To authors’ knowledge, by Sep 2019, this survey is the ever first general survey of rehabilitation capacity of primary health care in China from a literature study, as well as the first analysis of factors that influence rehabilitation service capacity in the primary health system. In the general survey, we found more than 88% of CHCs and THCs involved in this survey have been well equipped to provide rehabilitation services. But, the imbalance between urban and rural community health centers remains prominent, even though the government has made efforts to minimize the gap. For nearly the same average number of disabilities (600.3 of CHCs, 592.6 of THCs), CHCs’ number of patients is 1.56 times as THCs’ (7456.9 vs 4762.6). Compared to THCs, CHCs obviously equipped with higher-quality equipment, more rehabilitation doctors (1.9 vs 1.2) and more rehabilitation counseling (189.1 vs 37.6). Reasons that make this kind of gap between urban and rural may be various, such as economic level, physician attraction, transportation facilities, and citizens’ health awareness. Consequently, this phenomenon of the urban-rural imbalance inspires the government and community to shift more financial support and health education to the rural area to improve the rehabilitation capacity of primary health centers there.
As to factors that were analyzed by multivariable ordinary logistic regression, categories of rehabilitation diseases and the number of rehabilitation bed are considered statistically significant. However, we should not ignore the number of rehabilitation physicians as a potential factor even though it is not statistically significant (P=0.05, 95%CI [-0.882,0.005]). For instance, β value of categories of rehabilitation diseases is -1.136, which means primary health centers house more than 9 categories of rehabilitation diseases would attract a larger number of patients, comparing to those with less than 9. It indicates that increase the types of rehabilitation diseases would improve CBR service capacity, which should be considered during the planning of the primary health care system. Following the same logic, increasing the number of rehabilitation beds and physicians should also be included in the plan when possible.
Since 2009, the Chinese government has been putting a large number of resources to improve its primary health care system. For example, in 2014, the expenditure on primary care reached ¥110 billion(20). In less than 10 years, the infrastructures and facilities of the CHCs and THCs were significantly enhanced(21).
Along with the giant leap in the primary health care system under a powerful and effective push from China government on medical services, the rehabilitation capacity of these primary health centers also advanced in both hardware and software. However, in the southwest of China, there are dozens of regions troubling in short of appropriate medical service, and inevitable lack of affordable and convenient rehabilitation services, because of poverty, inadequate transportation and lack of health awareness. Chengdu, as the central city of southwest China, has a powerful and comprehensive influence on regional development in every aspect, including economy, education, culture, technology, and medicine. The outcome of our study, therefor, may be representative to entire southwest China rather than a city.
Due to poor education and training systems on general practitioners, rehabilitation services could not be well delivered to disabilities, even though CHCs have been equipped with the newest equipment and technology. Hence, creating an optimal general practitioner training system would be another driver that could further improve rehabilitation service capacity in the primary health system.
Limitation
In this survey covering all 390 basic primary health centers of Chengdu city, we eventually received 379 intact replies that could be used in analysis. Other 11 primary centers were ruled out from analysis due to incomplete data, which may lead to unknown bias in the results. Another limitation is that we selected the number of patients as a proxy of CBR service, which we think could reflect the scale and service quality of a primary health center. Patients did not know exactly how a primary health center is, they would select which is better according to their experience and impression during accepting CBR service. Hence, patients’ subjective judgement decides whether to accept CBR service in CHCs and then has an influence on our results.