Willingness of patients with chronic disease in rural China to contract with family doctors: implication for targeting characteristics

Abstract

Background Rural residents with chronic conditions have a stronger need for health services, which should make using family doctor contract services a priority. This study aimed to evaluate the rate of willingness among rural residents with chronic conditions to contract with family doctors and examine its determinants. Methods A cross-sectional study was conducted from May, 2018 to June, 2018 in Shandong Province in China. A total of 769 rural unsigned residents with chronic conditions were included in the analysis. Using the Andersen model as the theoretical framework, logistic regression models were chosen to analyse the factors associated with willingness to contract with family doctors. Results This study found that the rate of willingness to contract with family doctors among chronic patients in rural Shandong was 46.7%. A higher willingness was observed in those living a further distance from the village clinic (more than 600 m: OR = 1.85, 95%CI =1.17–2.93), having received publicity for family doctor contract services (OR = 1.71, 95% CI = 1.06–2.76), reporting need for utilizing a chronic disease management program (OR = 3.36, 95% CI = 2.20–5.23), and reporting need for higher medical insurance reimbursement (OR = 1.91, 95% CI = 1.28–2.83). Conclusions The prevalence of contract willingness was relatively low among unsigned rural residents with chronic conditions in rural Shandong, China. The need factors were powerful factors affecting their willingness to contract with family doctors. The government should therefore strengthen targeted publicity and education to rural residents with chronic conditions and provide targeted healthcare services, such as chronic disease management programs and medical services with higher reimbursement rates, to promote their willingness to contract with family doctors.

Preference to Family Doctor Contracted Service of Patients with Chronic Disease in Urban China: A Discrete Choice Experiment

“… 44 From the perspective of doctor competency, a published preference study targeting rural FDCS users, where experienced health-care provider was limited, indicated a high preference for the quality of family doctor. 5 , 15 This study finding suggested that even for the urban area, lacking qualified family doctors was still one of the top concerns of FDCS users. The conclusion was supported by a multi-center survey where the respondents regarded the levels of skills as the main reason that they refused to visit primary care institutions.…”

“… Family doctor competency: the family doctor competency indicated physicians’ skills and professional title, which was closely related to patient confidence with FDCS. 15 A family doctor with high credentials and a well-renowned professional title will boost the willingness for service use. The attribute levels are: low, medium and high.4) Referral convenience: this attribute measured the satisfaction of the need for utilizing referrals to specialists.…”

“…A prospective survey indicated that all contracted patients (80.79%) implemented family doctors were important for non-communicable disease management. 15 As China’s healthcare security system is facing heavy financial barriers caused by the rapidly surging chronic disease morbidity rate, 16 , 17 FDCS can provide a less costly alternative.…”

Analysis on the relationship between effort-reward imbalance and job satisfaction among family doctors in China: a cross-sectional study

“…Family doctors exerted greater effort toward organizational overall goals, suggesting that they might overestimate their abilities and devote more effort to tasks that were beyond their capabilities, leading to failed reciprocity between efforts and rewards. Moreover, due to the huge population and rapid ageing of the population, an endless number of rules and regulations, a lack of promotion and learning opportunities, and poor wages and salaries, community doctors are working in a high-stress environment and experiencing decreasing job satisfaction [ 49 , 68 , 69 ].Research suggested that employees with the effort-reward imbalance and high overcommitment were at a higher risk of stress-related mental and physical distress illnesses [ 63 , 70 ] which resulted in decreasing job satisfaction. In addition, lowering the job satisfaction at workplace leads to a low sense of belonging and enthusiasm for work, as well as to a decreasing organization’s retention rate [ 71 , 72 ].…”

The current situation of mental health education and its influencing factors among the elderly migrant population in China: A cross-sectional study

“…All regions in China are currently promoting community-based family doctor contracting services to establish long-term, stable service relationships between family doctors and residents. Because of this, health institutions can rely on community family doctors to establish mental health les and provide mental health tracking services for mobile older adults in their service area the cell grid, to follow the biopsychosocial medicine model, and to increase the content and frequency of services such as home visits, health monitoring, and intervention [43]. The application of the grid model can effectively ensure that all elderly individuals can enjoy mental health services [44].…”