Factors associated with contracted services of Chinese family doctors from the perspective of medical staff and consumers: a cross-sectional study

Wang, Huanyan; Shi, Lei; Han, Xuanye; Zhang, Jinchan; Ma, Yuanshuo; Yang, Xi; Liu, Ming; Fan, Li; Lou, Fengge

doi:10.1186/s12913-019-4801-y

Cited by 25 publications

(21 citation statements)

References 16 publications

(16 reference statements)

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“…It is well known that health service quality is associated with the retention of current customers and the attraction of new ones, decreased costs, and enhanced hospital image [22,23]. Previous studies showed that service quality was the most important factor influencing patients' decision to contract with family doctors [24][25][26]. However, the current study's results show that service quality has no significant effect on patients' willingness to contract with village doctors.…”

Section: Discussioncontrasting

confidence: 64%

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

Zhu

et al. 2020

IJERPH

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Historically, cooperative medical insurance and village doctors are considered two powerful factors in protecting rural residents’ health. However, with the central government of China’s implementation of new economic policies in the 1980s, cooperative medical insurance collapsed and rural residents fell into poverty because of sickness. In 2009, the New Rural Cooperative Medical Insurance (NRCMI) was implemented to provide healthcare for rural residents. Moreover, the National Basic Drug System was implemented in the same year to protect rural residents’ right to basic drugs. In 2013, a village doctor contract service was implemented after the publication of the Guidance on Pilot Contract Services for Rural Doctors. This contract service aimed to retain patients in rural primary healthcare systems and change private practice village doctors into general practitioners (GPs) under government management. Objectives: This study investigates the factors associated with rural residents’ contract behavior toward village doctors. Further, we explore the relationships between trust, NRCMI reimbursement rate, and drug treatment effect. We used a qualitative approach, and twenty-five village clinics were chosen from three counties as our study sites using a random sampling method. A total of 625 villagers participated in the investigation. Descriptive analysis, chi-squared test, t-test, and hierarchical logistic analyses were used to analyze the data. Results: The chi-squared test showed no significant difference in demographic characteristics, and the t-test showed a significant difference between signed and unsigned contract services. The results of the hierarchical logistic analysis showed that trust significantly influenced patients’ willingness to contract services, and the drug treatment effect and NRCMI reimbursement rate moderated the influence of trust. Conclusion: Our findings suggest that the government should aim to strengthen trust in the doctor–patient relationship in rural areas and increase the NRCMI reimbursement rate. Moreover, health officers should perfect the contract service package by offering tailored contract services or expanding service packages.

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Section: Discussioncontrasting

confidence: 64%

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

Zhu

et al. 2020

IJERPH

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“…For the contracted physicians the contract enhanced their sense of responsibility to the contracted patients and improved doctor-patient communication. This behavior change in physicians could restore mutual trust, improve patient loyalty and establish long-term relationship [ 33 , 34 ]. Linni Gu’s research has shown that the contracted can improve the communication between physicians and patients, which would contribute to the mutual trust [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of family doctor contract services on patient perceived quality of primary care in southern China

et al. 2020

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Background Family doctor contract service is an important service item in China’s primary care reform. This research was designed to evaluate the impact of the provision of family doctor contract services on the patient-perceived quality of primary care, and therefore give evidence-based policy suggestions. Methods This cross-sectional study of family doctor contract service policy was conducted in three pilot cities in the Pearl River Delta, South China, using a multistage stratified sampling method. The validated Primary Care Assessment Tool-Adult Edition (PCAT-AS) was used to measure the quality of primary care services. PCAT-AS assesses each of the unique characteristics of primary care including first contact, continuity, comprehensiveness, coordination, family-centeredness, community orientation, culture orientation. Data was collected through face-to-face interviews held from July to November, 2015. Covariate analysis and multivariate Linear Regression were adopted to explore the effect of contract on the quality of primary care by controlling for the socio-demographic status and health care service utilization factors. Results A total of 828 valid questionnaires were collected. Among the interviewees, 453 patients signed the contract (54.7%) and 375 did not (45.3%). Multivariate linear regression showed that contracted patients reported higher scores in dimensions of PCAT total score (β = − 8.98, P < 0.000), first contact-utilization(β = − 0.71,P < 0.001), first contact-accessibility(β = − 1.49, P < 0.001), continuity (β = 1.27, P < 0.001), coordination (referral) (β = − 1.42, P < 0.001), comprehensiveness (utilization) (β = − 1.70, P < 0.001), comprehensiveness (provision) (β = − 0.99, P < 0.001),family-centeredness(β = − 0.52, P < 0.01), community orientation(β = − 1.78, P < 0.001), than un- contracted after controlling socio-demographic and service utilization factors. There were no statistically significant differences in the dimensions of coordination (information system) (β = − 0.25, P = 0.137) and culture orientation (β = − 0.264, P = 0.056) between the two both groups. Conclusions This study demonstrates that the pilot implementation of family doctor contract services has significantly improved patients’ perceived primary care quality in the pilot cities, and could help solve the quality problem of primary care. It needs further promotion across the province.

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“…shown that a family doctor contract service has a positive effect on compliance of patients with chronic conditions, enhancing awareness of the family doctor service, establishing stable relationships with family doctors, and improving visiting rates at primary care institutes. [15,[29][30]. Another study found that coordination is the weakest component of the primary care service [31].…”

Section: Resultsmentioning

confidence: 99%

Effect of family doctor contract services on patient perceived quality of primary care in Southern China

Feng

Cheng

Luo

et al. 2020

Preprint

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Background Family doctor contract service is an important service item in China’s primary care reform. This research was designed to evaluate the impact of the provision of family doctor contract services on the patient-perceived quality of primary care, and therefore give evidence-based policy suggestions. Methods This cross-sectional study of family doctor contract service policy was conducted in three pilot cities in the Pearl River Delta, South China,using a multistage stratified sampling method. The adapted Primary Care Assessment Tool-Adult Edition (PCAT-AS) was used to measure the quality of primary care services. Data was collected through face-to-face interviews held from July to November, 2015. Covariate analysis and multivariate Linear Regression were adopted to explore the effect of contract on the quality of primary care by controlling for the socio-demographic status and health care service utilization factors. Results A total of 828 valid questionnaires were collected. From the interviewees, 453 patients signed the contract (54.7%) and 375 did not (45.3%). Multivariate linear regression showed that patients who received services from contracted family doctors reported higher scores in dimensions of PCAT total score (β=-8.98, P<0.000), first contact-utilization(β=-0.71,P<0.001), first contact-accessibility(β=-1.49, P<0.001), continuity (β=1.27, P<0.001), coordination(referral) (β=-1.42, P<0.001), comprehensiveness(utilization) (β=-1.70, P<0.001), comprehensiveness(provision) (β=-0.99, P<0.001), family-centeredness(β=-0.52, P<0.01), community orientation(β=-1.78, P<0.001), than those who did not receive contract services after controlling socio-demographic and service utilization factors. There were no statistically significant differences in the dimensions of coordination (information system) (β=-0.25, P=0.137) and culture orientation (β=-0.264, P=0.056), than those who did not receive family doctor contract services. Conclusions This study demonstrates that the pilot implementation of family doctor contract services has significantly improved patients’ perceived primary care quality in the pilot cities, and could help solve the quality problem of primary care. It needs further promotion across the province.

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Factors associated with contracted services of Chinese family doctors from the perspective of medical staff and consumers: a cross-sectional study

Cited by 25 publications

References 16 publications

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

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

Effect of family doctor contract services on patient perceived quality of primary care in southern China

Effect of family doctor contract services on patient perceived quality of primary care in Southern China

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