Patient perspectives on choosing hospitals over primary healthcare clinics: barriers and preferences in health service utilization

Background
Access to health services is essential for effective healthcare systems, yet global inequalities persist in utilizing Hospital Outpatient Clinics (HOCs) and Primary Health Care Centers (PHCs). Patients often bypass PHCs in favor of HOCs, driven by perceptions of better care.

Objectives
To identify the barriers and preferences that influence patients’ choices between HOCs and PHCs among those attending HOCs.

Material and methods
A cross-sectional study was conducted among 500 patients attending HOCs in Baghdad, Iraq. Data was collected through structured in-person interviews using a validated questionnaire. The questionnaire included sections on socio-demographic information, healthcare utilization preferences, and perceived barriers to PHC utilization. Statistical analysis was performed using IBM SPSS Statistics, with descriptive statistics and Pearson’s Chi-square tests used to analyze the data.

Results
The study found that patients prioritize quality of care (73.1%) when choosing HOCs over PHCs, followed by access to care (40.1%) and patient–doctor relationships (34.1%). Barriers to PHC utilization included organizational issues (73.1%), concerns about quality of care (72.6%), and access difficulties (65.7%). Older patients, females, and individuals with lower socio-economic status were more likely to report barriers to PHC utilization. Gender-based differences in preferences and barriers were observed, with females emphasizing quality of care and males reporting more access-related issues.

Conclusions
The underutilization of PHCs is driven by systemic barriers, including insufficient diagnostic services, lack of specialists, and organizational ineffectiveness.