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Association between Primary Healthcare and Medical Expenditures in a Context of Hospital-Oriented Healthcare System in China: A National Panel Dataset, 2012–2016

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  • Mengping Zhou

    (Department of Health Administration, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China)

  • Jingyi Liao

    (Department of Health Administration, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China)

  • Nan Hu

    (Department of Biostatistics, FIU Robert Stempel College of Public Health and Social Work, Miami, FL 33199, USA
    Department of Family and Preventive Medicine, and Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT 84132, USA)

  • Li Kuang

    (Department of Health Administration, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China)

Abstract

Total health expenditure in China has grown considerably since a new round of health system reform was enacted in 2009. Researchers have shown that strengthening primary healthcare may be an option for countries to solve the rapid expansion of their medical expenditures. This study was designed to explore the association between the strength of primary healthcare and medical expenditures, in the context of the hospital-oriented healthcare system in China. A longitudinal ecological study was conducted using a 5-year panel dataset of 27 provinces in mainland China. The linear mixed effects regression model was used to assess the effects of primary healthcare-related metrics on medical expenditures, controlling for the provincial level specialty care physician supply and socio-economic parameters. All of the three primary healthcare-related metrics showed negative associations with the two medical expenditure parameters. Primary care physicians per 10,000 population was significantly associated with the per capita hospital medical expenditures ( p < 0.05), and the percentage of public health expenditure in total health expenditure was significantly associated with both per capita total medical expenditure and per capita hospital medical expenditures ( p < 0.01 for both). Our study found negative associations between the primary healthcare capacity and medical expenditure in the context of hospital-oriented healthcare systems in China, adding to the previous evidence that primary healthcare may play a positive role in reducing medical expenditure. Policies on increasing the primary care physician supply and the public share of total health expenditure should be conducted to strengthen the primary healthcare system. With the gradual advance of medical reform and the policy inclination to primary healthcare, this will play a more important role in controlling the rapid growth of medical expenditure.

Suggested Citation

  • Mengping Zhou & Jingyi Liao & Nan Hu & Li Kuang, 2020. "Association between Primary Healthcare and Medical Expenditures in a Context of Hospital-Oriented Healthcare System in China: A National Panel Dataset, 2012–2016," IJERPH, MDPI, vol. 17(18), pages 1-12, September.
    • Handle: RePEc:gam:jijerp:v:17:y:2020:i:18:p:6917-:d:417213
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    1. Jacob Novignon & Solomon Olakojo & Justice Nonvignon, 2012. "The effects of public and private health care expenditure on health status in sub-Saharan Africa: new evidence from panel data analysis," Health Economics Review, Springer, vol. 2(1), pages 1-8, December.
    2. Starfield, Barbara & Shi, Leiyu, 2002. "Policy relevant determinants of health: an international perspective," Health Policy, Elsevier, vol. 60(3), pages 201-218, June.
    3. Huazhang Li & Kun Liu & Jianjun Gu & Yimin Zhang & Yun Qiao & Xiaoming Sun, 2017. "The development and impact of primary health care in China from 1949 to 2015: A focused review," International Journal of Health Planning and Management, Wiley Blackwell, vol. 32(3), pages 339-350, July.
    4. Hansen, Paul & King, Alan, 1996. "The determinants of health care expenditure: A cointegration approach," Journal of Health Economics, Elsevier, vol. 15(1), pages 127-137, February.
    5. Dusheiko, Mark & Gravelle, Hugh & Martin, Stephen & Rice, Nigel & Smith, Peter C., 2011. "Does better disease management in primary care reduce hospital costs? Evidence from English primary care," Journal of Health Economics, Elsevier, vol. 30(5), pages 919-932.
    6. Mark Dusheiko & Hugh Gravelle & Stephen Martin & Nigel Rice & Peter C Smith, 2011. "Does Better Disease Management in Primary Care Reduce Hospital Costs?," Working Papers 065cherp, Centre for Health Economics, University of York.
    7. de Bruin, Simone R. & Versnel, Nathalie & Lemmens, Lidwien C. & Molema, Claudia C.M. & Schellevis, François G. & Nijpels, Giel & Baan, Caroline A., 2012. "Comprehensive care programs for patients with multiple chronic conditions: A systematic literature review," Health Policy, Elsevier, vol. 107(2), pages 108-145.
    8. Stefanini, Alessandro & Aloini, Davide & Benevento, Elisabetta & Dulmin, Riccardo & Mininno, Valeria, 2020. "A data-driven methodology for supporting resource planning of health services," Socio-Economic Planning Sciences, Elsevier, vol. 70(C).
    9. Asiskovitch, Sharon, 2010. "Gender and health outcomes: The impact of healthcare systems and their financing on life expectancies of women and men," Social Science & Medicine, Elsevier, vol. 70(6), pages 886-895, March.
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