OBJECTIVES: This paper aims to provide a comparison of five types of primary care providers in China: rural clinics, county hospitals, migrant clinics, urban community health centers (CHCs), and online platforms.

METHODS: We pooled the data from four programs that used standardized patients (SPs) to evaluate and compare the quality of primary care from various health care providers in China. We considered five different types of providers: a.) rural clinics; b.) county hospitals; c.) migrant clinics; d.) urban CHCs; and e.) online platforms. We evaluated the quality of care on three main domains: a.) process quality; b.) diagnosis quality; and c.) case management. We use multiple regressions to assess the differences in quality outcomes by provider type, and to examine the associations between quality outcomes and physician characteristics.

RESULTS: Overall, the quality of primary care in China is very poor across all provider types. Urban CHCs and online platforms generally provided higher-quality primary care than other providers. In particular, CHCs showed distinct advantages, including the highest process quality, diagnosis quality, and correct medications of the five provider types. Among the three poorer-quality provider types, the quality of care was higher in county hospitals than in rural clinics, and poorest in migrant clinics. Finally, we observe a positive association between physician qualifications and quality of primary care provided.

CONCLUSIONS: The findings reveal substantial quality gaps among care providers in China. Rural residents are most vulnerable to the poor quality of primary health care. While online platforms can play an important role in expanding access to higher-quality medical resources in underserved areas, they also have drawbacks and cannot serve as effective replacements for offline options. Improving primary health care quality in these areas requires financial incentives to attract high-quality practitioners and regulations, so as to prevent unnecessary care and prescriptions.