Abstract
Objective To evaluate the effectiveness, patient experience, and cost-efficiency of primary care versus hospital care for middle-aged and elderly patients with chronic diseases in China, in the context of achieving the triple aim of healthcare: improving population health, reducing per capita costs, and enhancing patient satisfaction.Methods A longitudinal cohort analysis using data from the China Health and Retirement Longitudinal Study (CHARLS) spanning the years 2011, 2013, 2015, and 2018.The study included participants aged 45 and older from 450 communities across mainland China, specifically targeting those with chronic diseases. Individuals without chronic conditions or with incomplete data were excluded.Results The analysis encompassed 50,800 subjects. Those who visited hospitals for outpatient treatment—mainly urban residents with higher education and income levels, and with comprehensive insurance coverage—demonstrated poorer health outcomes (OR = 1.06, 95%CI 1.02–1.10, p = 0.002) and higher medical expenses (OR = 1.99, 95% CI 1.93–2.06, p < 0.001) compared to those who utilized primary care facilities. No significant difference was observed in satisfaction levels between the two groups (OR = 0.99, 95% CI 0.92–1.07, p = 0.85).Conclusions This study indicates that for patients over 45 with chronic diseases, China's primary care can achieve health outcomes comparable to or better than large hospitals, at significantly lower costs. Despite some data limitations, it highlights the effectiveness of primary care in improving health for socioeconomically disadvantaged groups, advocating for more government investment and policy support to enhance primary care's affordability and functionality.