Abstract
BackgroundGeneral practitioner (GP) system is proved to be effective in over 50 countries worldwide. Guangdong province, as a reform pilot in China, initiated its patient-GP contract service reform in 2014. This study is designed to assess the patients’ acceptance of General Practitioners Contract (GPC) reform and explore its influencing factors.MethodsThis survey interviewed 1010 participants from 16 primary health centers (PHCs) chosen from 4 pilot cities in Guangdong during July and December in 2015. Data were collected through face-to-face interviews. The questionnaire was developed to discover the acceptance of GPC and covered three parts: respondents’ socio-demographic characteristics, health service utilization, and the patients’ assessment of primary health care centers. A binary logistic regression model was used to measure the influencing factors of respondents’ acceptance of GPC policy.ResultsA total of 611(60.5%) participants accepted GPC policy. Compared to patients visited PHCs over 7 times in the previous year, those visited PHCs fewer times reported lower acceptance of GPC policy (OR:0.68, 95% CI:0.49–0.96 for visits ≤3 times and OR:0.57, 95% CI:0.38–0.84 for visits = 4–6 times). Patients’ satisfaction with medical service coverage was positively associated with patients’ acceptance of GPC (OR: 1.72, 95% CI:1.01–3.98 for the satisfied versus the dissatisfied; OR: 1.38, 95% CI:0.92–3.30 for neutral versus the dissatisfied), and the satisfaction with drug list also positively influenced patients’ acceptance of GPC policy (OR: 1.44, 95% CI:1.26–2.73 for the satisfied versus the dissatisfied; OR:1.61, 95% CI:1.36–2.99 for neutral versus the dissatisfied). Meanwhile, age and education had positive impacts on the acceptance of the GPC policy.ConclusionThis study finds out that patients’ satisfaction with medical service coverage and drug list are the influencing factors for the acceptance of GPC policy. Therefore, improvement of medical service accessibility such as better follow-up of patients with chronic diseases and enhanced referral service, as well as the expansion of drug list, will improve patients’ acceptance of GPC policy. It also finds that patients using more primary health service are inclined to accept GPC policy, so more attractive and high-quality service should be provided in PHCs.
Highlights
General practitioner (GP) system is proved to be effective in over 50 countries worldwide
No significant difference was found in gender, marital status, self-reported health status or chronic conditions between groups who accepted to General practitioner contract policy (AGPC) and who didn’t (NAGPC), but significant differences were found in age, education background, monthly family income, proportion of medical expenditure to total family expenditures, and frequency of visiting primary health care (PHC)
By analysis patient satisfaction from eight dimensions, the results showed that the participants gave a good score on service attitude and medical ethics of doctors, but a poor rate on medical expenditure, the limited drugs in the drug list and medical equipment provided in PHCs
Summary
General practitioner (GP) system is proved to be effective in over 50 countries worldwide. In a mature and stable primary health care system, a relatively long-term and stable relationship between patients and qualified GP teams could be restrained through a service contract with an integrated supply of public health and essential medical services. Countries such as Britain and Australia have adopted the models of a mandatory contract between GPs and patients, while some countries, including France, have utilized voluntary contract models [4, 7,8,9]. The government aims to refine a PHC system based on GPs’ qualified and cost-effective care supply [14]
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