Does having a usual primary care provider reduce patient self-referrals in rural China’s rural multi-tiered medical system? A retrospective study in Qianjiang District, China

Abstract

IntroductionWithin China’s multi-tiered medical system, many patients seek care in higher-tiered hospitals without a referral by a primary-care provider. This trend, generally referred to as patient self-referral behavior, may reduce the efficiency of the health care system. This study seeks to test the hypothesis that having a usual primary care provider could reduce patients’ self-referral behavior.MethodsWe obtained medical records of 832 patients who were hospitalized for common respiratory diseases from township hospitals in Qianjiang District of Chongqing City during 2012–2014. Logit regressions were performed to examine the association between having a township hospital as a usual provider and self-referring to a county hospital after being discharged from a township hospital, while controlling for patients’ gender, age, income, education, severity of disease, distance to the nearest county hospital and the general quality of the township hospitals in their community. A propensity score weighting approach was applied.ResultsWe found that having a usual primary care provider was associated with a lower likelihood of self-referral (odds ratio = 0.58, 95% confidence interval [CI] =0.41–0.82), and a 9% (95% CI: -14%, − 3%) reduction in the probability of patients’ self-referral behavior.Discussion/conclusionThe results suggest that establishing a long-term relationship between patients and primary care providers may enhance the patient-physician relationship and reduce patients’ tendency for unnecessary use of medical resources.Electronic supplementary materialThe online version of this article (10.1186/s12913-017-2673-6) contains supplementary material, which is available to authorized users.

Patient Choice and Willingness Toward Gatekeepers as First-Contact Medical Institutions in Chinese Tiered Healthcare Delivery System: A Cross-Sectional Study

“…Family doctor system, which has been shown to play an important role in gatekeeping function of PCIs (30,31), was not an influencing factor in our study. Da Feng et al found that family doctors may reduce patients' tendency for unnecessary use of medical resources (32). However, according to our finding, family doctors were not playing a role in guiding healthcare seeking behaviors of patients.…”

National Health Insurance Deficit in Indonesia: Identification of Causes and Solutions for Resolution

“…Some countries allow participants to directly access advanced health facilities' fee-for-service payments while other countries continue to implement gate keepers and tiered referrals. China launched health service reforms by reintroducing the tiered referral system as a solution to reduce over-utilization in regional hospitals and control the cost of health services (Feng et al, 2017). Unfortunately, the results of this study suggest that tiered referral in secondary health facilities makes lead to overutilization.…”

Does Having a Usual Primary Care Provider Reduce Polypharmacy Behaviors of Patients With Chronic Disease? A Retrospective Study in Hubei Province, China

“…With a study showing that patients with primary care providers are likely to reduce patient self-referrals in rural China's rural multi-tiered medical system (Feng et al, 2017) and another study showing that general practitioners (GPs) can effectively reduce patient referral behavior, health maintenance organizations (HMOs) in the United States require patients to consult a primary care physician firstly before considering a referral (Sekhri, 2000;Hoel et al, 2021). Many European countries have GP systems that can effectively guide patients through graded care (Verhaak et al, 2004;Brown et al, 2014).…”