Open Access Open Access  Restricted Access Subscription or Fee Access

How does residents’ experiences with community health service affect their utilization wishes? A population-based survey in China

Fang Wang, Liuyi Zhang, Yao Cheng, Ping Zhang, Yuan Liang


Objectives: Although the number of community health services (CHS) agencies in China has increased rapidly, they are not well used by residents. The aim of this study was to explore residents’ experiences of CHS and their effects on residents’ utilization wishes.

Methods: We conducted a cross-sectional door-to-door survey in Wuhan City, in central China. Five indicators (use convenience, environment, attitudes, degree of seriousness and medical costs) were selected as independent variables to reflect residents’ experiences of CHS. Control variables included age, gender, marital status, education level, self-perceived economic status, duration of residence, doctor-diagnosed hypertension and health insurance.

Results: Among the five indexes of experiences, the results were as follows: use convenience (91.96%), attitudes (82.12%), degree of seriousness (79.53%), environment (71.94%) and medical costs (60.33%). After adjusting for the potential confounding variables, environment, degree of seriousness and medical costs were the most meaningful influences on residents’ utilization wishes (OR: 2.11, 95% CI: 1.11-4; OR: 2.19, 95% CI: 1.03-4.64; OR: 2.71, 95% CI: 1.46-5.03, respectively).

Conclusion: The effects of degree of seriousness and medical costs appear to indicate that residents’ use of CHS is rational. However, the effect of environment may reveal that residents’ use of CHS is partly perceptual (‘judging a book by its cover’). The sustainable development of CHS should take account of these factors.


China, community health services, general hospitals, health policy, market economy, patient perception, person-centered healthcare, socioeconomic transition

Full Text:



Wan, Y.C. & Wan, Y.I. (2010). Achievement of equity and universal access in China's health service: a commentary on the historical reform perspective from the UK National Health Service. Global Public Health 5 (1) 15-27.

Jefferson, G.H. (1998). China's State Enterprises: Public Goods, Externalities, and Coase. The American Economic Review 88 (2) 428-432.

Liu, Y., Rao, K. & Fei, J. (1998). Economic transition and health transition: comparing China and Russia. Health Policy 44 (2) 103-122.

Hovey, M. & Naughton, T. (2007). A survey of enterprise reforms in China: The way forward. Economic Systems 31 (2) 138-156.

Huang, X., Li, P. & Lotspeich, R. (2010). Economic growth and multi-tasking by state-owned enterprises: An analytic framework and empirical study based on Chinese provincial data. Economic Systems 34 (2)160-177.

Qi, L. & Prime, P.B. (2009). Market reforms and consumption puzzles in China. China Economic Review 20 (3) 388-401

Zhang, S., Zhang, W., Zhou, H., Xu, H., Qu, Z., Guo, M., Wang, F., Zhong, Y., Gu, L., Liang, X., Sa, Z., Wang, X. & Tian, D. (2015). How China's new health reform influences village doctors' income structure: evidence from a qualitative study in six counties in China. Human Resources for Health 5, 13, 26.

Mosquera, P.A., Hernández, J., Vega, R., Labonte, R., Sanders, D., Dahlblom, K. & San Sebastián, M. (2014). Challenges of implementing a primary health care strategy in a context of a market-oriented health care system: the experience of Bogota, Colombia. International Journal of Health Planning and Management 29 (4) e347-367.

Rosenthal, E.L., Brownstein, J.N., Rush, C.H., Hirsch, G.R., Willaert, A.M., Scott, J.R., Holderby, L.R. & Fox, D.J. (2010). Community health workers: part of the solution. Health Affairs (Project Hope) 29 (7) 1338-1342.

Ling, R., Liu, F., Lu, X. & Wang, W. (2011). Emerging issues in public health: a perspective on China’s healthcare system. Public Health 125 (1) 9-14.

He, A.J. (2014). The doctor–patient relationship, defensive medicine and overprescription in Chinese public hospitals: Evidence from a cross-sectional survey in Shenzhen city. Social Science & Medicine 123, 64-71.

The Central People’s Government of China. (2009). Act on further healthcare reform promulgated by the Chinese Communist Party Central Committee and State Council of PRC. []

Statistical Information Center of National Health and Family Planning Commission of China. (2013). January-February the National Health Service Status of China. []

Xu, J. (2008). Research status of community health service and development advice for Shanghai. Practical Preventive Medicine [in Chinese] 15 (6) 2000-2004.

Li, Z., Hou, J., Lu, L., Tang, S. & Ma, J. (2012). On residents' satisfaction with community health services after health care system reform in Shanghai, China, 2011. BMC Public Health 12 (Supplement 1) S9.

Zhou, W., Dong, Y., Lin, X., Lu, W., Tian, X., Yang, L. & Zhang, X. (2013). Community health service capacity in China: a survey in three municipalities. Journal of Evaluation in Clinical Practice 19 (1) 167-172.

Pan, X., Dib, H.H., Wang, X. & Zhang, H. (2006). Service utilization in community health centers in China: a comparison analysis with local hospitals, BMC Health Service Research 6, 93.

Dib, H.H., Sun, P., Minmin, Z., Wei, S. & Li, L. (2010). Evaluating community health centers in the City of Dalian, China: how satisfied are patients with the medical services provided and their health professionals? Health & Place 16 (3) 477-488.

Tang, L. (2013). The Chinese community patient’s life satisfaction, assessment of community medical service, and trust in community health delivery system. Health and Quality of Life Outcomes 11 (1) 18.

Yang, Y. & Yang, D. (2009). Community health service centers in China, not always trusted by the populations they serve? China Economic Review 20 (4) 620-624.

Tang, L. (2012). The patient's anxiety before seeing a doctor and her/his hospital choice behavior in China. BMC Public Health 12, 1121.

Blumenthal, D. & Hsiao, W. (2015). Lessons from the East - China's rapidly evolving health care system. New England Journal of Medicine 372 (14) 1281-1285.

Rice, G., Ingram, J. & Mizan, J. (2008). Enhancing a primary care environment: a case study of effects on patients and staff in a single general practice. British Journal of General Practice 58 (552) e1-e8.

Mpinga, E.K. & Chastonay, P. (2011). Satisfaction of patients: A right to health indicator? Health Policy 100 (2) 144-150.

Tang, C., Luo, Z., Fang, P. & Zhang, F. (2013). Do patients choose community health services (CHS) for first treatment in China? Results from a community health survey in urban areas. Journal of Community Health 38 (5) 864-872.



  • There are currently no refbacks.