Chinese cities are draining rural healthcare resources, UGA study finds

Rapid urbanization in China is disrupting healthcare services in rural communities, according to a new study from the University of Georgia.

The analysis conducted by UGA health economist Zhuo “Adam” Chen identified several ways that swelling urban centers have directly contributed to gaps in healthcare access in rural areas.

“This study is one of the first attempts to use city-level data to examine the impact of urbanization, among other factors, on the pattern of primary healthcare service utilization,” said Chen, an associate professor of health policy and management in UGA’s College of Public Health. “As China continues to urbanize, it’s urgent that we understand these shifts.”

In the 1980s, China moved from a planned to a market economy, and cities became the new economic centers. Chen and his co-author found that the urbanization and its impact on China’s rural healthcare systems have encouraged a practice called “bypassing,” where patients skip traditional primary care in favor of treatment in larger, acute settings like hospitals.

Bypassing leads to inefficiencies in care delivery and increased costs, says Chen, and ultimately it may lead to a demand for care that outstrips supply, even in China’s biggest cities.

Chen’s analysis links bypassing to the demographic changes accompanying the growth of urban centers. The new concentration of people and wealth, in addition to the transportation infrastructure built up to support migrant work, made it easier to access city hospitals. Increased revenue streams made way for higher quality service offerings and the perception that city hospitals were better options than rural clinics, says Chen.

As a result, rural communities are experiencing increasing access issues.

“Health resources in rural areas have drained out. ‘Barefoot doctors’ – the healthcare professionals providing primary care in rural areas sought opportunities elsewhere and left the profession or the area,” said Chen.

Rural primary clinics are losing the ability to sustain themselves, thus exacerbating access issues for the people who still need those providers, specifically older adults and children.

“As we have indicated, vulnerable populations and those who do not have access to alternative options may face challenges in accessing healthcare,” said Chen, “if we do not keep primary healthcare centers open and financially viable.”

Internet use was also shown to contribute to bypassing. Hospitals have the resources to support online appointments and payments, so areas with more internet users tended to have higher frequencies of bypassing.

Yet, internet technologies also offer potential solutions to rebalancing healthcare delivery.

“Telehealth and telemedicine will be useful in providing services in some of the areas, for example, mental health services, radiology, and even robotic surgeries in some cases,” said Chen.

Chen adds that more research needs to be done to understand what types of policy action can impact the consumer habits that urbanization has introduced, an issue that many low-and-middle-income countries, and even some rural areas in high-income countries, may encounter.

The study, “Whither the Roads lead to? Estimating Association between Urbanization and Primary Healthcare Service Use with Chinese Prefecture-level Data in 2014,” published in PLOS ONE in June and is available online here:

– Lauren Baggett

Posted on June 8, 2020.