J Korean Med Sci.  2024 Jan;39(2):e10. 10.3346/jkms.2024.39.e10.

Factors Affecting the Preference for Hospitals Over Clinics in Primary Care in Korea

• Kim AM
• Lee JS

• KMID: 2550797
• DOI: http://doi.org/10.3346/jkms.2024.39.e10

Abstract

Background
While the effect of gatekeeping was extensively studied, few efforts have been made to explain why the measures to strengthen gatekeeping do not work well in some countries. This study examined the patient factors related to the choice of level of health care facilities for outpatient care in Korea.
Methods
We examined a population-based sample representative of the population of Korea aged 15 and over in the healthcare experience survey of 2021. A logistic regression model examined the factors associated with choosing hospitals or clinics for outpatient care.
Results
Easy accessibility, kindness of medical staff, and recommendations from acquaintances were considered more important for those who chose clinics over hospitals. While those who chose clinics were more likely to feel that physicians and nurses more readily communicated with patients, those who chose hospitals were more likely to feel that the facility was comfortable. Whereas those who chose hospitals were more likely to trust the current health care system in Korea, those who chose clinics were more likely to think that the health care system needed to be reformed. The tendency was similar when analyzed only among those with good perceived health conditions and without chronic diseases.
Conclusion
This study demonstrates that the preference for hospitals over clinics is mainly based on desire rather than medical need and is not likely to be affected by measures intended to induce a voluntary change of behavior.

Keyword

Primary Health Care; Hospitals; Health Behavior; Gatekeeping; Korea

Reference

1. Heymann J, Cassola A, Raub A, Mishra L. Constitutional rights to health, public health and medical care: the status of health protections in 191 countries. Glob Public Health. 2013; 8(6):639–653. PMID: 23826994.

2. World Health Organization. A System of Health Accounts 2011: Revised Edition. Geneva, Switzerland: World Health Organization;2017.

3. Sripa P, Hayhoe B, Garg P, Majeed A, Greenfield G. Impact of GP gatekeeping on quality of care, and health outcomes, use, and expenditure: a systematic review. Br J Gen Pract. 2019; 69(682):e294–e303. PMID: 30910875.

4. Greenfield G, Foley K, Majeed A. Rethinking primary care’s gatekeeper role. BMJ. 2016; 354:i4803. PMID: 27662893.

5. Reibling N, Wendt C. Gatekeeping and provider choice in OECD healthcare systems. Curr Sociol. 2012; 60(4):489–505.

6. OECD, EU. Health at a Glance: Europe 2016. Paris, France: OECD Publishing;2016.

7. Wu D, Lam TP. Underuse of primary care in China: the scale, causes, and solutions. J Am Board Fam Med. 2016; 29(2):240–247. PMID: 26957381.

8. Zhang A, Nikoloski Z, Albala SA, Yip W, Xu J, Mossialos E. Patient choice of health care providers in China: primary care facilities versus hospitals. Health Syst Reform. 2020; 6(1):e1846844. PMID: 33314985.

9. Wu TY, Majeed A, Kuo KN. An overview of the healthcare system in Taiwan. London J Prim Care (Abingdon). 2010; 3(2):115–119.

10. Kim AM, Cho S, Kim HJ, Jung H, Jo MW, Lee JY, et al. Primary care patients’ preference for hospitals over clinics in Korea. Int J Environ Res Public Health. 2018; 15(6):1119. PMID: 29848995.

11. Yoon HS, Lee SI. Exploring Ways of Development of Primary Care in Korea. Seoul, Korea: Korea Development Institute;2012.

12. Long Q, Xu L, Bekedam H, Tang S. Changes in health expenditures in China in 2000s: has the health system reform improved affordability. Int J Equity Health. 2013; 12(1):40. PMID: 23764104.

13. Dai YX, Chen MH, Chen TJ, Lin MH. Patterns of psychiatric outpatient practice in Taiwan: a nationwide survey. Int J Environ Res Public Health. 2016; 13(10):955. PMID: 27690067.

