Facilitators and barriers to implement the family doctor contracting services in China: findings from a qualitative study

Abstract

ObjectiveTo identify the facilitators and barriers to implement family doctor contracting services in China by using Consolidated Framework for Implementation Research (CFIR) to shed new light on establishing family doctor systems in developing countries.DesignA qualitative study conducted from June to August 2017 using semistructured interview guides for focus group discussions (FGDs) and individual interviews. CFIR was used to guide data coding, data analysis and reporting of findings.Setting19 primary health institutions in nine provinces purposively selected from the eastern, middle and western areas of China.ParticipantsFrom the nine sampled provinces in China, 62 policy makers from health related departments at the province, city and county/district levels participated in 9 FGDs; 19 leaders of primary health institutions participated in individual interviews; and 48 family doctor team members participated in 15 FGDs.ResultsBased on CFIR constructs, notable facilitators included national reform involving both top-down and bottom-up policy making (Intervention); support from essential public health funds, fiscal subsidies and health insurance (Outer setting); extra performance-based payments for family doctor teams based on evaluation (Inner setting); and positive engagement of health administrators (Process). Notable barriers included a lack of essential matching mechanisms at national level (Intervention); distrust in the quality of primary care, a lack of government subsidies and health insurance reimbursement and performance ceiling policy (Outer setting); the low competency of family doctors and weak influence of evaluations on performance-based salary (Inner setting); and misunderstandings about family doctor contracting services (Process).ConclusionsThe national design with essential features including financing, incentive mechanisms and multidepartment cooperation, was vital for implementing family doctor contracting services in China. More attention should be paid to the quality of primary care and competency of family doctors. All stakeholders must be informed, be involved and participate before and during the process.

The effects of family physician-contracted service on health-related quality of life and equity in health in China

“…The hierarchical medical system emphasizes the importance of a clear division of health care roles and responsibilities for different levels of hospitals, and highlights the significance of taking strategies to encourage the utilization of primary care [ 8 ]. The implementation of the family physician-contracted service (FPCs) is one of the key actions, which improve people’s access to primary health care, minimize the unfair distribution of medical resources and improve the health of community residents [ 9 – 11 ].…”

Evaluation of the Spring Seedling Project—Zhaotong Program: A study of a novel continuing medical education program for rural doctors in China

“…4,5 The public health policy of China has always put emphasis on rural areas and grassroot communities, 6 as the quality and quantity of GPs are critical to meet the basic medical and public health needs of rural populations. 7 Although rural doctors in China undertake the duties of GPs, some receive no formal training in general practice. 8 Therefore, the government of China has aimed to improve the general practice literacy of rural doctors through various CME programs.…”

Factors Associated with Rural Residents’ Contract Behavior with Village Doctors in Three Counties: A Cross-Sectional Study from China

“…Previous studies have found that existing contract services were superficial and deceptive, pursued only quantity, were not accepted by patients, and lacked guarantee [7,8]. The contract rate was low, under 30%, in rural areas [9]. To solve these problems and improve the implementation of family doctor contract services, numerous studies have explored the factors that influence patients' willingness to utilize the contract services.…”