Background
Methods
Data source
Measures
Statistical analysis
Control variables
Results
Characteristics and health care utilization of the DM patients
2008 | 2013 | |||||
---|---|---|---|---|---|---|
Urban | Rural | Total | Urban | Rural | Total | |
Age-standardized prevalence (mean‰ [mean ± SD]) | ||||||
All | 27.5 (26.6, 28.4) | 4.8 (4.5, 5.1) | 10.7 (10.1, 11.3) | 49.5 (42.4, 56.6) | 21.8 (19.7, 23.9) | 35.2 (32.0, 38.4) |
East | 30.8 (28.5, 33.1) | 19.6 (17.4, 21.8) | 26.6 (24.5, 28.7) | 57.9 (50.7, 65.1) | 29.8 (27.6, 32.0) | 44.1 (41.3, 26.9) |
Central | 28.8 (25.6, 32.0) | 15.8 (14.3, 17.3) | 18.2 (15.6, 20.8) | 49.5 (41.6, 57.4) | 36.0 (32.4, 39.6) | 35.8 (31.6, 40.0) |
West | 20.8 (18.7, 22.9) | 7.8 (7.2, 8.4) | 8.7 (7.9, 9.5) | 39.5 (35.4, 43.6) | 12.7 (9.7, 15.7) | 25.1 (21.7, 28.5) |
Rate of previous 2-week outpatient visits (mean% [mean ± SD]) | ||||||
All | 15.1 (14.6–15.6) | 12.3 (11.8–12.8) | 14.3 (13.7–14.9) | 13.2 (12.7–13.7) | 11.3 (10.8–11.8) | 12.5 (12.0–13.0) |
East | 15.6 (15.0–16.2) | 16.3 (15.7–16.9) | 15.8 (15.2–16.4) | 15.6 (15.0–16.2) | 13.8 (13.3–14.3) | 14.9 (14.3–15.5) |
Central | 13.8 (13.2–14.4) | 8.6 (8.1–9.1) | 12.3 (11.7–12.9) | 10.7 (10.3–11.1) | 8.2 (7.8–8.6) | 9.7 (9.3–10.1) |
West | 15.4 (14.8–16.0) | 10.5 (10.0–11.0) | 14.5 (13.9–15.1) | 13.3 (12.8–13.8) | 11.8 (11.3–12.3) | 12.8 (12.3–13.3) |
percentage of outpatient visits to PHCs (%) | ||||||
All | 44.5 | 74.5 | 67.3 | 52.7 | 72.9 | 66.3 |
East | 39.3 | 65.8 | 48.8 | 49.6 | 68.5 | 55.1 |
Central | 48.8 | 74.6 | 53.6 | 53.6 | 72.5 | 67.1 |
West | 56.1 | 76.6 | 75.6 | 60.5 | 76.7 | 75.2 |
Characteristics (%) | 2008 | 2013 |
---|---|---|
Female | 50.17 | 52.24 |
Rural residents | 44.36 | 46.53 |
Age (years) a
| 55.81(9.16) | 52.15(9.22) |
Currently Married | 75.08 | 76.37 |
Household income per capita (1000 RMB) a
| 7.53(10.49) | 13.21(15.17) |
Education | ||
No formal education | 15.81 | 12.36 |
Primary school | 37.65 | 36.54 |
Junior and high school | 40.71 | 43.50 |
Junior college and above | 5.83 | 7.60 |
Employment status | ||
Farmers | 47.15 | 45.30 |
Unemployed or retired | 14.27 | 13.78 |
Informal employed | 11.52 | 13.25 |
Formal employed | 27.06 | 27.67 |
Health insurance status | ||
New Rural Cooperative Medical Scheme (NRCMS) | 57.68 | 48.74 |
Urban Employee-based Medical Insurance (UEBMI) | 2.90 | 14.85 |
Urban Resident-based Medical Insurance (URBMI) | 13.69 | 22.49 |
Having other chronic diseases | 24.85 | 30.67 |
Sickbed days for the illness (days) a
| 0.81 (0.19) | 1.02 (0.11) |
Distance to the nearest healthcare provider | ||
