A preliminary effect analysis of family doctor and medical insurance payment coordination reform in Changning District of Shanghai, China

Jiaoling Huang,Tao Zhang,Hong Liang,Yimin Zhang,Dongfeng Guo,Chengjun Liu,Luan Wang,Shanshan Liu,Wei Lu

doi:10.1186/s12875-019-0949-0

Abstract

BackgroundChangning District of Shanghai pioneered in implementing Family Doctor and Medical Insurance Payment Coordination Reform. The survey aimed to assess the effect of the reform to provide a decision-making basis for ensuring the “gatekeeper” role of the family doctor.MethodsA cross-sectional survey was conducted using a self-designed questionnaire in Changning District of Shanghai during January and February in 2014. Multi-stage random cluster was applied and 3040 residents were selected. Comparisons were made with statistically test between the contracted and non-contracted residents in four policy targeted dimensions, doctor-visiting behavior, health management and status, medical cost control and satisfaction.ResultsCompared with the non-contracted residents, the contracted residents (72.9%) presented a higher prevalence rate of chronic diseases (32.6%), a higher proportion (51.9%) in first-contact in the community health service center and a higher proportion to refer to specialists as well (P < 0.001).The result showed that the average annual medical expense were significantly higher than non-contracted residents (P < 0.001), however, the difference disappeared after age, medical insurance and other socio-demographic variables were controlled. In terms of self-management of non-communicable diseases and complication prevention, the blood pressure control rate and blood glucose control rate for the contracted group were also higher than the counterparts, reaching up to 85.6 and 72.7% respectively.ConclusionThe preliminary analysis indicated that the contracted residents performed better in orderly doctor visiting behavior, health management behavior, health status and satisfaction. Follow up survey is necessary to further analyze the policy effect.

Highlights

Changning District of Shanghai pioneered in implementing Family Doctor and Medical Insurance Payment Coordination Reform
First-contact in community health service centers (CHSCs) and referral via Community health service center (CHSC) implemented by family doctors have played as the active role of the “gatekeeper” of health systems, expecting to efficiently take advantage of health resources, control medical cost and improve health status [3, 4]
The Non-communicable diseases (NCD) rate was significantly higher in the contracted than the counterpart

Summary

Introduction

Changning District of Shanghai pioneered in implementing Family Doctor and Medical Insurance Payment Coordination Reform. First-contact in community health service centers (CHSCs) and referral via CHSCs implemented by family doctors have played as the active role of the “gatekeeper” of health systems, expecting to efficiently take advantage of health resources, control medical cost and improve health status [3, 4]. It was reported that PHC services and community health education provided by family doctors. With the establishment of the long-term and stable partnership between family doctors and community residents, it is more likely to detect and assess the health risks for contracted residents, to restrain the incidence of non-communicable diseases (NCDs) and complications [6, 7], to reduce hospitalization probability [8,9,10] and overdose as well [11]. The comparative studies of high-income countries have showed that the higher the proportion of family doctors, the lower the country’s overall health cost and the higher the quality evaluation score [12, 13]

Methods

Results

Discussion

Conclusion