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Guo J, Qian Y, Chen C, Liang H, Huang J. Does a GP service package matter in addressing the absence of health management by the occupational population? A modelling study. BMC Health Serv Res 2024; 24:638. [PMID: 38760746 PMCID: PMC11100196 DOI: 10.1186/s12913-024-10954-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 04/04/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVE To assess the influence of supply and demand factors on the contract behavior of occupational populations with general practitioner (GP) teams. METHODS We employed a system dynamics approach to assess and predict the effect of the general practitioner service package (GPSP) and complementary incentive policies on the contract rate for 2015-2030. First, the GPSP is designed to address the unique needs of occupational populations, enhancing the attractiveness of GP contracting services, including three personalized service contents tailored to demand-side considerations: work-related disease prevention (WDP), health education & counseling (HEC), and health-care service (HCS). Second, the complementary incentive policies on the supply-side included income incentives (II), job title promotion (JTP), and education & training (ET). Considering the team collaboration, the income distribution ratio (IDR) was also incorporated into supply-side factors. FINDINGS The contract rate is predicted to increase to 57.8% by 2030 after the GPSP intervention, representing a 15.4% increase on the non-intervention scenario. WDP and HEC have a slightly higher (by 2%) impact on the contract rate than that from HCS. Regarding the supply-side policies, II have a more significant impact on the contract rate than JTP and ET by 3-5%. The maximum predicted contract rate of 75.2% is expected by 2030 when the IDR is 0.5, i.e., the GP receives 50% of the contract income and other members share 50%. CONCLUSION The GP service package favorably increased the contract rate among occupational population, particularly after integrating the incentive policies. Specifically, for a given demand level, the targeted content of the package enhanced the attractiveness of contract services. On the supply side, the incentive policies boost GPs' motivation, and the income distribution motivated other team members.
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Affiliation(s)
- Jing Guo
- School of Social Development and Public Policy of Fudan University, Shanghai, China
| | - Ying Qian
- Business School, University of Shanghai for Science and Technology, Shanghai, China
| | - Chen Chen
- Pengpuxincun Community Health Service Center, Shanghai, China
| | - Hong Liang
- School of Social Development and Public Policy of Fudan University, Shanghai, China
| | - Jiaoling Huang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Wang X, Chu J, Zhao D, Gao T, Luo J, Wang X, Chai S, Li J, Sun J, Li P, Zhou C. The impact of hypertension follow-up management on the choices of signing up family doctor contract services: does socioeconomic status matter? BMC PRIMARY CARE 2024; 25:130. [PMID: 38658816 PMCID: PMC11040762 DOI: 10.1186/s12875-024-02383-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND This study aimed to explore the association between hypertension follow-up management and family doctor contract services, as well as to examine whether socioeconomic status (SES) had an interaction effect on this relationship among older adults in China. METHODS We used data from the sixth National Health Service Survey of Shandong Province, China, including 3,112 older adults (age ≥ 60 years) with hypertension in 2018. Logistic regression models and a margins plot were used to analyze the role of SES in the relationship between hypertension follow-up management and family doctor contract services. RESULTS The regular hypertension follow-up management rate and family doctor contracting rate were 81.8% and 70.9%, respectively, among older adults with hypertension. We found that participants with regular hypertension follow-up management were more likely to sign family doctor contract services (OR=1.28, 95%CI: 1.04, 1.58, P=0.018). The interaction effect occurred in the groups who lived in rural areas (OR=1.55, 95%CI: 1.02, 2.35), with high education level (OR=0.53, 95%CI: 0.32, 0.88) and had high incomes (OR=0.53, 95%CI: 0.35, 0.81). CONCLUSIONS Our findings suggested that regular hypertension follow-up management was associated with family doctor contract services and SES influenced this relationship. Primary health care should improve the contracting rate of family doctors by strengthening follow-up management of chronic diseases. Family doctors should focus on improving services quality and enriching the content of service packages especially for older adults with higher income and education level.
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Affiliation(s)
- Xuehong Wang
- Centre for Health Management and Policy Research, School of Public Health Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Institute of Health and Elderly Care, Shandong University, Jinan, 250012, China
| | - Jie Chu
- Shandong Center for Disease Control and Prevention, Jinan, 250012, China.
| | - Dan Zhao
- Centre for Health Management and Policy Research, School of Public Health Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Institute of Health and Elderly Care, Shandong University, Jinan, 250012, China
| | - Tingting Gao
- Centre for Health Management and Policy Research, School of Public Health Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Institute of Health and Elderly Care, Shandong University, Jinan, 250012, China
| | - Jingjing Luo
- Centre for Health Management and Policy Research, School of Public Health Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Institute of Health and Elderly Care, Shandong University, Jinan, 250012, China
| | - Xueqing Wang
- Centre for Health Management and Policy Research, School of Public Health Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Institute of Health and Elderly Care, Shandong University, Jinan, 250012, China
| | - Shujun Chai
- Centre for Health Management and Policy Research, School of Public Health Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Institute of Health and Elderly Care, Shandong University, Jinan, 250012, China
| | - Jiayan Li
- Centre for Health Management and Policy Research, School of Public Health Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Institute of Health and Elderly Care, Shandong University, Jinan, 250012, China
| | - Jingjie Sun
- Shandong Health Commission Medical Management Service Center, Jinan, 250012, China
| | - Peilong Li
- Shandong Health Commission Medical Management Service Center, Jinan, 250012, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Institute of Health and Elderly Care, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
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Zhang L, Zhang P, Chen W. Can family doctor system improve health service utilization for patients with hypertension and diabetes in China? A difference-in-differences study. BMC Health Serv Res 2024; 24:454. [PMID: 38605337 PMCID: PMC11007929 DOI: 10.1186/s12913-024-10903-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 03/26/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Family doctors, serving as gatekeepers, are the core of primary health care to meet basic health needs, provide accessible care, and improve attainable health. The study objective was to evaluate the impact of the family doctor system on health service utilization among patients with hypertension and diabetes in China. METHODS Difference-in-Differences (DID) models are constructed to estimate the net effect of the family doctor system, based on the official health management records and medical insurance claim data of patients with hypertension and diabetes in an eastern city of China. RESULTS The family doctor system significantly increases follow-up visits (hypertension patients coef. = 0.13, diabetes patients coef. = 0.08, both p < 0.001) and outpatient visits (hypertension patients coef. = 0.08, diabetes patients coef. = 0.05, both p < 0.001) among the contracted compared to the non-contracted. The proportion of outpatient visits in community health centers among the contracted significantly rose (hypertension patients coef. = 0.02, diabetes patients coef. = 0.04, both p < 0.001) due to significantly more outpatient visits in community health centers and fewer in secondary and tertiary hospitals. It also significantly mitigates the increase in inpatient admissions among hypertension patients but not among diabetes patients. CONCLUSIONS The examined family doctor system strengthens primary care, both by increasing follow-up visits and outpatient visits and promoting a rationalized structure of outpatient utilization in China.