Less than 2 km | 79.91 | 80.57% |
2–4 km | 12.74 | 13.96% |
4- km and farther | 7.35 | 5.47% |
Per capita GDP (PGDP) (1000 RMB) a
| 18.55 (4.27) | 40.31 (11.45) |
N | 1953 | 14031 |
Physician density and distribution
2008 | 2013 | |||||
---|---|---|---|---|---|---|
Urban | Rural | Total | Urban | Rural | Total | |
Physicians in PHCs per 1000 people (mean [mean ± SD]) | ||||||
All | 0.46 (0.42–0.50) | 0.39 (0.35–0.43) | 0.41 (0.36–0.46) | 0.56 (0.51–0.61) | 0.37 (0.34–0.40) | 0.44 (0.40–0.48) |
East | 0.54 (0.49–0.59) | 0.38 (0.35–0.41) | 0.44 (0.39–0.49) | 0.66 (0.60–0.72) | 0.41 (0.36–0.46) | 0.51 (0.45–0.57) |
Central | 0.38(0.34–0.42) | 0.43 (0.39–0.47) | 0.41 (0.36–0.46) | 0.46 (0.41–0.51) | 0.38 (0.34–0.42) | 0.42 (0.38–0.46) |
West | 0.37 (0.33–0.41) | 0.38 (0.34–0.42) | 0.39 (0.35–0.43) | 0.61 (0.56–0.66) | 0.32 (0.28–0.36) | 0.40 (0.35–0.45) |
Physicians in hospitals per 1000 people (mean [mean ± SD]) | ||||||
All | 1.96 (1.89–2.03) | 0.55 (0.51–0.59) | 0.74 (0.68–0.80) | 2.62 (2.49–2.75) | 0.80 (0.76–0.84) | 1.47 (1.43–1.51) |
East | 2.11 (2.03–2.19) | 0.50 (0.46–0.54) | 0.82 (0.76–0.88) | 3.56 (3.35–3.77) | 0.93 (0.88–0.98) | 2.00 (1.94–2.06) |
Central | 1.64 (1.56–1.72) | 0.71 (0.66–0.76) | 0.79 (0.73–0.85) | 2.33 (2.24–2.42) | 0.77 (0.73–0.81) | 1.39 (1.33–1.45) |
West | 2.11 (1.98–2.24) | 0.49 (0.45–0.53) | 0.65 (0.60–0.70) | 1.83 (1.74–1.92) | 0.73 (0.69–0.77) | 1.07 (1.02–1.12) |
Impact of health workforce on outpatient visits
Model 1 | Model 2 | |||
---|---|---|---|---|
IRR* (95%CI) |
p value | IRR* (95%CI) |
p value | |
All | ||||
Physicians in PHCs | 1.19 (1.02, 1.40) | 0.027 | 1.25 (1.21, 1.29) | <0.001 |
Physicians in hospitals | 1.20 (1.08, 1.35) | <0.001 | 1.04 (1.01, 1.04) | <0.001 |
PGDP | 1.10 (1.04, 1.15) | <0.001 | ||
Physicians in PHCs with PGDP | 0.83 (0.73, 0.94) | 0.003 | ||
Physicians in hospitals with PGDP | 1.15 (1.08, 1,24) | <0.001 | ||
Rural | ||||
Physicians in PHCs | 1.39 (1.29, 1.49) | <0.001 | 1.34 (1.17, 1.53) | <0.001 |
Physicians in hospitals | 1.02 (1.00, 1.04) | 0.062 | 1.02 (1.01, 1.04) | <0.001 |
PGDP | 1.04 (0.98, 1.10) | 0.170 | ||
Physicians in PHCs with PGDP | 0.73 (0.70, 0.77) | <0.001 | ||
Physicians in hospitals with PGDP | 0.99 (0.98, 1.02) | 0.825 | ||
Urban | ||||
Physicians in PHCs | 1.13 (1.05, 1.21) | 0.001 | 1.19 (1.15, 1.23) | <0.001 |
Physicians in hospitals | 1.04 (0.93, 1.16) | 0.462 | 1.01 (1.00, 1.02) | 0.015 |
PGDP | 1.23 (1.04, 1.46) | 0.014 | ||
Physicians in PHCs with PGDP | 0.98 (0.98, 0.99) | <0.001 | ||
Physicians in hospitals with PGDP | 1.17 (1.06, 1.30) | 0.002 | ||
East | ||||
