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

Abstract

Background: 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. Methods: 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. Results: 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. Conclusion: 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.

Do Residents and Healthcare Providers Differ in Preference for Family Doctor Contract Service? Evidence From a Discrete Choice Experiment

“…This is not surprising, and the level of healthcare team is generally considered as representing appropriateness and quality of primary care, which could be linked with desired effect of care for patients. In line with this research, previous studies conducted in China revealed that respondents had a strong preference for the healthcare providers with high competence ( 13 , 27 , 28 ). However, recent evidence showed that the low competency of FDs was still one of the notable barriers to implement FDCS in China ( 8 ).…”

“…However, most of these studies focused on the view of the demander (residents/patients). For instance, Fu et al ( 13 ) conducted a DCE in Chinese rural population and suggested residents valued the FDs' competence most. Zhu et al ( 14 ) found that the most valued attribute in general practitioner (GP) care for patients was the organizational factors related to whether the provider had sufficient medicine and equipment to provide capable primary care service.…”

Health Service Needs from a Household Perspective: An Empirical Study in Rural Empty Nest Families in Sinan and Dangyang, China

“…In 2016, the Chinese Government proposed a family doctor system, in which general practitioners would establish a long-term service relationship with families that signed a contract with them. The family doctors would offer 95% of the family’s primary care and play a vital role as the primary health gatekeeper [ 21 , 22 , 23 ]. However, due to a lack of several essential uniform features such as health insurance support, appropriate incentive mechanisms, objective evaluation methods, and an effective way of delivering service, so there is some difficulty implementing the family doctor contracting services in China [ 24 ].…”

Health Service Needs From a Household Perspective: an Empirical Study in Rural Empty Nest Households in China

“…In 2016, Chinese government proposed a family doctor system, in which general practitioners would establish a long-term service relationship with families that signed contract with them. The family doctors would offer 95% of primary care and play a key role as the primary health gatekeeper [13]. But due to a lack of several essential uniform features such as health insurance support, appropriate incentive mechanisms, objective evaluation methods, as well as effective way of delivering service, so there was some difficulty to implement the family doctor contracting services in China [14].…”