Effects of primary care visits on preventing chronic conditions and avoiding hospital care in the context of China's health system reform: a nationwide panel study.

BACKGROUND: Primary care is widely recognised as essential for the prevention and management of chronic conditions and has been a major focus of China's health system reform. However, evidence on its effects remains mixed. This study examined whether primary care visits was associated with preventing the development of additional chronic conditions that are considered preventable or manageable in primary care, and with reducing hospital outpatient and inpatient care utilisation among people already living with these conditions. METHODS: We used data on 11,425 individuals across four survey waves between 2011 and 2018 from the China Health and Retirement Longitudinal Study. We estimated the effects of primary care visits using the individual fixed-effect model with inverse-probability-of-treatment weighting to account for selection bias. RESULTS: An additional primary care visit was associated with a lower number of additional chronic conditions acquired in the following wave (-0.011, 95% CI: -0.017 to -0.004). This association was stronger among urban residents (-0.016, 95% CI: -0.027 to -0.005), respondents with at least primary school education (-0.014, 95% CI: -0.024 to -0.003), and those with a single chronic condition (-0.018, 95% CI: -0.034 to -0.002). By contrast, among individuals with at least one such chronic condition, primary care visits were not significantly associated with hospital outpatient visits (-0.010, 95% CI: -0.029 to 0.009) or inpatient admissions (0.010, 95% CI: -0.020 to 0.040). CONCLUSION: In China, among adults aged 45 years and older, greater primary care use may help prevent the development of additional chronic conditions, but it does not appear to reduce short-term hospital use among people with existing conditions. Primary care strengthening may therefore contribute more to long-term chronic disease prevention than to immediate reductions in hospital utilisation. Further reforms should focus not only on increasing use, but also on improving the quality and targeting of primary care.