Physicians in PHCs | 1.18 (1.01, 1.39) | 0.037 | 1.23 (1.19, 1.28) | <0.001 |
Physicians in hospitals | 1.02 (1.00, 1.04) | 0.069 | 1.02 (1.01, 1.03) | <0.001 |
PGDP | 1.17 (1.03, 1.32) | 0.012 | ||
Physicians in PHCs with PGDP | 0.92 (0.90, 0.95) | <0.001 | ||
Physicians in hospitals with PGDP | 0.99 (0.97, 1.02) | 0.721 | ||
Central | ||||
Physicians in PHCs | 1.33 (1.16, 1.51) | <0.001 | 1.40 (1.10, 1.78) | 0.005 |
Physicians in hospitals | 1.02 (0.90, 1.16) | 0.721 | 1.04 (1.01–1.07) | 0.020 |
PGDP | 1.01 (0.90, 1.12) | 0.896 | ||
Physicians in PHCs with PGDP | 0.87 (0.81, 0.94) | <0.001 | ||
Physicians in hospitals with PGDP | 1.08 (0.96, 1.22) | 0.171 | ||
West | ||||
Physicians in PHCs | 1.45 (1.06, 1.99) | 0.021 | 1.67 (1.38–2.02) | <0.001 |
Physicians in hospitals | 0.92 (0.56, 1.53) | 0.762 | 0.93 (0.83–1.03) | 0.156 |
PGDP | 0.97 (0.86, 1.10) | 0.669 | ||
Physicians in PHCs with PGDP | 0.84 (0.80, 0.88) | <0.001 | ||
Physicians in hospitals with PGDP | 1.15 (0.99, 1.33) | 0.071 |
Impact of health workforce on choice of health providers
PHCs | county/district hospitals | Municipal hospitals and above | ||||
---|---|---|---|---|---|---|
RRR (95%CI) |
p value | RRR (95%CI) |
p value | RRR (95%CI) |
p value | |
All | ||||||
Physicians in PHCs | 2.14 (1.52–3.03) | <0.001 | 0.31 (0.20–0.48) | <0.001 | 0.69 (0.32–1.46) | 0.331 |
Physicians in hospitals | 1.15 (1.03, 1.28) | 0.012 | 1.31 (1.16, 1.49) | <0.001 | 1.36 (1.15, 1.60) | <0.001 |
Rural | ||||||
Physicians in PHCs | 3.63 (2.64, 4.98) | <0.001 | 1.68 (1.15, 2.45) | 0.007 | 0.23 (0.13, 0.40) | <0.001 |
Physicians in hospitals | 1.09 (0.94–1.26) | 0.256 | 1.21 (1.06–1.39) | 0.005 | 1.03 (0.90–1.19) | 0.625 |
Urban | ||||||
Physicians in PHCs | 1.22 (0.93–1.62) | 0.152 | 0.86 (0.65–1.14) | 0.207 | 1.74 (1.34–2.26) | <0.001 |
Physicians in hospitals | 1.21 (1.08–1.36) | 0.001 | 2.22 (1.94–2.53) | <0.001 | 2.22 (1.78–2.78) | <0.001 |
East | ||||||
Physicians in PHCs | 1.83 (1.33–2.53) | <0.001 | 0.47 (0.32–0.69) | <0.001 | 0.29 (0.16–0.53) | <0.001 |
Physicians in hospitals | 1.25 (1.14–1.38) | <0.001 | 1.75 (1.57–1.94) | <0.001 | 2.12 (1.84–2.45) | <0.001 |
Central | ||||||
Physicians in PHCs | 1.80 (0.97–3.37) | 0.063 | 0.78 (0.39–1.58) | 0.499 | 0.03 (0.01–0.11) | <0.001 |
Physicians in hospitals | 1.11 (0.97–1.29) | 0.114 | 1.42 (1.21–1.66) | <0.001 | 1.09 (0.91–1.30) | 0.352 |
West | ||||||
Physicians in PHCs | 5.31 (3.57–7.90) | <0.001 | 4.00 (2.45–6.53) | <0.001 | 1.92 (0.80–4.60) | 0.142 |
Physicians in hospitals | 1.04 (0.85–1.27) | 0.720 | 1.46 (1.16–1.83) | 0.001 | 1.49 (1.11–2.01) | 0.008 |