A Comparison of Quality of Community Health Services Between Public and Private Community Health Centers in Urban China

Background:This study was the first of its kind to evaluate and compare the quality of private and public community health centers (CHCs) in urban China.Methods:A total of 2501 CHCs in 35 cities were chosen in 2011 using a multistage sampling method, and data on human resources, medical equipment and drug inventory were collected. A subset of 422 CHCs was randomly selected and 100 prescriptions from each CHCs were reviewed to evaluate prescribing practice. In total, 12,386 patients who visited the selected 422 CHCs were interviewed to assess patient satisfaction and payments.Results:Controlling for population covered per CHC and geographic regions, private CHCs were higher than public CHCs in average building area (2310.96 vs. 2000.92 square meters), average number of medical equipment (6.42 vs. 6.14), average number of physicians and nurses per 10,000 population (4.86 vs. 3.81 and 3.38 vs. 2.62), and average number of medicines in stock (435.08 vs. 375.83), but lower in average percentage of medicines on the national essential medicines list (67.29% vs. 77.55%). Prescriptions from private CHCs had significantly higher number of drugs per prescription (2.38 vs. 2.24), higher percentage of prescriptions with injections (36.44% vs. 30.50%), and higher percentage of prescriptions with antibiotics (37.17% vs. 30.14%). Patient satisfaction was similar between the 2 groups, and patient payments per visit were lower in private CHCs after controlling for patients' sociodemographic characteristics.Conclusions:Private CHCs are better equipped and better staffed than public CHCs but are less compliant with national policy on essential medicines and have poorer prescribing quality in China, warranting more rigorous government supervision.