Does having a usual primary care provider reduce patient self-referrals in rural China’s rural multi-tiered medical system? A retrospective study in Qianjiang District, China

Does having a usual primary care provider reduce patient self-referrals in rural China’s rural multi-tiered medical system? A retrospective study in Qianjiang District, China

BMC Health Services Research, November 2017

29179717

Da Feng, Donglan Zhang, Boyang Li, Yan Zhang, Ray Serrano, Danxiang Shi, Yuan Liu, Liang Zhang

Within China's multi-tiered medical system, many patients seek care in higher-tiered hospitals without a referral by a primary-care provider. This trend, generally referred to as patient self-referral behavior, may reduce the efficiency of the health care system. This study seeks to test the hypothesis that having a usual primary care provider could reduce patients' self-referral behavior. We obtained medical records of 832 patients who were hospitalized for common respiratory diseases from township hospitals in Qianjiang District of Chongqing City during 2012-2014. Logit regressions were performed to examine the association between having a township hospital as a usual provider and self-referring to a county hospital after being discharged from a township hospital, while controlling for patients' gender, age, income, education, severity of disease, distance to the nearest county hospital and the general quality of the township hospitals in their community. A propensity score weighting approach was applied. We found that having a usual primary care provider was associated with a lower likelihood of self-referral (odds ratio = 0.58, 95% confidence interval [CI] =0.41-0.82), and a 9% (95% CI: -14%, - 3%) reduction in the probability of patients' self-referral behavior. The results suggest that establishing a long-term relationship between patients and primary care providers may enhance the patient-physician relationship and reduce patients' tendency for unnecessary use of medical resources.