Yun Liu|Qingxia Kong|Shasha Yuan|Joris van de Klundert
Factors influencing choice of health system access level in China: A systematic review
Erasmus University Rotterdam|Erasmus University Rotterdam|Chinese Academy of Medical Sciences & Peking Union Medical College|Prince Mohammad Bin Salman College of Business and Entrepreneurship|Erasmus University Rotterdam
china patients increasingly choose access already severely overcrowded higher level hospitals leaving lower level facilities low utilization rates situation undermines effectiveness efficiency health system situation tends worsen despite policy measures aimed improvement systematically review factors affecting patient choice synthesize scientific understanding health system access china review provides evidence base measures direct patient flow towards lower level facilitieswe screened peerreviewed literature published april 2009 january 2016 investigates chinese patients choice health care facilities different levels assessed 45 studies total applied two structured forms extract data studys characteristics methodology factorsthe results identified four factor types 1 patient 2 provider 3 context 4 composite combined patient provider andor context attributes patient factors mentioned evidence patient factors often inconclusive evidence suggests provider factors drug variety equipment composite factor perceived quality push patients lower levels towards higher levelsunderuse primary care facilities overcrowding higher level facilities likely amplified current demographic trends evidence suggests improving drug availability equipment perceived quality primary care services improve situation welldesigned research considers interactions factors called better inform future interventions