Choice of and Equity in First-Contact Care in China’s Zhejiang and Qinghai Province: A Comparative Study

Abstract Background The imbalance between health needs and healthcare resources has become more serious in China. The hierarchical diagnosis and treatment system has played an important role in solving the problem, one goal of which was to increase the use of basic-level medical facilities. This study aimed to compare the choice of and equity in first-contact care among residents in Zhejiang and Qinghai provinces, China. Methods First-hand data were obtained through a cross-sectional survey of residents of Zhejiang and Qinghai. We first compared the proportion of residents who select primary healthcare institutions as the setting for first-contact care. Then we compared horizontal equity using the concentration index decomposition method. An urban-rural subgroup analysis was carried out for both provinces. Results A total of 4899 residents were enrolled, 2872 from Zhejiang and 2027 from Qinghai. The proportion of residents selecting a PHI as their first-contact care provider was 82.5% in Qinghai, and 54.4% in Zhejiang. The horizontal inequity index of selecting a PHI as first-contact care was − 0.180 and 0.007 in Zhejiang and Qinghai, respectively. The HI was − 0.088, -0.160, 0.069, and − 0.058 in rural Zhejiang, urban Zhejiang, rural Qinghai, and urban Qinghai, respectively. Conclusions The proportion of residents selecting a PHI as their first-contact care provider in Zhejiang was lower and the extents of horizontal inequity were more serious compared with Qinghai’s. We suggest that medical reform should be implemented based on socioeconomic development, because of China’s geographic vastness and the considerable amount of difference in development among geographic areas. Larger gaps in the medical insurance reimbursement ratio between different levels of medical institutions might aid in increasing the equitable utilization of PHIs.