Table 2.
Patients’ sociodemographic characteristics and practices and attitudes towards downward referral
| Category | N (%) | Willingness of downward referral |
χ2‡ | p Value§ | |
|---|---|---|---|---|---|
| Yes (A*, T†) | No (A*, T†) | ||||
| Part I: sociodemographic characteristics | |||||
| Gender | 0.067 | 0.796 | |||
| Male | 406 (46.9) | 151 (152.8) | 255 (253.2) | ||
| Female | 460 (53.1) | 175 (173.2) | 285 (286.8) | ||
| Occupation | 5.779 | 0.448 | |||
| Others | 209 (24.1) | 89 (78.7) | 120 (130.3) | ||
| Medical staff | 93 (10.7) | 31 (35.0) | 62 (58.0) | ||
| Civil servant | 34 (3.9) | 10 (12.8) | 24 (21.2) | ||
| Retiree | 185 (21.4) | 69 (69.6) | 116 (115.4) | ||
| Farmer | 79 (9.1) | 34 (29.7) | 45 (49.3) | ||
| Worker¶ | 131 (15.1) | 47 (49.3) | 84 (81.7) | ||
| Student | 135 (15.5) | 46 (50.8) | 89 (84.2) | ||
| Age (year) | 3.570 | 0.613 | |||
| <20 | 37 (4.3) | 12 (13.9) | 25 (23.1) | ||
| 20–29 | 292 (33.7) | 104 (109.9) | 188 (182.1) | ||
| 30–39 | 168 (19.4) | 73 (63.2) | 95 (104.8) | ||
| 40–49 | 103 (11.9) | 40 (38.8) | 63 (64.2) | ||
| 50–59 | 115 (13.3) | 42 (43.3) | 73 (71.7) | ||
| ≥60 | 151 (17.4) | 55 (56.8) | 96 (94.2) | ||
| Average monthly income (RMB) | 2.709 | 0.608 | |||
| <2000 | 273 (31.5) | 104 (102.8) | 169 (170.2) | ||
| 2000–2999 | 250 (28.9) | 94 (94.1) | 156 (155.9) | ||
| 3000–4999 | 211 (24.4) | 76 (79.4) | 135 (131.6) | ||
| 5000–7999 | 81 (9.4) | 36 (30.5) | 45 (50.5) | ||
| ≥8000 | 51 (5.9) | 16 (19.2) | 35 (31.8) | ||
| Marital status | 3.573 | 0.168 | |||
| Divorced/widowed | 38 (4.4) | 15 (14.3) | 23 (23.7) | ||
| Married | 586 (67.7) | 232 (220.6) | 354 (365.4) | ||
| Single | 242 (27.9) | 79 (91.1) | 163 (150.9) | ||
| Level of education | 2.209 | 0.697 | |||
| Primary degree and below | 47 (5.4) | 22 (17.7) | 25 (29.3) | ||
| Junior high school degree | 191 (22.1) | 71 (71.9) | 120 (119.1) | ||
| Senior school degree | 179 (20.7) | 70 (67.4) | 109 (111.6) | ||
| Junior college degree | 180 (20.8) | 65 (67.8) | 115 (112.2) | ||
| Bachelor's degree and above | 269 (31.1) | 98 (101.3) | 171 (167.7) | ||
| Annual medical expense (RMB) | 2.305 | 0.512 | |||
| <1000 | 387 (44.7) | 150 (145.7) | 237 (241.3) | ||
| 1000–4999 | 339 (39.1) | 129 (127.6) | 210 (211.4) | ||
| 5000–9999 | 89 (10.3) | 27 (33.5) | 62 (55.5) | ||
| ≥10 000 | 51 (5.9) | 20 (19.2) | 31 (31.8) | ||
| Medical insurance** | 3.274 | 0.070 | |||
| No | 66 (7.6) | 18 (24.8) | 48 (41.2) | ||
| Yes | 800 (92.4) | 308 (301.2) | 492 (498.8) | ||
| Part II: practices and attitudes towards downward referral | |||||
| Experience of downward referral | 0.147 | 0.701 | |||
| No | 793 (91.6) | 297 (298.5) | 496 (494.5) | ||
| Yes | 73 (8.4) | 29 (27.5) | 44 (45.5) | ||
| Degree of medical demand met by healthcare services provided by CHSs†† | 8.112 | 0.088 | |||
| Completely unable to be met | 59 (6.8) | 24 (22.2) | 35 (36.8) | ||
| Can be met a little | 220 (25.4) | 98 (82.8) | 122 (137.2) | ||
| Moderate | 479 (55.3) | 162 (180.3) | 317 (298.7) | ||
| Can partly be met | 98 (11.3) | 39 (36.9) | 59 (61.1) | ||
| Can completely be met | 10 (1.2) | 3 (3.8) | 7 (6.2) | ||
| Degree of satisfaction with CHSs†† | 5.368 | 0.252 | |||
| Completely dissatisfied | 39 (4.5) | 13 (14.7) | 26 (24.3) | ||
| Mostly dissatisfied | 123 (14.2) | 57 (46.3) | 66 (76.7) | ||
| Moderate | 530 (61.2) | 193 (199.5) | 337 (330.5) | ||
| Mostly satisfied | 156 (18.0) | 58 (58.7) | 98 (97.3) | ||
| Completely satisfied | 18 (2.1) | 5 (6.8) | 13 (11.2) | ||
| Recognition of the community first treatment system†† | 19.541 | 0.001 | |||
| Cannot recognise | 44 (5.1) | 19 (16.6) | 25 (27.4) | ||
| Recognise a little | 132 (15.2) | 67 (49.7) | 65 (82.3) | ||
| Moderate | 515 (59.5) | 193 (193.9) | 322 (321.1) | ||
| Partly recognise | 155 (17.9) | 40 (58.3) | 115 (96.7) | ||
| Completely recognise | 20 (2.3) | 7 (7.5) | 13 (12.5) | ||
| Cost-saving because of downward referral†† | 32.169 | 0.000 | |||
| No | 673 (77.7) | 287 (253.3) | 386 (419.7) | ||
| Yes | 193 (22.3) | 39 (72.7) | 154 (120.3) | ||
*A is the actual frequency in χ2 test.
†T is the theoretical frequency in χ2 test.
‡The χ2 is the test statistic of χ2 test.
§p Value<0.05 is considered statistically significant.
¶Workers are the population working in factories and enterprises.
**Medical insurance includes the three basic types of medical insurance in China (Urban Employees’ Basic Medical Insurance System, Urban Residents’ Basic Medical Insurance System, New Rural Co-operative Medical Care System) and private health insurance.
††The judgement on different aspects of patients’ attitudes towards downward referral was determined according to the degree (from the most negative option to the most positive option) of patients’ knowledge, understanding and perception.
CHS, community health system; RMB, renminbi.