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Affiliation(s)
- Luying Zhang
- School of Public Health, Fudan University, Shanghai, China
| | - Peng Zhang
- School of Humanities, Shanghai Institute of Technology, 100 Haiquan Road, Fengxian District, Shanghai, China
| | - Wen Chen
- School of Public Health, Fudan University, Shanghai, China.
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Zhao N, Gu M, Li J, Zhang H, Yang J. Factors influencing contracting of residents with family doctors in China: a national cross-sectional survey. BMC Health Serv Res 2024; 24:213. [PMID: 38360648 PMCID: PMC10870580 DOI: 10.1186/s12913-024-10606-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Family doctor contract services (FDCS) have been introduced in China in 2009 [1] and rapidly expanded recently. This study sought to investigate factors that influenced the willingness of Chinese residents to use FDCS. METHODS We employed multistage stratified and convenience sampling to administer questionnaires to 1455 Beijing, Qinghai, and Fujian residents. The willingness of residents in each province to contract family doctors was analyzed using the chi-square test and binary logistic regression. RESULTS The analysis in this study found that the signing rate of family doctors in China was about 27.77%, with differences in the signing up levels in Beijing (13.68%), Fujian (64.49%) and Qinghai (11.22%). In addition, the binary logistic regression results emphasized the relative importance of age, education, medical preference and policy knowledge on the willingness to sign up. Distrust of family doctors' medical skills (65.7%), not knowing how to contract (47.8%), and not knowing what medical problems can be solved (41.1%) were the top three reasons accounting for the reluctance of residents to contract with family doctors. CONCLUSION Residents from different backgrounds have different willingness to sign up, so the specific circumstances and needs of different groups should be taken into account. In order to increase the signing-up rate, consideration can be given to promoting the family doctor model in Fujian throughout the country. Individual hesitation can be eliminated by increasing the reimbursement rate of health insurance, reducing the out-of-pocket expenses of contracted patients, and providing incentives of certain discounts for consecutive contracted patients.
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Affiliation(s)
- Ning Zhao
- School of Public Health, Capital Medical University, Beijing, China
| | - Mei Gu
- School of Public Health, Capital Medical University, Beijing, China
| | - Jin Li
- School of Public Health, Capital Medical University, Beijing, China
| | - Haiyan Zhang
- Department of Health Education, Beijing Huairou Hospital of University of Chinese Academy of Sciences, Beijing, China
| | - Jia Yang
- School of Public Health, Capital Medical University, Beijing, China.
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Rao X, Luo L, Wang X. A spatial feature analysis of primary health care utilization in a large city in China and its implications for family doctor contract service policy. BMC Health Serv Res 2024; 24:194. [PMID: 38351077 PMCID: PMC10863294 DOI: 10.1186/s12913-023-10389-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 11/28/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Family doctor contract policy is now run by the State Council as an important move to promote the hierarchical medical system. Whether the family doctor contract policy achieves the initial government's goal should be measured further from the perspective of patient visits between hospitals and community health centers, which are regarded as grass medical agencies. METHODS The spatial feature measurement method is applied with ArcGIS 10.2 software to analyze the spatial aggregation effect of patient visits to hospitals or community health centers among 20 districts of one large city in China and analyze the family doctor contract policy published in those areas to compare the influence of visit tendencies. RESULTS From year 2016-2020, visits to hospitals were in the high-high cluster, and the density was spatially overflow, while there was no such tendency in visits to community health centers. The analysis of different family doctor contract policy implementation times in 20 districts reflects that the family doctor contract policy has a very limited effect on the promotion of the hierarchical medical system, and the innovation of the family doctor contract policy needs to be considered. CONCLUSIONS A brief summary and potential implications. A multi-integrated medical system along with family doctor contract policy needs to be established, especially integrated in leadership and governance, financing, workforce, and service delivery between hospitals and community health centers, to promote the hierarchical medical system.
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Affiliation(s)
- Xin Rao
- Department of General Practice office of General Practice Medical Center, West China HospitalSCU, Chengdu, China
- Institute of Hospital Management, West China HospitalSCU, Chengdu, China
| | - Li Luo
- Institute of Service ManagementSchool of business, SCU, Chengdu, China
| | - Xingyue Wang
- Department of Graduate Medical Education, West China Hospital/School of Medicine, SCU, Chengdu, China.
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Gao T, Yan G, Zhang M, Leng B, Jiang F, Mi W. Effect of social integration on family doctor contracting services among migrant populations in China: a national cross-sectional survey. Fam Pract 2023; 40:538-545. [PMID: 37555256 DOI: 10.1093/fampra/cmad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND The family doctor (FD) contracting system is a key reform in the development of the Chinese health system, and is considered an effective way to ensure equitable access to healthcare services. This study investigates the effects of social integration on FD contracting services among migrant populations. METHODS In total, 120,106 respondents from the 2018 China Migrants Dynamic Survey were included in this study. Two multivariate regression models were used to estimate the effect of social integration and other factors on FD contracting services among migrant populations. RESULTS This study found that only 14.0% of the migrant populations had a FD. Multiple dimensions of social integration and some covariates were shown to be positively associated with FD contracting services, including average monthly household income, local medical insurance (odds ratio [OR] = 1.34, 95% confidence interval [CI] = 1.29-1.39), employment status (OR = 0.86, 95% CI = 0.82-0.91), settlement intention (OR = 1.15, 95% CI = 1.09-1.22), received health education (OR = 4.88, 95% CI = 4.51-5.27), sex (OR = 1.16, 95% CI = 1.12-1.20), age (OR = 1.66, 95% CI = 1.51-1.82), marital status (OR = 1.38, 95% CI = 1.31-1.46), sickness within a year (OR = 0.84, 95% CI = 0.79-0.89), and flow range (OR = 1.12, 95% CI = 1.07-1.16). CONCLUSIONS All dimensions of social integration, including economic integration, social identity, and social involvement, are associated with FD contracting services among migrant populations. Policymakers should focus on improving the signing rates of migrant populations and implement more effective measures to enhance their social integration, such as settlement incentives and encouraging social participation.
