Abstract
BackgroundGatekeeper policy, requiring a patient to visit a primary care provider first, and the patient needs to get his or her primary care provider’s referral before seeing a specialist or going to a hospital, has been implemented in China for about ten years, and it is necessary to assess the patients’ acceptance of gatekeeper policy and to explore the factors influencing patients’ acceptance.MethodsA cross-sectional study with 1162 respondents was conducted between July and September 2015 at four community health centers (CHCs) in Wuhan, China. Face-to-face interview was used to collect information on demographics, acceptance of the gate keeper policy and satisfaction with community health services. Patients’ satisfaction with community health service was evaluated using the European Patients Evaluate General/Family Practice scale and binary logistic regression model was used to examine the factors influencing patients’ acceptance of community health services as gate keepers.ResultsA total of 512 (43.06%) patients accepted gatekeeper policy. Mandatory reimbursement provision (OR: 1.63, 95% CI: 1.23–2.15), patient satisfaction with the aspects of medical care (OR: 1.92, 95% CI: 1.12–3.29) and organization of care (OR: 1.66, 95% CI: 1.05–2.62) were associated with acceptance of gatekeeper policy, after adjusting for potential confounders. Moreover, young people (OR: 0.35, 95%CI: 0.22–0.56) seemed to be more reluctant to accept the policy, when compared with the elder.ConclusionsOur study suggests that mandatory reimbursement provision greatly affects patients’ acceptance of gatekeeper policy, therefore, the policy-maker should pay attention to the negative effect of its mandatory reimbursement provision on patients’ acceptance of the policy. However, improving the aspects of medical care and organization of care will contribute to implementation of gatekeeper policy.
Highlights
Gatekeeper policy, requiring a patient to visit a primary care provider first, and the patient needs to get his or her primary care provider’s referral before seeing a specialist or going to a hospital, has been implemented in China for about ten years, and it is necessary to assess the patients’ acceptance of gatekeeper policy and to explore the factors influencing patients’ acceptance
China achieved near-universal health insurance coverage before economic reform, and about 90% of residents were covered by Cooperative Medical System in rural areas, while in urban areas, almost everyone was covered by Government Insurance Scheme (GIS) and Labor Insurance Scheme [1]
Significant differences were found in the distribution of age and chronic conditions between Patients who accept the gatekeeper policy (AGP) and NAGP. 64.4% AGP were over 60 years old while the percentage of NAGP patients was only 45.5%. 63.9% patients who attended Community Health Centers (CHC) for treatment due to mandatory reimbursement provision were not willing to accept gatekeeper policy and 43.1% patients who voluntarily attended CHC for treatment could accept gatekeeper policy
Summary
Gatekeeper policy, requiring a patient to visit a primary care provider first, and the patient needs to get his or her primary care provider’s referral before seeing a specialist or going to a hospital, has been implemented in China for about ten years, and it is necessary to assess the patients’ acceptance of gatekeeper policy and to explore the factors influencing patients’ acceptance. People covered by GIS spent only a few amount of money or were free of charge on their medical care. They were required to abide to gatekeeper policy. In China, the gatekeeper policy is around compulsory reimbursement provision: if a patient is subjected to the gatekeeper policy, he or she could get all or most of compensation and if the patient seeks care from a specialist or a hospital without referral, he or she has to pay all the charges by him or herself. People covered by SMI could freely choose any medical institution for medical care without restrictions. Discontent with insufficient access to health service and expensive medical cost [4] threatened social stability and deteriorated the doctor-patient relationship [5]
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