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Table 3 Propensity-score weighting regression examining the association between having a usual provider and self-referral to higher-level hospitals among patients with respiratory diseasea

From: 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

Variables

Odds Ratio

(95% Confidence Interval)

Marginal Effectb

(95% Confidence Interval)

Usual providerc

 Primary care providers

0.58** (0.41, 0.82)

−0.09** (−0.14, −0.03)

 Other providers or none

1.00

 

Age (years)

  > 65

0.70 (0.42,1.19)

−0.17** (−0.26, −0.06)

 45–65

0.37*** (0.20,0.70)

−0.06 (−0.14, 0.03)

  < 45

1.00

 

Gender

 Female

0.63* (0.43,0.91)

−0.07* (−0.13, −0.02)

 Male

1.00

 

Household net income per yeard

 CNY30,000 and above

3.52*** (2.03,6.12)

0.21*** (0.12, 0.29)

 CNY15,000-CNY30,000

0.99 (0.65,1.50)

−0.00 (−0.07, 0.07)

 Less than CNY15,000

1.00

 

Ethnicitye

 Han population

4.47*** (3.13,6.40)

0.25*** (0.20, 0.31)

 Minorities

1.00

 

Census registration

 Urban

2.43** (1.45,4.07)

0.14** (0.06, 0.22)

 Rural

1.00

 

Distance to county hospitals (km)

  > = 50

0.62 (0.41,0.95)

−0.08** (−0.14, −0.01)

 25–50

0.65** (0.38,1.13)

−0.07 (−0.15, 0.02)

  < 25

1.00

 

Disease onset in last month

 Yes

3.95*** (2.59,6.02)

0.23*** (0.17, 0.30)

 No

1.00

 

Disease categoriesf

 Type B

5.61*** (3.36,9.37)

0.29*** (0.22, 0.37)

 Type C

0.78 (0.43,1.38)

−0.04 (−0.14, 0.06)

 Type D

1.94* (1.12,3.35)

0.12* (0.02, 0.21)

 Type A

1.00

 

Patient’s status at dischargeg

  

Others

1.46(0.98,2.17)

0.06(−0.01,0.13)

Improved

1.00

 

Capacity of township hospitalsh

 Very poor

1.35 (0.85,2.16)

0.10 (−0.01, 0.18)

 Poor

1.66 (0.94,2.93)

0.08 (−0.01, 0.17)

 Fair

1.82* (1.10,3.00)

0.03* (0.01, 0.12)

 Good

1.00

 

N

832

832

  1. aNon self-referrals referred to patients who received health care from primary care providers - township hospitals
  2. bSelf-referrals were defined as patients who received care from township hospitals, and then sought care in higher-level hospitals (county hospitals) without referral from primary care physicians
  3. cMinorities mainly include the Miao population and Tujia population
  4. dHousehold net income per year is measured by net household income owned by the residents after subtracting related expenditures. 1 Chinese currency Yuan (CNY) = 0.15 U.S. Dollars
  5. eHaving a primary care provider as a usual provider was approximately measured as that in the past 3 years, patients visited primary care providers more than other hospitals; other providers or none was measured as patients visited higher level hospitals more often than primary care providers or had no particular preference for health care providers
  6. fDisease category: Type A represents ordinary acute diseases; Type B refers to acute disease with co-morbidities; Type C refers to common chronic diseases without comorbidities; Type D is chronic diseases with comorbidities
  7. gPatient’s status at discharge: Others included stable, worse
  8. hCapacity of township hospitals: Four levels of capacity of township hospitals were measured via a comprehensive evaluation conducted by ××. The index included number of physicians and nurses, number of beds, hospital patient volume, outpatient volume, whether or not the providers are able to do the lower abdominal surgery in township hospitals
  9. * P < 0.05; ** P < 0.01; *** P < 0.001
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BMC Health Services Research

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