health Coverage: 2019 Monitoring Report: Executive Summary;2019.