Residents' Awareness of Family Doctor Contract Services, Status of Contract with a Family Doctor, and Contract Service Needs in Zhejiang Province, China: A Cross-Sectional Study.

Xiaopeng Shang,Junfen Lin,Yinwei Qiu,Yangmei Huang,Wei Wang,Yanrong Zhao,Chonggao Hu,Yang Liu,Bi’E Li,Qing Yang

doi:10.3390/ijerph16183312

Abstract

In China, family doctor services originated in 2009. After two years, the Chinese government proposed the establishment of a family doctor contract system suitable for China’s national conditions. Then, in 2016, a multi-department jointly issued an important document, which further clarified the development goals of family doctor contract services in the next five years. Zhejiang Province has been exploring responsible doctor contract services since 2012, which was promoted throughout the province in 2015. Objectives: The aim of this study was to investigate the residents’ awareness of Zhejiang Province, China, of family doctor contract services, the status of signing such a contract, and the demand for service items in the contracted service package. Further, we sought to explore the relevant influential factors in order to provide a reference and evidence-based recommendations for the further development of family doctor contract services. Design: We enrolled 3960 residents from nine counties in Zhejiang Province using a multistage stratified random sampling method. A survey using a self-designed questionnaire was used to collect the demographic data, residents’ awareness of family doctor contract services, the status of contracting, and demand for different items from October to December 2017. Data were analyzed by SPSS 21.0. Results: In total, 3871 residents returned valid questionnaires, with a response rate of 97.75%. The awareness rate of residents of family doctor contract services was 71.58% (2771/3871). Age, education level, and chronic medical history status were the influencing factors affecting residents’ awareness. The contracted rate was 50.43% (1952/3871). Age, education level, personal monthly income, chronic disease history, and awareness of family doctor contract services were the influencing factors. Residents who have a contract with family doctors have a higher demand for family doctor contract services, and different residents have different needs for the project because of their physical condition, education level, marital status, household registration, and personal monthly income level. The top three needs of the residents for contracted services were health consultation (84.64%), regular physical examination (81.71%), and increasing the proportion of medical insurance reimbursements (80.06%). Conclusions: The awareness rate of family doctor contract services and the contracting rate are unsatisfactory among residents of Zhejiang Province. It is suggested that the government should more heavily publicize family doctor contract services, expand the coverage, introduce personalized contract schemes to meet the needs of different groups, and promote the rapid development of family doctor contract services in Zhejiang Province.

Highlights

In the past decade, the demand for medical services among Chinese residents has steadily grown.Some studies have shown that the number of medical treatments in primary health care institutions has increased, but the proportion of medical treatments has declined, which has become a major obstacle for the promotion of China’s hierarchical medical system [1]
It is suggested that the government should more heavily publicize family doctor contract services, expand the coverage, introduce personalized contract schemes to meet the needs of different groups, and promote the rapid development of family doctor contract services in Zhejiang Province
The survey items mainly covered three parts: (1) demographic information and sociological status, including age, sex, nationality, household registration, education level, marital status, personal income per month, and chronic disease history; (2) residents’ awareness of Family doctor contract services (FDCS) and status of signing a contract; (3) the 10 service items selected from the list of the contents of the FDCS [10], including health consultation, follow-up of chronic patients, long-term prescriptions for chronic patients, rehabilitation guidance, appointment referral, regular physical examination, increase in the proportion of medical insurance (MI) reimbursement, Traditional Chinese Medicine (TCM) health care, family bed service, and free door-to-door service to understand the needs of the residents for each item

Summary

Introduction

The demand for medical services among Chinese residents has steadily grown.Some studies have shown that the number of medical treatments in primary health care institutions has increased, but the proportion of medical treatments has declined, which has become a major obstacle for the promotion of China’s hierarchical medical system [1]. Doctor contract services (FDCS) are essentially the extension and development of community health services based on the principle of full notification, voluntary signing, and standardized service, providing a proactive, continuous, and comprehensive health accountability management model by signing service contracts with residents. Party of China and the State Council issued the “Opinions on Deepening the Reform of the Medical and Health System” [4], which emphasized providing active, continuous, and accountable services and comprehensively developing various models of family doctor services. In 2011, the State Council issued the “Guiding Opinions on Establishing a General Practitioner System” [6], which proposed the establishment of a general practitioner system suitable for China’s national conditions, to establish a hierarchical medical system, and implement a GP service.

Objectives

Methods

Results

Discussion

Conclusion