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Affiliation(s)
- Tiantian Gao
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Genquan Yan
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Meiying Zhang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Bing Leng
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Fan Jiang
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission (NHC) Key Lab of Health Economics and Policy Research (Shandong University), Jinan, China
| | - Wei Mi
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Wang W, Zhang J, Lu J, Wei X. Patient views of the good doctor in primary care: a qualitative study in six provinces in China. Glob Health Res Policy 2023; 8:24. [PMID: 37434267 DOI: 10.1186/s41256-023-00309-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 06/07/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND China has been striving to train primary care doctors capable of delivering high-quality service through general practitioner training programs and family doctor team reforms, but these initiatives have not adequately met patient needs and expectations. In order to guide further reform efforts to better meet patient expectations, this study generates a profile of the good doctor in primary care from the patient perspective. METHODS Semi-structured interviews were conducted in six provinces (Shandong, Zhejiang, Henan, Shaanxi, Shanxi, Heilongjiang) in China. A total of 58 interviewees completed the recorded interviews. Tape-based analysis was used to produce narrative summaries. Trained research assistants listened to the recordings of the interviews and summarized them by 30-s segments. Thematic analysis was performed on narrative summaries to identify thematic families. RESULTS Five domains and 18 attributes were generated from the analysis of the interview data. The domains of the good doctor in primary care from the patient perspective were: strong Clinical Competency (mentioned by 97% of participants) and Professionalism & Humanism (mentioned by 93% of participants) during service delivery, followed by Service Provision and Information Communication (mentioned by 74% and 62% of participants, respectively). Moreover, Chinese patients expect that primary care doctors have high educational attainment and a good personality (mentioned by 41% of participants). CONCLUSIONS This five-domain profile of the good doctor in primary care constitutes a foundation for further primary care workforce capacity building. Further primary care reform efforts should reflect the patient views and expectations, especially in the family physician competency framework and primary care performance assessment system development. Meanwhile, frontline primary care organizations also need to create supportive environments to assist competent doctors practice in primary care, especially through facilitating the learning of primary care doctors and improving their well-being.
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Affiliation(s)
- Wenhua Wang
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 West Xianning Road, Xi'an, People's Republic of China
| | - Jinnan Zhang
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 West Xianning Road, Xi'an, People's Republic of China
| | - Jiao Lu
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 West Xianning Road, Xi'an, People's Republic of China
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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Wang A, Tang C, Zhou L, Lv H, Song J, Chen Z, Yin W. How surface acting affects turnover intention among family doctors in rural China: the mediating role of emotional exhaustion and the moderating role of occupational commitment. HUMAN RESOURCES FOR HEALTH 2023; 21:3. [PMID: 36703192 PMCID: PMC9878490 DOI: 10.1186/s12960-023-00791-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Family doctors in rural China are the main force for primary health care, but the workforce has not been well stabilized in recent years. Surface acting is an emotional labor strategy with a disparity between inner feelings and emotional displays, provoking negative effects such as emotional exhaustion, occupational commitment reduction, and, consequently, increasing turnover rate. With the Conservation of Resources theory, this study explores how the surface acting of rural family doctors affects turnover intention through emotional exhaustion and investigates what role occupational commitment plays in this relationship. METHODS With a valid response rate of 93.89%, 953 valid data were collected by an anonymous self-administered questionnaire survey in December 2021 in Shandong Province, China. Cronbach's Alpha and confirmatory factor analysis (CFA) were used to estimate reliability and construct validity, respectively. The PROCESS macro in SPSS was performed to analyze the mediating and moderated mediation effects of surface acting, emotional exhaustion, occupational commitment, and turnover intention. RESULTS Reliability and validity indicated that the measurement instruments were acceptable. Surface acting had a direct positive effect on turnover intention (β = 0.481, 95% CI [0.420, 0.543]). Emotional exhaustion partially mediated the effect of surface acting on turnover intention (indirect effect: 0.214, 95% CI [0.175, 0.256]). Occupational commitment moderated the effect of emotional exhaustion on turnover intention (β = - 0.065, 95% CI [- 0.111, - 0.019]), and moderated the indirect effect of surface acting on turnover intention via emotional exhaustion (index of moderated mediation: - 0.035). CONCLUSIONS Emotional exhaustion partially mediates the relationship between surface acting and turnover intention among family doctors in rural China, and occupational commitment moderates the direct effect of emotional exhaustion on turnover intention and further moderates the mediating effect. Policymakers should pay more attention to the effects of emotional labor and emotional resource depletion on the stability of rural health human resources.
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Affiliation(s)
- Anqi Wang
- School of Public Health, Weifang Medical University, Weifang, China
| | - Changhai Tang
- School of Public Affairs, Zhejiang University, Hangzhou, China
- School of Business, NingboTech University, Ningbo, China
| | - Lifang Zhou
- School of Management, Weifang Medical University, Weifang, China
| | - Haiyuan Lv
- School of Management, Weifang Medical University, Weifang, China
| | - Jia Song
- School of Management, Weifang Medical University, Weifang, China
| | - Zhongming Chen
- School of Management, Weifang Medical University, Weifang, China
| | - Wenqiang Yin
- School of Management, Weifang Medical University, Weifang, China
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Li L, Zhu L, Zhou X, Zeng G, Huang H, Gan Y, Lu Z, Wang X, Chen Z, Sun K, Yang D, Zhang Q, Wu C. Patients’ trust and associated factors among primary care institutions in China: a cross-sectional study. BMC PRIMARY CARE 2022; 23:109. [PMID: 35524197 PMCID: PMC9075926 DOI: 10.1186/s12875-022-01709-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 04/14/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Empirical evidence on patients’ trust and the factors among primary care institutions (PCIs) in China is limited. This study aimed to investigate patients’ trust and explore some associated factors among PCIs in the central region of China.
