The effect of pairing assistance under medical alliance policy on
healthcare utilization for patients with chronic diseases in rural China
Abstract
Pairing assistance (PA) of health professionals between county hospitals
and township health centers is one of the key components of the reform
of medical alliances in China to strengthen the development of health
workforce in primary health care (PHC). This study aims to examine the
effect of PA on healthcare utilization for patients with chronic
diseases in rural areas. Two waves of National Health Services Survey
(2013 and 2018) were used. A total of 13893 and 22725 rural residents
with chronic diseases were included in the 2013 and 2018 waves,
respectively. Multiple logistic regressions were used to examine the
associations between PA and outpatient and inpatient service utilization
in PHC. Chow test was used to examine the difference between PA in two
models. Among rural patients with chronic diseases, two-week outpatient
visits increased from 22.69% to 27.54%, and annual hospitalization
admission increased from 20.72% in 2013 to 25.44%. PA was associated
with a significant decrease in outpatient visits (p<0.001) in
2018 after controlling for individual and county characteristics.
Patients in PA counties were 1.45 times (95% CI 1.10-1.90) more likely
to use PHC outpatient care in 2013, but the difference disappeared in
2018 (OR=0.85, 95% CI 0.71-1.01). PA did not reverse the downward trend
in the share of PHC outpatient visits. PA under medical alliances in
China provides a potential model for building integrated people-centered
health systems for other low- and middle-income countries.