Background To improve the efficiency of the use of medical resources, China has implemented medical alliances (MAs) to implement a hierarchical diagnosis and treatment system. The willingness to undertake a first visit to primary care institutions (PCIs) is an important indicator of the effect of this system. Beijing has also built MAs since 2013, but to date, there have been few studies on the first visit to PCIs in Beijing. The purpose of this study is to analyze patients’ willingness to make their first visit to PCIs and its influencing factors to provide references for the realization of a hierarchical diagnosis and treatment system. Methods Two relatively different districts with large differences in resources in Beijing, D and F, were selected, and a self-reported questionnaire and convenience sampling method were applied. A cross-sectional survey was administered to 1221 patients of MAs. The chi-square test and binary logistic regression were used to analyze the influencing factors of patients’ willingness to undertake a first visit to a PCI. Results Fewer patients in District D received medical alliance services (44.42%) than those in District F (59.25%), but patients in District D had a higher degree of satisfaction with the services they received (72.04%) than those in District F (28.96%). Patients in District D had a higher willingness to undertake a first visit (64.00%) than those in District F (58.18%). Patients of an older age, low medical expenses, participation in urban employees’ basic medical insurance, a high understanding of MAs and high satisfaction with medical services were indicators of being more willing to choose primary care institutions for their first visit. Conclusions The different medical resources and MA constructions in the two districts have resulted in a difference between the two districts in terms of the willingness of individuals to make their first visit to PCIs. Strengthening the service capabilities of PCIs remains a priority. The government should propose solutions to solve the problems encountered in practice and actively promote the realization of MAs and hierarchical diagnosis and treatment. Electronic supplementary material The online version of this article (10.1186/s12913-019-4184-0) contains supplementary material, which is available to authorized users.

Background: To promote the integration of medical resources, Beijing has built medical alliances since 2012, but this reform has not changed the state of disordered medical treatment. Patients are still willing to go to high-level hospitals for medical treatment. What causes patients to prefer high-level hospitals? To explore the reasons behind this preference for high-level medical treatment among patients and to guide patients to make visits in an orderly manner, we conducted this study and compared patients' satisfaction with hospitals of different levels in the context of medical resource integration. Methods: This study conducted a questionnaire survey among 1250 patients who were selected in 18 medical alliances in Beijing from October to December 2016. The study type is a comparative study based on cross-sectional data. Patient satisfaction was the main outcome, and descriptive analysis, chi-square tests, nonparametric tests and binary logistic regression analysis were used. The level of statistical significance was set at p < 0.05. Results: The overall satisfaction score of the medical alliances was 3.375, and the satisfaction scores of core hospitals and cooperative hospitals were 2.77 and 3.07, respectively. The overall patient satisfaction rate was 44.62%, and the satisfaction rates of core hospitals and cooperative hospitals were 34.34 and 50.43%, respectively. The type of hospital and understanding of medical alliance policy were the factors associated with patient satisfaction with the medical alliance. Conclusions: The patients' satisfaction with cooperative hospitals was higher than their satisfaction with core hospitals. Although the patients were more satisfied with the service attitude of the cooperative hospitals, they still preferred core hospitals due to their higher expectations for their medical treatment and greater trust in their medical technology. It is necessary to explore the establishment of closed medical alliances under the unified management of human and financial resources to enable medical alliances to become a community of common interests and provide integrated medical services for patients.

ObjectiveThe low performance of primary medical institutions (PMIs) in China is a significant issue. The WHO proposed that the main reason for the failure of the healthcare system in developing countries is poor organisational capabilities. However, there is no international tool for evaluating the organisational capabilities of PMIs. Therefore, this study aimed to develop an index system for evaluating the organisational capabilities of PMIs.DesignWe searched the literature (English and Chinese) published before June 2020 in the PubMed, China National Knowledge Infrastructure and Wanfang databases to conduct a literature review and develop a preliminary indicator pool. Then, two rounds of Delphi expert consultations were conducted by email from June to September 2020, followed by screening, revision and supplementation of the indicators using the boundary value method. Finally, the analytic hierarchy process was used to determine the weight of the indicators.SettingThe Delphi consultation questionnaire was distributed to the leaders of PMIs in districts D, F and S in Beijing, China.ParticipantsNineteen leaders of PMIs who had a profound understanding of PMI operations and management and were able to participate in Delphi research from a professional and comprehensive perspective were included in this study.ResultsThe Cr values were 0.76 (first-level indicators) and 0.78 (second-level indicators), indicating that the expert consultation results were accurate and reliable. The result of the expert coordination coefficient test was significant at the p<0.01 level, suggesting that the experts’ views were consistent. The organisational capability index system includes 3 first-level indicators, 9 second-level indicators and 37 third-level indicators.ConclusionsAn index system for the organisational capabilities of PMIs was developed. This index system is a scoring system that focuses on basic service capabilities, management capabilities and sustainable development capabilities, and it can determine the priority of improvement areas for PMIs.

Background: In order to promote the vertical flow and integration of medical resources, Beijing built medical alliances since 2012, but this practice did not change the disordered state of medical treatment. Patients are still willing to go to high-level hospitals for medical treatment. What causes patients to prefer high-level hospitals? Through previous research, patients' choice of medical treatment was affected by patients' satisfaction. Therefore, we compared the patients' satisfaction in different level hospitals under the background of the medical resource integration. Methods: This study conducted a 48-person interview and a questionnaire survey among 1,250 patients who were treated in 18 medical alliances in Beijing from October to December 2016. The patients’ satisfaction was the main outcome, descriptive analysis, a chi-square test, a nonparametric test and binary logistic regression analysis were used. The level of statistical significance was set at p<0.05. Results: The total satisfaction score of the medical alliances is 3.375, and the satisfaction score of core hospitals and cooperative hospitals is 2.77 and 3.07 respectively. The overall patient satisfaction rate is 44.62%, among which the satisfaction rate of core hospitals is 34.34% and that of the cooperative hospitals is 50.43%. The type of hospital and understanding of medical alliance policy are the influencing factors of the patients’ satisfaction with the medical alliance. Conclusions: Patients are more satisfied with the core hospitals. However, because core hospitals have obtained the most subsidies with limited financial compensation, the gap between core hospitals and cooperative hospitals is growing. The phenomenon of disorderly medical treatment in China seems more intense. Therefore, it is necessary to explore the establishment of closed medical alliances so that provide integrated medical services for patients.