Methods
The data was collected through a multistage stratified sampling method with a structured self-administered questionnaire, which was distributed from January to March 2021 among 2,287 Chinese patients ever involved in seeking healthcare among PCIs. Patients’ trust was measured with the Chinese version of the Wake Forest Physician Trust Scale (C-WFPTS). Differences in C-WFPTS scores among groups were estimated by t-tests or ANOVA analyses. Multiple linear regression analysis was used to analyze influencing factors for patients’ trust in primary care physicians.
Results
Based on the C-WFPTS with a full score of 50, the average score of patients’ trust was 34.19 (SD = 5.83). Multiple linear analyses indicated that the patients who were older aged, married, with education of higher level, living in urban regions, under better health status and with a family doctor contract reported a higher level of patients’ trust.
Conclusion
Patients’ trust in primary care physicians was at a medium but slightly improved level in the central region of China. Age, marital status, education, residential area, health status, and a family doctor contract were significant predictors of patients’ trust.
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Yan N, Liu T, Xu Y, Fang X, Ma X, Yang M, Du J, Tan Z, Fan EW, Huang J, Akinwunmi B, Zhang CJP, Ming WK, Luo L. Healthcare preferences of the general Chinese population in the hierarchical medical system: A discrete choice experiment. Front Public Health 2022; 10:1044550. [PMID: 36466449 PMCID: PMC9713319 DOI: 10.3389/fpubh.2022.1044550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/26/2022] [Indexed: 11/18/2022] Open
Abstract
Background Chinese health insurance system faces resource distribution challenges. A patient-centric approach allows decision-makers to be keenly aware of optimized medical resource allocation. Objective This study aims to use the discrete choice model to determine the main factors affecting the healthcare preferences of the general Chinese population and their weights in the three scenarios (chronic non-communicable diseases, acute infectious diseases, and major diseases). Methods This study firstly identified the key factors affecting people's healthcare preferences through literature review and qualitative interviews, and then designed the DCE questionnaire. An online questionnaire produced by Lighthouse Studio (version 9.9.1) software was distributed to voluntary respondents recruited from mainland China's entire population from January 2021 to June 2021. Participants were required to answer a total of 21 questions of three scenarios in the questionnaire. The multinomial logit model and latent class model were used to analyze the collected data. Results A total of 4,156 participants from mainland China were included in this study. The multinomial logit and latent class model analyses showed that medical insurance reimbursement is the most important attribute in all three disease scenarios. In the scenario of "non-communicable diseases," the attributes that participants valued were, from the most to the least, medical insurance reimbursement (45.0%), hospital-level (21.6%), distance (14.4%), cost (9.7%), waiting time (8.3%), and care provider (1.0%). As for willingness to pay (WTP), participants were willing to pay 204.5 yuan, or 1,743.8 yuan, to change from private hospitals or community hospitals to tertiary hospitals, respectively. Conclusions This study explores the healthcare preferences of Chinese residents from a new perspective, which can provide theoretical reference for the refinement of many disease medical reimbursement policies, such as developing different reimbursement ratios for various common diseases and realizing rational configuration of medical resources.
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Affiliation(s)
- Ni Yan
- Department of Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Taoran Liu
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yuan Xu
- Department of Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Xuanbi Fang
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Xinyang Ma
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Meng Yang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Jianhao Du
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Zijian Tan
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Er-wen Fan
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Jian Huang
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology, and Research (A*STAR), Singapore, Singapore,Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Babatunde Akinwunmi
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital Boston, Boston, MA, United States,Center for Genomic Medicine (CGM), Massachusetts General Hospital and Harvard Medical School, Harvard University, Boston, MA, United States
| | - Casper J. P. Zhang
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wai-Kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China,*Correspondence: Wai-Kit Ming
| | - Liangping Luo
- Department of Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China,Liangping Luo
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Geng J, Bao H, Feng Z, Meng J, Yu X, Yu H. Investigating patients' preferences for new anti-diabetic drugs to inform public health insurance coverage decisions: a discrete choice experiment in China. BMC Public Health 2022; 22:1860. [PMID: 36199056 PMCID: PMC9533494 DOI: 10.1186/s12889-022-14244-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/21/2022] [Indexed: 11/15/2022] Open
Abstract
Background Diabetes is a major public health concern with a considerable impact on healthcare expenditures. Deciding on health insurance coverage for new drugs that meet patient needs is a challenge facing policymakers. Our study aimed to assess patients’ preferences for public health insurance coverage of new anti-diabetic drugs in China. Methods We identified six attributes of new anti-diabetic drugs and used the Bayesian-efficient design to generate choice sets for a discrete choice experiment (DCE). The DCE was conducted in consecutive samples of type 2 diabetes patients in Jiangsu Province. The mixed logit regression model was applied to estimate patient-reported preferences for each attribute. The interaction model was used to investigate preference heterogeneity. Results Data from 639 patients were available for analysis. On average, the most valued attribute was the improvement in health-related quality of life (HRQoL) (β = 1.383, p < 0.001), followed by positive effects on extending life years (β = 0.787, p < 0.001), and well-controlled glycated haemoglobin (β = 0.724, p < 0.001). The out-of-pocket cost was a negative predictor of their preferences (β = -0.138, p < 0.001). Elderly patients showed stronger preferences for drugs with a lower incidence of serious side effects (p < 0.01) and less out-of-pocket costs (p < 0.01). Patients with diabetes complications favored more in the length of extended life (p < 0.01), improvement in HRQoL (p < 0.05), and less out-of-pocket costs (p < 0.001). Conclusion The new anti-diabetic drugs with significant clinical effectiveness and long-term health benefits should become the priority for public health insurance. The findings also highlight the value of accounting for preference heterogeneity in insurance policy-making. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14244-z.
