The Ecology of Medical Care in Shanghai: Temporal Trends and International Comparisons

Lin Pan,1,* Biao Wang,1,* Rui Huang,2 Li Luo1,2 1School of Public Health, Fudan University, Shanghai, 200032, People’s Republic of China; 2Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, 200032, People’s Republic of China*These authors contributed equally to this workCorrespondence: Li Luo, Fudan University, 130 Dong’an Road, Xuhui District, Shanghai, 200032, People’s Republic of China, Email [email protected]: To better understand the temporal evolution of healthcare utilization in Shanghai, this study examines changes in Shanghai’s ecology of medical care from 2018 to 2023 and compares them with other countries to contextualize global trends.Methods: Using data from the 7th Shanghai Health Service Survey (2023), this study estimated monthly health-related symptoms and healthcare-seeking behaviors per 1,000 residents, examined subgroup differences via logistic regression, and contextualized findings through a scoping review of international studies applying the ecology of medical care framework.Results: In 2023, per 1,000 Shanghai residents per month, 503 reported illness, 495 sought treatments (including healthcare visits or self-medication), 228 visited healthcare facilities, 144 visited primary care, 98 self-medicated, 31 used TCM, 6 were hospitalized, and 3 underwent surgery. Compared to 2018, self-reported illness (+59), treatment seeking (+62), and self-medication (+6) increased, while outpatient visits, primary care, TCM use, and hospitalizations declined. Internationally, Shanghai shows relatively low illness reporting, primary care use, TCM use, and hospitalization rates, but relatively high treatment-seeking and self-medication.Conclusion: These findings suggest a shift in Shanghai’s healthcare utilization from formal services toward individual-led actions, with increased treatment-seeking, higher self-medication, and decreased outpatient, primary care, TCM, and hospitalization use. Internationally, Shanghai shows a distinctive pattern of high treatment-seeking and self-care despite low formal service use, indicating greater reliance on informal health strategies.Keywords: The ecology of medical care, Patterns of healthcare utilization, Logistic regression, Shanghai, China