Factors Affecting Health Care Users' First Contact with Primary Health Care Facilities in North Eastern China, 2008-2018

Background: China set out the vision to establishing a hierarchical medical system, with primary health care (PHC) facilities serving health care users' first contact. Common ailments were listed, supported by a series of auxiliary policy measures. We aim to assess whether these policies were effective to prompt users' preference to PHCs within these contexts.

Methods: Using data from three waves of National Health Service Survey, we examined trends in care users' first contact with PHC facilities in Jilin, a north eastern province, during 2008-2018. We analysed trends and factors affecting care users' choices, stratified by type of diseases and urban-rural settings.

Results: From 38 823 respondents, the survey identified 3302 health care users who sought outpatient care. 54.92% and 82.49% with diseases recommended to PHC, in urban and rural Jilin, respectively, contacted PHC facilities first. While 33.51% and 61.19% with diseases not recommended to PHC did so. Care users' first contact with PHC facilities followed an inverse U shape during 2008-2018. Such trends were more profound among care users with hypertension and/or diabetes. Neither social health insurance coverage nor contracting with family doctors was associated with care users' first contacts. Only 1.25% care users had referral experiences. Low perceived quality was the main barrier to choose PHC facilities.

Conclusion: Health care users sought PHC in a chaotic manner in Jilin. None of the recent efforts seemed effective in prompting their preference to PHC facilities. Without levering quality of PHC, an effective hierarchical medical system could be hardly forged in China.