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Affiliation(s)
- Jinsong Geng
- Medical School of Nantong University, 226001, Nantong, Jiangsu, China.
| | - Haini Bao
- Medical School of Nantong University, 226001, Nantong, Jiangsu, China.,The First People's Hospital of Lianyungang, 222061, Lianyungang, Jiangsu, China
| | - Zhe Feng
- Medical School of Nantong University, 226001, Nantong, Jiangsu, China
| | - Jingyi Meng
- Medical School of Nantong University, 226001, Nantong, Jiangsu, China
| | - Xiaolan Yu
- Medical School of Nantong University, 226001, Nantong, Jiangsu, China
| | - Hao Yu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 02215, Boston, MA, USA
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Hou Y, Tao W, Hou S, Li W. Levels, trends, and determinants of effectiveness on the hierarchical medical system in China: Data envelopment analysis and bootstrapping truncated regression analysis. Front Public Health 2022; 10:921303. [PMID: 36203685 PMCID: PMC9530448 DOI: 10.3389/fpubh.2022.921303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/19/2022] [Indexed: 01/22/2023] Open
Abstract
Background The hierarchical medical system (HMS) refers to the classification of treatment according to disease priorities based on severity and difficulty to promote the fairness of medical services for residents, which is regarded as the key to the success of medical reform in China. Methods In the past decade of "New Medical Reform," the efficiency of HMS, including secondary and tertiary hospitals and primary healthcare centers (PHCs), was measured horizontally and vertically by employing the combination of an output-oriented superefficiency slack-based model-data envelopment analysis (SE-SBM-DEA) model with the Malmquist total factor productivity index (MTFP). In the second stage, the overall technical efficiency (OTE) scores were regressed against a set of environmental characteristics and several managerial factors through bootstrapping truncated regression. Results On average, the OTE score in tertiary hospitals was 0.93, which was higher than that in secondary hospitals and PHCs (0.9 and 0.92, respectively). In terms of trend, the OTE of tertiary hospitals declined at first and then increased. The opposite was true of secondary hospitals, in which the APC of the OTE was 10.82 and -3.11% in early and late 2012, respectively. The PHCs generally showed a fluctuating downward trend. In the aspects of productivity, all institutions showed a downturn by an annual average rate of 2.73, 0.51, and 2.70%, respectively. There was a significant negative relationship between the ratio of outpatients to inpatients and tertiary hospitals. Additionally, the medical technical personnel per 1,000 population negatively affected PHCs. In contrast, the GDP per capita had a significantly positive effect on tertiary hospitals, and the number of beds per 1,000 population positively influenced PHCs. Conclusion The efficiency of medical institutions at various levels in HMS was unbalanced and took the form of an "inverted pyramid." Multilateral factors influence the efficiency of HMS, and to address it, multi-intervention packages focusing on sinking high-quality medical resources and improving healthcare capacity, and guiding hierarchical medical practice should be adopted.
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Affiliation(s)
- Yuanxin Hou
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China
| | - Wenjuan Tao
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China
| | - Shufen Hou
- Department of Critical Care Medicine, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Weimin Li
- President's Office, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Weimin Li
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Chen J, Wang Y, Du W, Liu S, Xiao Z, Wu Y. Analysis on the relationship between effort-reward imbalance and job satisfaction among family doctors in China: a cross-sectional study. BMC Health Serv Res 2022; 22:992. [PMID: 35922789 PMCID: PMC9351256 DOI: 10.1186/s12913-022-08377-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family doctor contract services was launched in Sichuan province in 2016. The focus was mainly on developing primary health care services but paying less attention to the work stress and job satisfaction of in-service family doctors. OBJECTIVE This study aims to explore the influencing factors of job satisfaction, and the relation between work stress indicators and job satisfaction among family physicians. METHODS An analytical online cross-sectional survey was performed among 1,105 family doctors from 23 districts and counties in Chengdu. Self-administered questionnaire was completed. Sociodemographic factors, work stress measured by Effort-Reward Imbalance (ERI)scale, and job satisfaction assessed by the short Chinese version of the Minnesota Satisfaction Questionnaire (MSQ) were collected in this study. A statistical analysis and hierarchical linear regression analysis were performed to explore the influencing factors and the correlations among related variables. RESULTS The overall mean MSQ score was 52.01 ± 13.23. Analysis of doctor satisfaction indicated that age, education, job rank, type of institution, years of working and monthly income were statistically significant (P < 0.05). There were negative correlation coefficients between general job satisfaction and effort/reward ratio (ERR) (r = -0.130, P < 0.001) and overcommitment (r = -0.615, P < 0.001). CONCLUSION The level of job satisfaction among family doctors was considerable low. Age, education, job rank, type of institution, years of working and monthly income were influencing factors of job satisfaction. ERI and overcommitment had a negative correlation with general job satisfaction.
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Affiliation(s)
- Jinhua Chen
- Department of General Practice, Chengdu First People's Hospital, Chengdu, 610041, China
| | - Yijun Wang
- Department of General Practice, Chengdu First People's Hospital, Chengdu, 610041, China
| | - Wen Du
- Department of General Practice, Chengdu First People's Hospital, Chengdu, 610041, China
| | - Shuyi Liu
- Department of General Practice, Chengdu First People's Hospital, Chengdu, 610041, China.
| | - Zhu Xiao
- Department of General Practice, Chengdu First People's Hospital, Chengdu, 610041, China
| | - Yuelei Wu
- Department of General Practice, Chengdu First People's Hospital, Chengdu, 610041, China.
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Structural Equation Modeling Analysis of Factors Influencing Family Doctor Contracted Services Based on Survey Data from Changning District, Shanghai. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:2648833. [PMID: 35783524 PMCID: PMC9246594 DOI: 10.1155/2022/2648833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 04/08/2022] [Accepted: 05/10/2022] [Indexed: 11/21/2022]
Abstract
Objective Family doctors fulfill the role of gatekeepers in protecting residents' health with contracted services. Providing these valuable services involves multiple causes, relationships, and indirectly observable variables. This study used structural equation modeling to construct a dynamic model of the work of family doctors to provide a basis for incentives. Methods This study used 2-year follow-up data from a survey of 294 family doctors in Changning District, Shanghai. Data were analyzed using confirmatory factor analysis and structural equation modeling. The measurement model and structural model were defined, identified, verified, integrated, and revised to identify the factors motivating family doctors to provide contracted services. A dynamic path for the family doctor contracted services model was established and eventually modified with six endogenous latent variables: cognition, environmental satisfaction, income satisfaction, support satisfaction, stability, and contracting performance, underpinned by 27 measurement variables. Result The standardized regression coefficient of the effect of cognition on environmental satisfaction was 0.37 (P < 0.05) and the degree of variation interpretation was 0.14. The effect of cognition on income satisfaction was 0.54 (P < 0.05) and the degree of variation interpretation was 0.29. The effect of cognition on stability was 0.40 (P < 0.01), the effect of environmental satisfaction on stability was 0.12 (P < 0.05), and the effect of income satisfaction on stability was 0.22 (P < 0.05), all with a degree of variation interpretation of 0.369. Finally, the effect of stability on contracting performance was 0.51 (P < 0.05) with a degree of variation interpretation of 0.343. Conclusions The degree of family doctors' understanding (cognition) of their own work largely determines their behavioral orientation and service effectiveness. These results raise the possibility of enhancing family doctors' work stability and improving the performance of contracted services by increasing the income of family doctors.
