Stated preferences for family doctor contract services: a survey of the rural elderly in Anhui Province, China

Abstract

ObjectiveA number of factors contribute to the utilisation of family doctor contract services (FDCS) in China. This study aims to measure the preferences of the elderly for the FDCS and identify the key factors (and their relative importance) that may guide policymakers in more accurately providing the FDCS.Participants and methodsA discrete choice experiment was performed to elicit the preferences for FDCS among the rural elderly in China. Attributes and levels were established based on qualitative methods. Four attributes were included: service type, service package, physician’s reputation and annual contract costs. A D-efficient design was used to create a set of profiles that represented FDCS. The survey was conducted face to face using a sample of participants aged 60 and above in rural areas of Anhui Province. The data were analysed using a latent class logit (LCL) model.ResultsA total of 545 valid questionnaires were included in the analysis. The average age of the participants was 69.44 (SD 5.80). Two latent classes were identified with the LCL model. All four attributes proved statistically significant at the level of both the population mean and the two classes. The rural elderly showed a preference for FDCS with a relatively good reputation, lower annual contract costs, the basic service with the add-on of chronic disease service and home visit. Age, gender, education, self-reported health status and the number of chronic diseases were found to be associated with latent class membership.ConclusionIn this study, the physician’s reputation had the largest impact on the rural elderly’s choice of FDCS. Policy recommendations included the need to strengthen family doctor team training, devote greater attention to improving the family doctor’s medical skills and service approaches, and increased FDCS efficiency for the care of the rural elderly.

Healthcare preferences of chronic disease patients under China's hierarchical medical system: an empirical study of Tianjin's reform practice

“…The empirical analysis in this study reveals that improving the service quality of medical institutions and standardizing the diagnosis and treatment process not only enhances patients' trust in medical services, but also deepens their reliance on primary care. This finding is consistent with previous research findings that suggest that good organizational structure and processes can increase user satisfaction and dependence 39 – 43 . It is worth noting that although the physical condition of healthcare facilities and the modernization of equipment had an effect on patient attraction, this effect was not significant in this study.…”

“…In short, having better physicians will more effectively direct the flow of patients to primary healthcare. In addition, a good family doctor system has been shown to be positively associated with better health outcomes and lower healthcare costs 38 , 39 . Tianjin has taken the lead in developing family doctor contracting services since the policy's implementation, and the contracting rate has reached a high level.…”

“…Tianjin has taken the lead in developing family doctor contracting services since the policy's implementation, and the contracting rate has reached a high level. A large body of evidence suggests that residents' level of trust in their family doctors influences their choice of primary care services 39 , 40 .…”

Effect of multiple chronic conditions on family doctor contracting in the elderly in China: the moderating role of socioeconomic status

“…Thus the elderly with MCCs have a higher demand for health services and may be more likely to contract with family doctors. Wang's study showed that the elderly want family doctors to provide more chronic disease management services [ 22 ]. Yang's study found that the elderly with cardiovascular-metabolic multimorbidity were more willing to contract with family doctors.…”