Abstract：
BACKGROUND: Stronger primary health care (PHC) is critical to achieving the United Nations\' Sustainable Development Goals. However, there is scarce evidence on the impact of PHC on health system performance in developing countries. Since 2009, China has implemented an ambitious health system reform, among which PHC has received unprecedented attention. This study investigates the role of PHC resource in improving health status, financial protection and health equity.
METHODS: We obtained province-level and individual-level data to conduct a longitudinal study across the period of China\'s health system reform. The dependent variables included health outcomes and financial protection. The independent variables were the number of PHC physicians and share of PHC physicians in all physicians. Mixed-effect models were used for adjusted associations.
RESULTS: From 2003 to 2017, the number of PHC physicians slightly increased by 31.75 per 100,000 persons and the share of PHC physicians in all physicians increased by 3.62 percentage points. At the province level, greater PHC physician density was positively associated with life expectancy, negatively associated with age-standardized excess mortality, infectious disease mortality, perinatal mortality low birth weight, as well as the share of health expenses in total consumption expenses. At the individual and household level, greater PHC physician density was positively associated with self-assessed health, and negatively associated with incidence of catastrophic health expenditures. Compared to other quintiles, the poorest quintile benefited more from PHC physician density.
CONCLUSIONS: In China, an increased PHC physician supply was associated with improved health system performance. While China\'s PHC system has been strengthened in the context of China\'s health system reforms, further effective incentives should be developed to attract more qualified PHC workers.
METHODS: We obtained province-level and individual-level data to conduct a longitudinal study across the period of China\'s health system reform. The dependent variables included health outcomes and financial protection. The independent variables were the number of PHC physicians and share of PHC physicians in all physicians. Mixed-effect models were used for adjusted associations.
RESULTS: From 2003 to 2017, the number of PHC physicians slightly increased by 31.75 per 100,000 persons and the share of PHC physicians in all physicians increased by 3.62 percentage points. At the province level, greater PHC physician density was positively associated with life expectancy, negatively associated with age-standardized excess mortality, infectious disease mortality, perinatal mortality low birth weight, as well as the share of health expenses in total consumption expenses. At the individual and household level, greater PHC physician density was positively associated with self-assessed health, and negatively associated with incidence of catastrophic health expenditures. Compared to other quintiles, the poorest quintile benefited more from PHC physician density.
CONCLUSIONS: In China, an increased PHC physician supply was associated with improved health system performance. While China\'s PHC system has been strengthened in the context of China\'s health system reforms, further effective incentives should be developed to attract more qualified PHC workers.
摘要：
背景：加强初级卫生保健（PHC）对于实现联合国可持续发展目标至关重要。然而,很少有证据表明PHC对发展中国家卫生系统绩效的影响。自2009年以来，中国实施了雄心勃勃的卫生体制改革，其中PHC受到了前所未有的关注。本研究调查了PHC资源在改善健康状况中的作用，财政保护和卫生公平。
方法：我们获得了省级和个人层面的数据，以进行中国卫生体制改革期间的纵向研究。因变量包括健康结果和财务保护。独立变量是PHC医生的数量和所有医生中PHC医生的份额。混合效应模型用于调整后的关联。
结果：从2003年到2017年，PHC医生的数量每10万人中略有增加31.75人，PHC医生在所有医生中的份额增加了3.62个百分点。在省一级,更高的PHC医生密度与预期寿命呈正相关，与年龄标准化的超额死亡率呈负相关，传染病死亡率，围产期死亡率低出生体重，以及医疗费用在总消费费用中的份额。在个人和家庭层面，更高的PHC医师密度与自我评估的健康状况呈正相关，并与灾难性卫生支出的发生率呈负相关。与其他五分位数相比，最贫穷的五分之一人口从PHC医生密度中受益更多。
结论：在中国，PHC医师供应增加与卫生系统性能改善相关.在中国卫生体制改革的背景下，中国的PHC制度得到了加强，应制定进一步有效的激励措施，以吸引更多合格的PHC工人。
方法：我们获得了省级和个人层面的数据，以进行中国卫生体制改革期间的纵向研究。因变量包括健康结果和财务保护。独立变量是PHC医生的数量和所有医生中PHC医生的份额。混合效应模型用于调整后的关联。
结果：从2003年到2017年，PHC医生的数量每10万人中略有增加31.75人，PHC医生在所有医生中的份额增加了3.62个百分点。在省一级,更高的PHC医生密度与预期寿命呈正相关，与年龄标准化的超额死亡率呈负相关，传染病死亡率，围产期死亡率低出生体重，以及医疗费用在总消费费用中的份额。在个人和家庭层面，更高的PHC医师密度与自我评估的健康状况呈正相关，并与灾难性卫生支出的发生率呈负相关。与其他五分位数相比，最贫穷的五分之一人口从PHC医生密度中受益更多。
结论：在中国，PHC医师供应增加与卫生系统性能改善相关.在中国卫生体制改革的背景下，中国的PHC制度得到了加强，应制定进一步有效的激励措施，以吸引更多合格的PHC工人。