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Wang L, Liu W. Effects of Family Doctor Contract Services on the Health-Related Quality of Life Among Individuals With Diabetes in China: Evidence From the CHARLS. Front Public Health 2022; 10:865653. [PMID: 35602141 PMCID: PMC9114482 DOI: 10.3389/fpubh.2022.865653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/07/2022] [Indexed: 11/19/2022] Open
Abstract
Background Family doctor contract services (FDCS) has played a key role in diabetes management in China since 2016. The influence of FDCS on the physiological indexes of individuals with diabetes has been examined. However, little attention has been paid to its effect on the Health-Related Quality of Life (HRQoL). This study aims to fill this knowledge gap by evaluating the effect of FDCS on the HRQoL of individuals with diabetes. Methods We identified 382 individuals with diabetes receiving all follow-up surveys in 2013, 2015, and 2018 from the China Health and Retirement Longitudinal Study (CHARLS). The HRQoL of the included individuals was estimated using results from the Short Form 36 (SF-36) questionnaire. The propensity score matching with the difference-in-differences (PSM-DID) approach was applied to quantify the effect of FDCS on the HRQoL among individuals with diabetes. A robust test was performed by setting the 2015 data as the treatment group for the placebo test. Results The mean score of role-emotional (RE) increased from 54.25 to 61.63 among those who signed up to receive FDCS, while the corresponding score decreased from 57.77 to 51.04 among those who did not receive FDCS. Results from the regression analysis indicated that the use of FDCS was associated with significant improvement in RE (+14.10, p = 0.04) among individuals with diabetes. We did not find a statistically meaningful association between the FDCS and any of the other HRQoL domains: physical functioning (PF), role-physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), and mental health (MH), respectively. The robustness analysis of the model indicated that the results were robust. Conclusion The FDCS for diabetes in China was associated with a significant improvement in RE. Due to a limited time since the launch of FDCS (i.e., 2016), the recipient's physical health did not show marked improvement. In the future, FDCS should pay more attention to the physiological health of individuals with diabetes. Moreover, psychological services also need to be maintained and not slackened. At the same time, it is strongly recommended to pay more attention to the HRQoL of individuals with diabetes and more comprehensive health.
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Affiliation(s)
- Lingjie Wang
- School of Public Health, Fujian Medical University, Fuzhou, China
| | - Wenbin Liu
- School of Public Health, Fujian Medical University, Fuzhou, China
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16
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Chen Y, Sylvia S, Wu P, Yi H. Explaining the declining utilization of village clinics in rural China over time: A decomposition approach. Soc Sci Med 2022; 301:114978. [PMID: 35461080 DOI: 10.1016/j.socscimed.2022.114978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 11/19/2022]
Abstract
With a goal of improving health system quality and efficiency, reforms of China's health system over the past decade have sought to strengthen primary healthcare in lower-level clinics and health centers. Despite these wide-ranging reforms and initiatives, population-based studies have documented dramatic declines in patients' use of primary care facilities during this period. In this paper, we explore the determinants of this trend in China's rural areas using detailed longitudinal data following a nationally-representative sample of rural households and village clinics from 2011 to 2018. We estimate that between 2011 and 2018, the probability that individuals sought care at village clinics when ill dropped by 44%. At the same time, the utilization of outpatient services in county hospitals increased by 56% and patient self-treatment increased by 20%. Detailed Kitagawa-Oaxaca-Blinder decompositions suggest four primary drivers of this trend: the shifting burden of disease in rural areas, changes in how patients choose to seek care given different disease conditions, declining drug inventory in village clinics, and the decreasing importance of remoteness as a determinant of healthcare seeking behavior. Our results highlight the deteriorating role of village clinics in the rural healthcare system and the increasing importance of self-treatment and higher-tier primary care services.
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Affiliation(s)
- Yunwei Chen
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Paiou Wu
- School of Advanced Agricultural Sciences, Peking University, Beijing, China.
| | - Hongmei Yi
- School of Advanced Agricultural Sciences, Peking University, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China.
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Wang C, Gu Y, Zhao L, Zhang Y, Zhou R, Gu M, Wang L. Stated preferences for family doctor contract services: a survey of the rural elderly in Anhui Province, China. BMJ Open 2022; 12:e053277. [PMID: 35241465 PMCID: PMC8896044 DOI: 10.1136/bmjopen-2021-053277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE A number of factors contribute to the utilisation of family doctor contract services (FDCS) in China. This study aims to measure the preferences of the elderly for the FDCS and identify the key factors (and their relative importance) that may guide policymakers in more accurately providing the FDCS. PARTICIPANTS AND METHODS A discrete choice experiment was performed to elicit the preferences for FDCS among the rural elderly in China. Attributes and levels were established based on qualitative methods. Four attributes were included: service type, service package, physician's reputation and annual contract costs. A D-efficient design was used to create a set of profiles that represented FDCS. The survey was conducted face to face using a sample of participants aged 60 and above in rural areas of Anhui Province. The data were analysed using a latent class logit (LCL) model. RESULTS A total of 545 valid questionnaires were included in the analysis. The average age of the participants was 69.44 (SD 5.80). Two latent classes were identified with the LCL model. All four attributes proved statistically significant at the level of both the population mean and the two classes. The rural elderly showed a preference for FDCS with a relatively good reputation, lower annual contract costs, the basic service with the add-on of chronic disease service and home visit. Age, gender, education, self-reported health status and the number of chronic diseases were found to be associated with latent class membership. CONCLUSION In this study, the physician's reputation had the largest impact on the rural elderly's choice of FDCS. Policy recommendations included the need to strengthen family doctor team training, devote greater attention to improving the family doctor's medical skills and service approaches, and increased FDCS efficiency for the care of the rural elderly.
