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Patient preference and choice of healthcare providers in Shanghai, China: a cross-sectional study

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      This study aimed to assess patients’ healthcare-seeking preferences in mild, chronic, and serious illness; identify influential factors; and examine the reasons underlying patients’ healthcare-seeking preference.


      A retrospective study.


      The study was conducted in 14 tertiary hospitals in Shanghai, China.


      Questionnaires were distributed to 1519 patients, and 1114 were completed and returned. All patients participated in the study voluntarily, provided written informed consent, and possessed the ability to complete the questionnaire.

      Main outcome measures

      We measured and compared preferences and choice of healthcare providers in patients if they had experienced mild, chronic, or serious illness.


      More than 50% of participants, including those who were >60 years of age, had consulted a doctor more than three times during the preceding year, were single, and were most likely to decide not to seek medical treatment. Community health facilities were the most frequently selected healthcare provider in mild illness. In addition, patients who had no personal preference, did not express a preference for a good environment or first-class medical technology, were concerned about close proximity and short waiting times, and pursued low medical costs were most likely to choose a community health facility. General hospitals were the most frequently selected healthcare provider in chronic and serious illness. In addition, patients who earned higher monthly incomes, did not pursue low medical costs, were not concerned about short waiting times or close proximity, and expressed a preference for first-class medical technology, were most likely to choose general hospitals.


      Patients’ healthcare-seeking preference was influenced mainly by healthcare providers’ characteristics, illness severity, and sociodemographic characteristics. These findings indicate that patients’ current healthcare-seeking preference was not ideal and requires optimisation.

      Related collections

      Most cited references 44

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      Malaria remains an important cause of death, especially in sub-Saharan Africa. Self-treatment with antimalarial drugs is a common practice that raises important issues for policy-makers. A number of important questions concerning factors related to self-treatment, adequacy of self-treatment and the role of self-treatment in malaria mortality remain unanswered. Although there are some common patterns, there is considerable diversity in treatment practices, even within a single country. Social science research on malaria treatment needs to move beyond description to evaluation of interventions. This will require a greater degree of methodological rigour and more attention to the generation of data that can be compared across time periods and studies. Definitions of malaria cases and the role of local disease categories in identifying cases need to be made more explicit. Illnesses should be classified by severity, using measures of perceived severity as well as biomedical signs of severity. Each treatment step should be considered in terms of four levels of analysis: who provided the treatment or advice, what the treatment was, where it was obtained and when it was taken in relationship to onset of illness.
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          Cancer-related health behaviours may be affected by barriers to healthcare seeking and beliefs about cancer. The aim was to assess anticipated barriers to healthcare seeking and beliefs about cancer in a sample of the Danish population and to assess the association with socio-economic position.

            Author and article information

            [1 ]departmentDepartment of Military Health Service Management, College of Military Health Service Management , Second Military Medical University , Shanghai, China
            [2 ]departmentDepartment of Medical Affairs , No. 187th hospital of PLA , Haikou, China
            Author notes
            [Correspondence to ] Professor Lulu Zhang; zllrmit@

            WY, ML and FY contributed equally.

            BMJ Open
            BMJ Open
            BMJ Open
            BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
            1 November 2017
            : 7
            : 10
            29092898 5695435 bmjopen-2017-016418 10.1136/bmjopen-2017-016418
            © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

            This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

            Funded by: FundRef, National Natural Science Foundation of China;
            Funded by: Military Health Support Strategy and Key Technology Research for Special Injuries in the South China Sea Region;
            Funded by: Important Disease Joint Research Project in Health Systems of Shanghai;
            Health Services Research
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            influential factor, preference, choice, healthcare, patient


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