Knowledge, attitudes, and practices related to the establishment of the National Hierarchical Medical System (NHMS) among outpatients in Chinese tertiary hospitals

Abstract

This study sought to assess the status of, and factors associated with, knowledge, attitudes, and practices (KAP) related to the establishment of the National Hierarchical Medical System (NHMS) among outpatients receiving care in tertiary hospitals in China.A cross-sectional study surveying tertiary outpatients was conducted. This study investigated KAP concerning the establishment of the NHMS among outpatients from tertiary hospitals, who could have sought medical care from a general practitioner in surrounding primary care medical institutions. Several factors associated with outpatients' knowledge were identified and included in fully adjusted analyses using logistic regression.Survey questionnaires were completed by 565 outpatients in 4 tertiary hospitals. Approximately half (51.86%) of the sample was aware of the NHMS. In multivariable analysis sex, age, education level, and place of residence were associated (P < .05) with knowledge of NHMS. Overall 74.69% of respondents expressed positive attitudes toward the establishment of the NHMS. However, a much lower proportion, 21.95%, was willing to choose nearby grassroots sub-unit hospitals as their first choice when seeking health care.The present study revealed outpatients in China may lack knowledge of the NHMS, yet most have a positive attitude toward the establishment of the NHMS. Even so, there was hesitation in terms of seeking care from the NHMS, indicating the need for policy makers to take action to increase public awareness surrounding NHMS-related information to improve the public's KAP on the establishment of the NHMS. This study highlights information useful for policy makers in China and other countries planning or evaluating related policies.

Violence against healthcare workers and other serious responses to medical disputes in China: surveys of patients at 12 public hospitals

“…Further-more, given legal channels for resolving confusion or anxiety are sometimes lacking and there is difficulty in implementing penalties for violence [17], verbally or physically attacking the healthcare worker becomes a way to release patients' anger [12,16]. That said, policies aimed at promoting the role of general practitioners in primary care have been suggested as a way to bring about positive change to the existing system through improved access to care [40]. Financial challenges within the healthcare system, such as physicians not receiving sufficient salary and patients paying too much for medical care, could also be contributing to the worsening patient-physician relationship and may ultimately lead to patients' extreme actions [6,33].…”

“…For example, the National Hierarchical Medical System, among other things, includes policies relating to promoting the role of general practitioners. However, past research has noted a relatively limited awareness of this policy and the role of general practitioners [40]. Thus, providing greater awareness of the role of general practitioners and the National Hierarchical Medical System has been suggested [40] as a means of addressing health care access issues, to an extent, given the relatively underutilized primary care settings throughout China.…”

<p>Outpatients’ Satisfaction in the Context of 10 Years of Health-Care Reform: A Cross-Sectional Study of Tertiary Hospitals in Shiyan, China</p>

“…Even so, in regard to seeking health care in a hierarchical system, the continued hesitancy of the majority of patients indicates the need for policy makers to take action to improve public awareness of the NHMS. 7,8 Therefore, local government could cooperate with the GPs, family doctors and other professionals to conduct health education and to guide residents to form a scientific view of medical treatment, building the "minor illness in the community, serious illness to the hospital, rehabilitation back to the community" medical model.…”

“…[2][3][4][5] The implementation of the National Hierarchical Medical System (NHMS) had been pushed ahead, and many relevant policies, including the national general practitioner (GP) system and the twoway referral system, were launched. [6][7][8] In this way, the NHMS could improve the accessibility of medical services and the efficiency of medical resource utilization. The aim of these policies is to provide more convenient and affordable medical and health services and to improve healthcare quality, making it more beneficial for the citizens.…”

Older adults’ choices of first‐contact care and related factors in Zhejiang and Qinghai Province, China

“…The National Hierarchical Medical System (NHMS) is one of the key measures to encourage utilization of PHI. In NHMS, PHI act as gatekeepers, providing first‐contact care and transferring patients to secondary or tertiary hospitals for further treatment, as required . If patients go directly to high‐level hospital without referral, they will receive a lower reimbursement ratio from medical insurance …”