Journal Article

Does contracting family doctor promote primary healthcare utilization among older adults? - evidence from a difference-in-differences analysis

Wang, Yi, Fu, Peipei, Zhao, Dan, Yang, Shijun, Zhou, Chengchao

2024

Overview

Introduction In 2016, the Chinese government officially scaled up family doctor contracted services (FDCS) scheme to guide patients’ health seeking behavior from tertiary hospitals to primary health facilities. Methods This study evaluated the overall gate-keeping effects of this scheme on healthcare utilization of rural residents by using a difference-in-differences (DiD) design. The analysis was based on Shandong Rural Elderly Health Cohort 2019 and 2020. Participants who contracted FDCS in second round and were not contracted with a family doctor in the first round were regarded as treatment group. In total, 310 respondents who have used medical care were incorporated for final study. Results Participants who contracted FDCS (treatment group) experienced a significant decline in the mean level of first-contact health-care facilities, decreasing from 2.204 to 1.981. In contrast, participants who did not contract FDCS (control group), showed an increasing trend in the mean level of first-contact health-care facilities, rising from 2.128 to 2.445. Our results showed that contracting FDCS is associated with approximately 0.54 extra lower mean level of first-contact health-care facilities ( P  = 0.03, 95% CI: -1.03 to 0.05), which suggests an approximately 24.5% reduction in the mean first-contact health-care facility level for participants compared with contracted FDCS than those who did not. Conclusions The study suggested primary healthcare quality should be strengthened and restrictive first point of contact policy should be enacted to establish ordered healthcare seeking behavior among rural residents.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / Aged patients / Aged, 80 and over / Aging / Care and treatment / China / China - epidemiology / Cities / Contract Services / Difference in differences / Evaluation / Family doctor contracted services / Family medicine / Female / Geriatrics/Gerontology / Health behavior / Health care / Health care policy / Health services utilization / Healthcare utilization / Hospitals / Humans / Male / Medical care / Medicine / Medicine & Public Health / Middle Aged / National health insurance / Older people / Patient Acceptance of Health Care / Per capita / Physicians / Physicians (General practice) / Physicians, Family / Primary care / Primary Health Care / Public health / Rehabilitation / Rural China / Rural Population / Rural populations / Utilization / Variables