Expansion and provincial inequality in physician home-visit activity in China, 2018–2023: a national ecological panel study of community health service capacity

In many parts of the world, the way people receive medical care is shifting. Instead of waiting in a hospital, more patients are being seen in their own homes, especially as populations age and people with multiple health conditions prefer to stay where they are comfortable. This shift relies on a mix of doctors, nurses, and community workers who travel to patients' doors. However, measuring exactly how much of this care is happening is surprisingly difficult. Different countries count different things: some track how many unique people receive help, while others count how many times a professional visits a house. Some records focus on nurses, others on doctors, and some blend social support with medical treatment. Because the definitions vary so widely, it is hard to compare one country's progress to another's or to know if a system is truly expanding or just changing how it reports its numbers.

A new study from China tackles this complexity by looking at a specific, official record: the number of times doctors visit patients' homes. The researchers wanted to understand how this activity has changed over time, whether it is becoming more equal across different regions, and if having more medical staff and clinics actually leads to more home visits. They focused on the years from 2018 to 2023, a period that saw significant changes in how health services were organized. By examining data from all 31 provinces on the Chinese mainland, the team aimed to separate the actual growth in service from the noise of changing reporting methods or one-time events.

The study found that the recorded number of doctor home visits in China grew dramatically. In 2018, community health centers reported about 21 million visits. By 2023, that number had risen to nearly 58 million. When adjusted for the size of the population, this means the rate of visits per thousand residents jumped from 15 to nearly 41. This represents a compound annual growth rate of 22.3 percent, a very steep climb. The growth was not steady; it was particularly sharp between 2020 and 2021, when the number of visits surged by more than half in a single year. While almost every province saw an increase, two regions, Shandong and Zhejiang, were responsible for more than a third of the total national increase during that jump.

Despite the rapid growth, the researchers also looked at whether this care was becoming more evenly distributed. They used two different ways to measure inequality: one that treats every province as an equal unit, and another that weighs the provinces by how many people live there. Both measures showed that the gap between provinces narrowed over the five-year period. The data suggests that the distribution of these visits became more balanced, meaning residents in different parts of the country were becoming more similar in their access to these recorded services. However, the study notes that this does not necessarily mean every individual's need was met, only that the overall numbers across regions became closer.

A key part of the research was trying to understand what drives these numbers. The team looked at whether having more registered nurses or more community health facilities in a province led to more home visits. They found that while the number of nurses and facilities did grow, it happened much more slowly than the number of visits. The number of nurses increased by about 8 percent a year, and the number of facilities grew by just over 1 percent. In contrast, the visits grew much faster. When the researchers tried to link the number of nurses directly to the number of visits using statistical models, the connection was not clear. The data did not provide a precise answer showing that more nurses automatically meant more visits. In fact, the statistical range was wide enough that it could not rule out a positive link, but it also could not confirm one with certainty.

The study highlights a crucial distinction in what the data actually measures. The official records count "family health service visits," which are defined as occasions when a doctor goes to a home. This is not the same as counting how many unique patients were helped, nor does it count visits made by nurses, which are tracked under different rules in China. The researchers emphasize that the rapid rise in numbers might reflect changes in how services are organized, how data is reported, or how doctors and nurses share tasks, rather than a simple doubling of the work done by individual staff members. For instance, the ratio of visits to the number of nurses doubled, but this does not prove that each nurse is working twice as hard; it could mean that doctors are doing more of the visiting, or that the same patient is being visited more frequently.

The most significant finding is the sudden jump in activity in 2021. The data shows a clear break in the trend, with a massive increase that year that was not sustained by an equally high growth rate in the following years. The researchers cannot say exactly why this happened based on the numbers alone. It could be due to a change in reporting rules, a new policy encouraging visits, a catch-up in services after the start of the pandemic, or a genuine surge in demand. Because the data does not include details on payment, specific medical needs, or the exact nature of the visits, the study cannot pinpoint the cause. It simply confirms that a major shift occurred.

Ultimately, the paper concludes that while the recorded activity of doctor home visits in China has expanded significantly and become more evenly spread across provinces, the data does not yet tell the whole story. The growth outpaced the growth in the number of medical staff and facilities, but the link between having more staff and having more visits remains unclear in this specific dataset. The researchers suggest that to truly understand the health of the system, future tracking needs to distinguish between different types of providers, count unique patients rather than just visits, and account for the specific needs of the population. Without these finer details, it is difficult to know if the system is simply counting more events or if it is successfully delivering more care to the people who need it most.