A Study of Comparing Primary Care Services Between Two Different Models in Shenzhen and Zhuhai, China

Background:

Primary care is associated with the goals of equity and efficiency in health care system. In China, primary care services are provided via community health centers (CHCs). In Shenzhen, most CHCs are financed by the government through public hospitals and managed by them, while in Zhuhai, all CHCs are established and operated as a private business. The objectives of this study were to describe and compare primary care services by focusing on key inputs (human resources and finance) and outputs (scope of primary care services) in two different models.

Method:

Mixed methods were employed for this study. Policy documents and relevant reports were collected from local health authorities in two cities. Institution based questionnaires and in-depth interviews with providers and managers in selected CHCs were carried out so as to collect information about the population situation in the district where the CHCs locate, human resources, financing and services provision.

Results:

Hospital plays an important role in managing hospital-owned CHCs including human resources, financing and technical support. Resident committees lack the trust of private CHCs, while hospital-operated CHCs are welcome. The capacity of health service providers was quite low in private model, with 10.13% having bachelor’s degrees, compared with hospital-owned ones with 51.35%. The distribution of subsidy from government between two models was different. Private centers had the lower proportion than hospital-owned ones, which in turn resulted in a higher percentage of total revenue from charge for services. Furthermore, public health services were not fully exploited in private CHCs because hospitals are in competition with community health centers.

Conclusion

Our results suggest that private CHCs were under more difficult circumstances than hospital-owned ones. Establishing a supportive and equal environment is needed for private CHCs so as to provide a strong primary care.