Status of supply and demand for primary health care in different provinces of China: a mixed-method study

China has implemented extensive reforms to strengthen primary health care (PHC), but mismatches may remain between residents’ demand and PHC institutions’ capacity to deliver core PHC functions. This study examined the mismatch between residents’ demand for PHC services and the service supply capacity of PHC institutions across three provinces in China. A mixed-method study was conducted in three provinces in North-eastern, Central and Western China. The data comprised a survey assessing demand for PHC services and interviews with PHC providers. The demand survey used the Primary Health Care Assessment Tool Chinese Version (PCAT-C), whereas the supply-side survey used semi-structured qualitative interviews. The factors affecting the delivery of PHC services were analyzed using the World Health Organization (WHO) health systems building blocks framework. A total of 12 primary care facilities, 1838 residents, and 31 PHC providers were included in this study. Quantitative results indicated that residents needed coordination services the most, followed by first contact services and ongoing care services; the elderly and residents with multimorbidity exhibited the greatest demand for PHC services. By integrating quantitative and qualitative findings, we identified a mismatch between the supply and demand for PHC services in all six core dimensions. Inadequate staffing of general practitioners (GPs), fragmented information systems, absence of policy support for referrals, inadequate supply of medicines, and unequal allocation of health resources are the main factors contributing to these discrepancies. PHC supply and demand mismatch in the studied provinces in China reflects not only resource insufficiency, but also incomplete functional integration. Although basic public health services and family doctor-related services have expanded service availability, PHC institutions have not yet fully achieved their intended roles in first contact, coordination and continuity of care. Future reforms could consider strengthening integrated referral systems, interoperable information platforms, medicine continuity, GPs competency, medical insurance incentives and quality-oriented family doctor services.