Determinants of the use of different types of health care provider in urban China: A tracer illness study of URTI

With the reform of urban health delivery systems in China, concern has been growing about the effect of these changes on health care demand and utilization at basic-level health institutions, especially Community Health Services Centers (CHC). Using data from the fourth China National Health Services Survey (NHSS) that was conducted in 2008, the authors conducted a tracer illness study of urban people with acute upper respiratory tract infections (URTI) to examine the factors that affect their use of different outpatient health care providers. The study addresses the observed demand for both public and private providers and is believed to be the first to attempt this for urban China. The findings indicate that overall private clinics are important sources of medical care for low consumption households, that insured patients are less likely to use private clinics and more likely to use CHC and that children are more likely to see a high-level provider. A number of other factors, including city size and severity of illness were found to play a role in determining provider utilization. We discuss the policy implications of the results in terms of meeting the health care needs of the urban population in China.