Comparing Quality of Public Primary Care between Hong Kong and Shanghai Using Validated Patient Assessment Tools

PLOS ONE, Dec 2019

Objectives Primary care is the key element of health reform in China. The objective of this study was to compare patient assessed quality of public primary care between Hong Kong, a city with established primary care environment influenced by its colonial history, and Shanghai, a city leading primary care reform in Mainland China; and to measure the equity of care in the two cities. Methods Cross sectional stratified random sampling surveys were conducted in 2011. Data were collected from 1,994 respondents in Hong Kong and 811 respondents in Shanghai. A validated Chinese version of the primary care assessment tool was employed to assess perceived quality of primary care with respect to socioeconomic characteristics and health status. Results We analyzed 391 and 725 respondents in Hong Kong and Shanghai, respectively, who were regular public primary care users. Respondents in Hong Kong reported significant lower scores in first contact accessibility (1.59 vs. 2.15), continuity of care (2.33 vs. 3.10), coordination of information (2.84 vs. 3.64), comprehensiveness service availability (2.43 vs. 3.31), comprehensiveness service provided (2.11 vs. 2.40), and the total score (23.40 vs. 27.40), but higher scores in first contact utilization (3.15 vs. 2.54) and coordination of services (2.67 vs. 2.40) when compared with those in Shanghai. Respondents with higher income reported a significantly higher total primary care score in Hong Kong, but not in Shanghai. Conclusions Respondents in Shanghai reported better quality of public primary care than those in Hong Kong, while quality of public primary care tended to be more equitable in Shanghai.

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Comparing Quality of Public Primary Care between Hong Kong and Shanghai Using Validated Patient Assessment Tools

March Comparing Quality of Public Primary Care between Hong Kong and Shanghai Using Validated Patient Assessment Tools Xiaolin Wei 0 1 3 Haitao Li 0 1 3 Nan Yang 0 1 3 Samuel Y. S. Wong 0 1 3 Onikepe Owolabi 0 1 3 Jianguang Xu 0 1 3 Leiyu Shi 0 1 3 Jinling Tang 0 1 3 Donald Li 0 1 3 Sian M. Griffiths 0 1 3 0 Funding: The study was funded by the Research Grants Council (RGC) of Hong Kong (CUHK 4002- SPPR-10) and the Communicable Disease and Health Service Delivery (COMDIS HSD) Research Consortium of the Department for International Development of the UK Government (UKAID). The funders had no roles in research design, data collection, interpretation of the data, writing and submitting the manuscript 1 Academic Editor: Harry Zhang, Old Dominion University , UNITED STATES 2 5041, Baltimore, Maryland 21205, United States of America , 5 Admiralty Centre Tower 1, 18 Harcourt Road, Hong Kong, Hong Kong SAR , China 3 1 School of Public Health, Prince of Wales Hospital , Shatin, NT, Hong Kong SAR , China , 2 Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine , Keppel Street, WC1E 7HT, London , United Kingdom , 3 Shanghai Commission of Health and Family Planning , 300 Shibo County Road, Shanghai, 200125, China, 4 Hampton House, 615 N Wolfe St - Competing Interests: The authors have declared that no competing interests exist. Respondents in Shanghai reported better quality of public primary care than those in Hong Kong, while quality of public primary care tended to be more equitable in Shanghai. Primary care responds to common health problems that account for the vast majority of the populations health needs. Studies have demonstrated that better primary care is associated with improved health outcomes and reduced health inequity [14]. Countries in different regions of the world are moving towards primary care oriented health systems based on the WHO call in 2008 [5]. However, equitable distribution of high quality primary care remains an ultimate but out of reach goal in many countries [6]. Urban areas have an increasing need for primary care because of their large populations and relatively high income inequality distribution [7]. Hong Kong and Shanghai are among the largest metropolitan cities in the world. They have similar health indicators while both face the challenge of a rapidly growing aging population. Hong Kong, as a former British colony and a current special administrative region in China, retains its former socioeconomic policies where the government funds most of inpatient services, while the majority (over 70%) of primary care is provided through private doctors [8]. Government outpatient clinics (GOPCs) provide about 20% of primary care services. Most GOPCs open during office hours with some on evenings and Saturdays. GOPCs are operated with a fixed quota of patient consultations on each day. Patients need to make an appointment prior to a consultation. For any visit to a specialist in public hospitals except for emergencies, patients need to obtain referral from the GOPC or a private doctor. Though opening to the general public, GOPCs targeted for patients with chronic illnesses, those who are poor and civil servants. GOPCs is heavily subsidized by the government and only charge a flat visit fee of HK$45 (US$ 6) which is waived for those who are on government social assistance. GOPCs provide acute care and limited preventive services. In mainland China, the over-dependence on hospitals for minor illnesses has made its healthcare less accessible and more expensive to the public [9]. Since 2009, China has implemented a comprehensive health reform plan which strengthened the roles of primary care facilities, i.e., community health centers (CHC) in the urban areas and township hospitals in the rural areas [10]. All CHCs in Shanghai are fully funded by the government with a mandate to provide integrated health services including acute care, preventive care, health education and promotion, rehabilitation, chronic disease management and technical support for family planning to a population of around 50,000 within the catchment area of a CHC. CHCs are walk-in clinics, opening in regular office hours with some in evenings and on weekends. The average cost of a consultation is 20 RMB (US$ 3.25) in 2011 and most can be covered by health insurance.[11] In Shanghai, patients may seek care directly in big hospitals without being referred from primary care doctors. CHCs in Shanghai provide service to the general public, but specifically address health needs of the elderly, the poor and those with chronic diseases. Comparing the quality of primary care in different health systems can provide insights into the impact of primary care policies. However, most current studies only measured primary care within one health system. This study aims to compare patient assessments of the quality of public primary care in Hong Kong and Shanghai, and to measure the equity of ca (...truncated)


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Xiaolin Wei, Haitao Li, Nan Yang, Samuel Y. S. Wong, Onikepe Owolabi, Jianguang Xu, Leiyu Shi, Jinling Tang, Donald Li, Sian M. Griffiths. Comparing Quality of Public Primary Care between Hong Kong and Shanghai Using Validated Patient Assessment Tools, PLOS ONE, 2015, Volume 10, Issue 3, DOI: 10.1371/journal.pone.0121269