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Affiliation(s)
- Cuilian Wang
- School of Health Service and Management, Anhui Medical University, Hefei, Anhui, China
- Stomatologic Hospital and College, Anhui Medical University, Hefei, Anhui, China
| | - Yuanyuan Gu
- Centre for the Health Economy, Macquarie University, Sydney, New South Wales, Australia
| | - Linhai Zhao
- School of Health Service and Management, Anhui Medical University, Hefei, Anhui, China
| | - Youran Zhang
- School of Health Service and Management, Anhui Medical University, Hefei, Anhui, China
| | - Rui Zhou
- School of Health Service and Management, Anhui Medical University, Hefei, Anhui, China
| | - Megan Gu
- Centre for the Health Economy, Macquarie University, Sydney, New South Wales, Australia
| | - Lidan Wang
- School of Health Service and Management, Anhui Medical University, Hefei, Anhui, China
- Center for Health Policy Research, Anhui Medical University, Hefei, Anhui, China
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Zhang J, Xu L, Qin W, Xu A. Do Residents and Healthcare Providers Differ in Preference for Family Doctor Contract Service? Evidence From a Discrete Choice Experiment. Front Public Health 2022; 10:800042. [PMID: 35223735 PMCID: PMC8866243 DOI: 10.3389/fpubh.2022.800042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/10/2022] [Indexed: 11/15/2022] Open
Abstract
Objective Few are known on how and to what extent residents and healthcare providers have different preferences for family doctor contract service (FDCS). This study aimed to elicit and compare the residents' and healthcare providers' preferences for FDCS through a discrete choice experiment (DCE). Methods Residents and healthcare providers recruited for the DCE were asked to choose repeatedly between two hypothetical service plans, which differed in six attributes: cost, service package, service delivery, type of service, accessibility of medicine, and level of healthcare team. We use mixed logit regression models to determine preferences for potential attributes. Results A total of 2,159 residents and 729 healthcare providers completed valid DCE questionnaires. The mixed logit model results suggested that cost, service package, service delivery, type of service, accessibility of medicine, and level of healthcare team all had a significant impact on residents' and healthcare providers' preference. The level of healthcare team was the most important characteristic of FDCS to both residents and healthcare providers, followed by types of service. They have different preferences on the cost and way of service delivery. Conclusions This study provides new evidence on how and to what extent residents and healthcare providers have different preferences for FDCS by determining their perception of various service attributes. These findings suggested that the optimal design and improvement of FDCS plans should consider not only residents but also healthcare providers' preferences to maximize contract service uptake.
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Affiliation(s)
- Jiao Zhang
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Research Center for Major Health Risk Management and TCM Control Policy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Lingzhong Xu
- Centre for Health Management and Policy Research, Cheeloo College of Medicine, School of Public Health, Shandong University, Jinan, China
- *Correspondence: Lingzhong Xu
| | - Wenzhe Qin
- Centre for Health Management and Policy Research, Cheeloo College of Medicine, School of Public Health, Shandong University, Jinan, China
| | - Aijun Xu
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Research Center for Major Health Risk Management and TCM Control Policy, Nanjing University of Chinese Medicine, Nanjing, China
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Cheng X, Zhang L. Health Service Needs from a Household Perspective: An Empirical Study in Rural Empty Nest Families in Sinan and Dangyang, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020628. [PMID: 35055450 PMCID: PMC8775500 DOI: 10.3390/ijerph19020628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/29/2021] [Accepted: 12/31/2021] [Indexed: 02/04/2023]
Abstract
This study aimed to explore the health service needs of empty nest families from a household perspective. A multistage random sampling strategy was conducted to select 1606 individuals in 803 empty nest households in this study. A questionnaire was used to ask each individual about their health service needs in each household. The consistency rate was calculated based on their consistent answers to the questionnaire. We used a collective household model to analyze individuals’ public health service needs on the family level. According to the results, individuals’ consistency rates of health service needs in empty nest households, such as diagnosis and treatment service (H1), chronic disease management service (H2), telemedicine care (H3), physical examination service (H4), health education service (H5), mental healthcare (H6), and traditional Chinese medicine service (H7) were 40.30%, 89.13%, 98.85%, 58.93%, 57.95%, 72.84%, and 63.40%, respectively. Therefore, family-level health service needs could be studied from a family level. Health service needs of H1, H3, H4, H5, and H7 for individuals in empty nest households have significant correlations with each other (r = 0.404, 0.177, 0.286, 0.265, 0.220, p < 0.001). This will be helpful for health management in primary care in rural China; the concordance will alleviate the pressure of primary care and increase the effectiveness of doctor–patient communication. Health service needs in empty nest households who took individuals’ public needs as household needs (n = 746) included the H4 (43.3%) and H5 (24.9%) and were always with a male householder (94.0%) or at least one had chronic diseases (82.4%). Health service needs in empty nest households that considered one member’s needs as household needs (n = 46) included the H1 (56.5%), H4 (65.2%), H5 (63.0%), and H7 (45.7%), and the member would be the householder of the family (90.5%) or had a disease within two weeks (100.0%). In conclusion, family members’ roles and health status play an important role in health service needs in empty nest households. Additionally, physical examination and health education services are the two health services that are most needed by empty nest households, and are suitable for delivering within a household unit.
