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
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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)