14. Li W, Wang D, Gan Y, Zhou Y, Chen Y, Li J, et al. Factors influencing government insurance scheme beneficiary acceptance of the gatekeeper policy: a cross-sectional study in Wuhan, China. BMC Health Serv Res. 2018; 18(1):241. PMID: 29615013.

15. Kato D, Ryu H, Matsumoto T, Abe K, Kaneko M, Ko M, et al. Building primary care in Japan: literature review. J Gen Fam Med. 2019; 20(5):170–179. PMID: 31516802.

16. Aoki T, Yamamoto Y, Ikenoue T, Kaneko M, Kise M, Fujinuma Y, et al. Effect of patient experience on bypassing a primary care gatekeeper: a multicenter prospective cohort study in Japan. J Gen Intern Med. 2018; 33(5):722–728. PMID: 29352418.

17. HIRA. Health care information statistics. Updated 2023. Accessed March 3, 2023. https://opendata.hira.or.kr/op/opc/selectMedInfoSvcList.do# .

18. Kim YY, Bae J, Lee JS. Effects of patients’ motives in choosing a provider on determining the type of medical institution. Patient Prefer Adherence. 2017; 11:1933–1938. PMID: 29200834.

19. Ministry of Health and Welfare. Healthcare experience survey 2021. Updated 2022. Accessed March 3, 2023. http://www.mohw.go.kr/react/jb/sjb030301vw.jsp .

20. Qader S, Lefebvre V, Tatem A, Pape U, Himelein K, Ninneman A, et al. Semi-automatic mapping of pre-census enumeration areas and population sampling frames. Humanit Soc Sci Commun. 2021; 8(1):3.

21. Ministry of Health and Welfare. Healthcare experience survey 2021. Updated 2021. Accessed March 3, 2023. https://www.khidi.or.kr/board/view?pageNum=1&rowCnt=20&no1=2304&linkId=48870937&refMenuId=MENU01522&menuId=MENU01521&maxIndex=&minIndex=&schType=0&schText=&schStartDate=&schEndDate=&boardStyle=&categoryId=&continent=&country= .

22. Wu D, Lam TP, Lam KF, Zhou XD, Sun KS. Health reforms in china: the public’s choices for first-contact care in urban areas. Fam Pract. 2017; 34(2):194–200. PMID: 28122845.

23. Fung CH, Elliott MN, Hays RD, Kahn KL, Kanouse DE, McGlynn EA, et al. Patients’ preferences for technical versus interpersonal quality when selecting a primary care physician. Health Serv Res. 2005; 40(4):957–977. PMID: 16033487.

24. Dopelt K, Bachner YG, Urkin J, Yahav Z, Davidovitch N, Barach P. Perceptions of practicing physicians and members of the public on the attributes of a “Good Doctor”. Healthcare (Basel). 2021; 10(1):73. PMID: 35052237.

25. Leach B, Gradison M, Morgan P, Everett C, Dill MJ, de Oliveira JS. Patient preference in primary care provider type. Healthc (Amst). 2018; 6(1):13–16. PMID: 28602803.

26. Kim AM, Park JH, Yoon TH, Kim Y. Hospitalizations for ambulatory care sensitive conditions as an indicator of access to primary care and excess of bed supply. BMC Health Serv Res. 2019; 19(1):259. PMID: 31029134.

27. KOSIS. Healthcare personnel by types of health care facilities. Updated 2023. Accessed March 3, 2023. https://kosis.kr/statHtml/statHtml.do?orgId=354&tblId=DT_HIRA44 .

28. Organization of Economic Co-operation and development. Focus on health care prices. Updated 2020. Accessed March 3, 2023. https://www.oecd.org/health/health-systems/Health-Care-Prices-Brief-May-2020.pdf .

29. Organization of Economic Co-operation and development. Healthcare prices and purchasing power parities. Updated 2020. Accessed March 3, 2023. https://www.oecd.org/health/health-purchasing-power-parities.htm .