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Affiliation(s)
- Xueyan Cheng
- Shanghai Health Development Research Center (Shanghai Medical Information Center), Shanghai 200032, China;
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Liang Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- School of Political Science and Public Administration, Wuhan University, Wuhan 430030, China
- Correspondence:
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Wang H, Sun H, Jin C, Wang M, Luo Y, Song W, Wang H. Preference to Family Doctor Contracted Service of Patients with Chronic Disease in Urban China: A Discrete Choice Experiment. Patient Prefer Adherence 2022; 16:2103-2114. [PMID: 35989974 PMCID: PMC9384844 DOI: 10.2147/ppa.s371188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Shanghai is one of the pioneers proposing family doctor contract service (FDCS). However, there is no quantitative research focusing on the Shanghai experience from a demand-side perspective. This study investigated Shanghai chronic patients' relative preferences for FDCS using a discrete choice experiment method. METHODS A face-to-face discrete choice experiment (DCE) was performed to elicit the preference with 300 samples. Attributes and levels were extracted from the literature review and focus group consultation with patients. Seven attributes, follow-up frequency, medicine accessibility, family doctor competency, health management, referral convenience, appointment flexibility, and shared decision-making, were decided. Three levels were attached to each attribute. A mixed logit model was used to evaluate the multiple-choice data. RESULTS A total of 248 patients completed the survey. Patient valued FDCS medicine accessibility (β=0.57, P < 0.05), and high family doctor competency (β= 0.43, P < 0.05), regular health management activities (β=0.36, P < 0.05), high follow-up frequency (β=0.31, P < 0.05) the most. The good doctor-patient shared decision-making atmosphere (β=0.12, P < 0.05), high referral convenience (β=0.06, P < 0.05) and high appointment flexibility (β=0.04, P < 0.05) are valued as less important. No significant preference heterogeneity was identified for patients with different sociodemographic characteristics. Respondents reported other FDCS needs, including online health consultation, specialist services in local institutes, higher reimbursement rates, free rehabilitation guidance for the disabled and personal health management. CONCLUSION This research is the first discrete choice experiment FDCS preference research targeting on Chinese urban population. The results suggested that to increase the quality of FDCS, policy-makers should prioritize follow-up frequency, medicine accessibility, family doctor competency and health management. The service package should consider a higher reimbursement rate and rehabilitation guidance for the disabled if extra health-care resources available. Future FDCS policy should consider stated societal preference and be congruent with it.
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Affiliation(s)
- Haode Wang
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, People’s Republic of China
| | - Hui Sun
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, People’s Republic of China
- Key Laboratory of Health Technology Assessment, National Health Commission; School of Public Health, Fudan University, Shanghai, People’s Republic of China
| | - Chunlin Jin
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, People’s Republic of China
| | - Meifeng Wang
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, People’s Republic of China
| | - Yashuang Luo
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, People’s Republic of China
| | - Wenqian Song
- Shanghai Overseas Rescue and Aid Service Center, Shanghai, People’s Republic of China
| | - Haiyin Wang
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, People’s Republic of China
- Correspondence: Haiyin Wang, Shanghai Health Development Research Center, Minhang District, No. 181 Xinbei Road, Shanghai, 201199, People’s Republic of China, Tel +86- 18917769216, Email
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Li J, Li J, Fu P, Chen Y, Tang X, Li Z, Yang S, Yan C, Li W, Gui Z, Zhou C. Willingness of patients with chronic disease in rural China to contract with family doctors: implication for targeting characteristics. BMC FAMILY PRACTICE 2021; 22:203. [PMID: 34649515 PMCID: PMC8518214 DOI: 10.1186/s12875-021-01553-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022]
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.
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Affiliation(s)
- Jie Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Jie Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
| | - Peipei Fu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
| | - Yan Chen
- School of Public Health, Wannan Medical College, Wuhu, 241002, China
| | - Xue Tang
- Department of Health Economics, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Zhixian Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Shijun Yang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Chen Yan
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Wenjuan Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Zhen Gui
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China. .,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China.
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Gu L, Zhu R, Li Z, Zhang S, Li J, Tian D, Sun Z. Factors Associated with Rural Residents' Contract Behavior with Village Doctors in Three Counties: A Cross-Sectional Study from China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238969. [PMID: 33276540 PMCID: PMC7730573 DOI: 10.3390/ijerph17238969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/27/2020] [Accepted: 11/27/2020] [Indexed: 01/26/2023]
Abstract
Historically, cooperative medical insurance and village doctors are considered two powerful factors in protecting rural residents' health. However, with the central government of China's implementation of new economic policies in the 1980s, cooperative medical insurance collapsed and rural residents fell into poverty because of sickness. In 2009, the New Rural Cooperative Medical Insurance (NRCMI) was implemented to provide healthcare for rural residents. Moreover, the National Basic Drug System was implemented in the same year to protect rural residents' right to basic drugs. In 2013, a village doctor contract service was implemented after the publication of the Guidance on Pilot Contract Services for Rural Doctors. This contract service aimed to retain patients in rural primary healthcare systems and change private practice village doctors into general practitioners (GPs) under government management. OBJECTIVES This study investigates the factors associated with rural residents' contract behavior toward village doctors. Further, we explore the relationships between trust, NRCMI reimbursement rate, and drug treatment effect. We used a qualitative approach, and twenty-five village clinics were chosen from three counties as our study sites using a random sampling method. A total of 625 villagers participated in the investigation. Descriptive analysis, chi-squared test, t-test, and hierarchical logistic analyses were used to analyze the data. RESULTS The chi-squared test showed no significant difference in demographic characteristics, and the t-test showed a significant difference between signed and unsigned contract services. The results of the hierarchical logistic analysis showed that trust significantly influenced patients' willingness to contract services, and the drug treatment effect and NRCMI reimbursement rate moderated the influence of trust. CONCLUSION Our findings suggest that the government should aim to strengthen trust in the doctor-patient relationship in rural areas and increase the NRCMI reimbursement rate. Moreover, health officers should perfect the contract service package by offering tailored contract services or expanding service packages.
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Affiliation(s)
- Linni Gu
- Business School, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing 100875, China; (L.G.); (Z.L.)
| | - Rui Zhu
- China Academy of Social Management/School of Sociology, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing 100875, China;
| | - Zhen Li
- Business School, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing 100875, China; (L.G.); (Z.L.)
| | - Shengfa Zhang
- School of Social Development and Public Policy, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing 100875, China; (S.Z.); (J.L.); (D.T.)
| | - Jing Li
- School of Social Development and Public Policy, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing 100875, China; (S.Z.); (J.L.); (D.T.)
| | - Donghua Tian
- School of Social Development and Public Policy, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing 100875, China; (S.Z.); (J.L.); (D.T.)
| | - Zhijun Sun
- Business School, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing 100875, China; (L.G.); (Z.L.)
- Correspondence:
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