Analysing the preferences for family doctor contract services in rural China: a study using a discrete choice experiment

Abstract

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background: </jats:bold>Preliminary evaluations have found that family doctor contract services (FDCSs) have significantly controlled medical expenses, better managed chronic diseases, and increased patient satisfaction and service compliance. In 2016, China proposed the establishment of a family doctor system to carry out contract services, but studies have found the uptake and utilization of these services to be limited. This study aimed to investigate rural residents’ preferences for FDCSs from the perspective of the Chinese public.<jats:bold>Methods:</jats:bold> A discrete choice experiment (DCE) was performed to elicit the preferences for FDCSs among rural residents in China. Attributes and levels were established based on a literature review and qualitative methods. Five attributes, i.e., cost, medicine availability, the reimbursement rate, family doctor competence, and family doctor attitude, were evaluated using a mixed logit model.<jats:bold>Results: </jats:bold>A total of 609 residents were included in the main DCE analysis. The respondents valued the high competence (coefficient 2.44, [SE 0.13]) and the good attitude (coefficient 1.42, [SE 0.09]) of family doctors the most. Cost was negatively valued (coefficient -0.01, [SE 0.01]), as expected. Preference heterogeneity analysis was conducted after adjusting the interaction terms, and we found that rural residents with higher educational attainment prefer a good attitude more than their counterparts with lower educational attainment. The estimated willingness to pay (WTP) for “high” relative to “low” competence was 441.13 RMB/year, and the WTP for a provider with a “good” attitude relative to a “poor” attitude was 255.77 RMB/year. <jats:bold>Conclusion: </jats:bold>The present study suggests that strengthening and improving the quality of primary health care, including the competence and attitudes of family doctors, should be prioritized to increase the uptake of FDCSs. The contract service package, including the annual cost, the insurance reimbursement rate and individualized services, should be redesigned to be congruent with residents having different health statuses and their stated preferences.</jats:p>

Analysis on the relationship between effort-reward imbalance and job satisfaction among family doctors in China: a cross-sectional study

“…in Heilongjiang province suggested that there was a gap between actual and desired workplace characteristics, which had a negative influence on workers' job satisfaction [42]. The popular researches about family doctors focused on the effect and challenge of family doctor contract services [43][44][45][46][47][48], chronic disease management to contract with family [50] and assessment of Chinese family physicians' service competences [51]. Up to this point, these studies about job satisfaction and family doctors have been explored, however, these studies usually discussed other medical occupations or the effect of implementation family doctor policies, lacking of the overall occupational perception survey among family doctors at Community health centres.…”

Structural Equation Modeling Analysis of Factors Influencing Family Doctor Contracted Services Based on Survey Data from Changning District, Shanghai

“…e focus of family doctor contracted services has shifted from quantity to service quality and satisfaction [24,25]. At the same time, family doctors' sense of identification with their profession has improved, especially for professional status, work value, and sense of achievement.…”

Exploration on “1+1+1” Family-Doctor Double Contract Service&lt;br /&gt; &lt;div&gt; &lt;br /&gt; &lt;/div&gt;

“…Family doctor contract services are aimed to maintain the health of community residents, with general practitioners as the core, by providing comprehensive, continuous, and convenient basic medical and health services for residents, including preventive healthcare, diagnosis and treatment referrals for common and frequently occurring diseases, disease rehabilitation, chronic disease management, health management, etc. [1] In 2015, Shanghai launched a pilot program for "1+1+1" family doctor double contract service. In addition to residents signing contracts with one family doctor, they chose one district level hospital and one municipal hospital as their preferred higher-level hospitals for referral.…”