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BMC Primary Care
Published in: BMC Primary Care 1/2019

Open Access 01-12-2019 | Research article

A preliminary effect analysis of family doctor and medical insurance payment coordination reform in Changning District of Shanghai, China

Authors: Jiaoling Huang, Wei Lu, Luan Wang, Tao Zhang, Chengjun Liu, Shanshan Liu, Hong Liang, Yimin Zhang, Dongfeng Guo

Published in: BMC Primary Care | Issue 1/2019

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Abstract

Background

Changning District of Shanghai pioneered in implementing Family Doctor and Medical Insurance Payment Coordination Reform. The survey aimed to assess the effect of the reform to provide a decision-making basis for ensuring the “gatekeeper” role of the family doctor.

Methods

A cross-sectional survey was conducted using a self-designed questionnaire in Changning District of Shanghai during January and February in 2014. Multi-stage random cluster was applied and 3040 residents were selected. Comparisons were made with statistically test between the contracted and non-contracted residents in four policy targeted dimensions, doctor-visiting behavior, health management and status, medical cost control and satisfaction.

Results

Compared with the non-contracted residents, the contracted residents (72.9%) presented a higher prevalence rate of chronic diseases (32.6%), a higher proportion (51.9%) in first-contact in the community health service center and a higher proportion to refer to specialists as well (P < 0.001).The result showed that the average annual medical expense were significantly higher than non-contracted residents (P < 0.001), however, the difference disappeared after age, medical insurance and other socio-demographic variables were controlled. In terms of self-management of non-communicable diseases and complication prevention, the blood pressure control rate and blood glucose control rate for the contracted group were also higher than the counterparts, reaching up to 85.6 and 72.7% respectively.

Conclusion

The preliminary analysis indicated that the contracted residents performed better in orderly doctor visiting behavior, health management behavior, health status and satisfaction. Follow up survey is necessary to further analyze the policy effect.
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Literature
1.
Taylor RB. Family medicine: current issues and future practice family medicine-principles and practice. New York: Springer; 1998. p. 1–5.CrossRef
2.
Dupuit S, Collins E, Shergill S, et al. Computer-based assistance in family medicine. Comput Methods Prog Biomed. 1998;55:201–3.
3.
Zhang Y, Li YL. Characteristics and enlightenment of foreign GPs. Chin J Hosp Manag. 2005;21(3):213–5.
4.
Zhang Y, An M, Cai WQ, et al. The enlightenment of foreign family doctor system to the community health management of our country. J Community Med. 2011;19(9):5–6.
5.
Kripalani S, LeFevre F, Phillips CO, et al. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. Jama. 2007;297(8):831–41.CrossRef
6.
Smetana GW, Landon BE, Bindman AB, et al. A comparison of outcomes resulting from generalist vs specialist care for a single discrete medical condition: a systematic review and methodologic critique. Arch Intern Med. 2007;167(1):10–20.CrossRef
7.
Mendis S, Johnston SC, Fan W, et al. Cardiovascular risk management and its impact on hypertension control in primary care in low-resource settings: a cluster-randomized trial. Bull World Health Organ. 2010;88(6):412–9.CrossRef
8.
Woodward CA, Abelson J, Tedford S, et al. What is important to continuity in home care?: perspectives of key stakeholders. Soc Sci Med. 2004;58(1):177–92.CrossRef
9.
Weinberger M, Oddone EZ, Henderson WG. Does increased access to primary care reduce hospital readmissions? N Engl J Med. 1996;334(22):1441–7.CrossRef
10.
World Health Organization. The world health report 2008: primary health care now more than ever. 2008.CrossRef
11.
Pongsupap Y, Lerberghe WV. Choosing between public and private or between hospital and primary care: responsiveness, patient-centeredness and prescribing patterns in outpatient consultations in Bangkok. Tropical Med Int Health. 2006;11(1):81–9.CrossRef
12.
Baicker K, Chandra A. Medicare Spending, The physician workforce, and beneficiaries” quality of care. 2004.
13.
Rose JH, O'Toole EE, Dawson NV, et al. Generalists and oncologists show similar care practices and outcomes for hospitalized late-stage cancer patients. Med Care. 2000;38(11):1103–18.CrossRef
14.
Jiangnan C. Why cannot hospital health alliance be successfully implemented. China Soc Secur. 2011(9):82–3.
15.
State council. Directions on the establishment of the general practitioner system, July 2011.
16.
He XL, Liang H. Theoretical discussion and policy proposal to promote the reform of family responsibility doctors system. Chin J Health Policy. 2012;5(6):3–8.
17.
Du LJ, Lin WL. Analysis of the problems and countermeasures existing in the policy insurance of community family doctor system. Chinese Rural Health Service Administration2, 013, 33 (8): 876–878.
18.
Ge M, Jiang P, Lu W, et al. The discussion about pushing approach, service mode and system architecture of family doctor system: taking Changning as an example. Chin Health Resour. 2012;15(5):420–2.
19.
Changning District Health Bureau of Shanghai. Mode and mechanism innovation of family doctor system - Shanghai Changning experiment. Shanghai: Shanghai Bookstore Publishing House; 2013.
20.
The NDRC, Startup of the pilot reform of GP practice and service mode [EB / OL].http: // www sdpc.​gov.​cn / shfz/ yywstzgg / ygdt / t20120830_502402.htm, 2012-08-28.
21.
Wu J, Shi Q. Consideration on the reform of family doctor contracted service and the mode of medical insurance payment. Chin Gene Pract. 2008;(5):34–6.
22.
Meng Q, Fang H, Liu X, Yuan B, Xu J. Consolidating the social health insurance schemes in China: towards an equitable and efficient health system. Lancet. 2015;386(10002):1484–92.CrossRef
23.
Lu W, Zhang YM, Liang H, et al. Analysis of the theoretical basis and policy value for family doctor contracted service and the co-reform of medical insurance payment. Chin J Health Policy. 2016;9(8):3–9.
24.
Babbie E. The Practice of Social Research. Twelfth ed. Belmont: Wadsworth Publishing Co Inc; 2009.
25.
Feng XT. Research methods of sociology. Beijing: China Renmin University Press; 2001.
26.
Zhan SK. Field investigation technology. Shanghai: Fudan University Press; 2003. p. 72–6.
27.
Cao Y, Chen J, Cao JW, et al. Kish grid sampling applied inworldwide health survey(China survey). J Fudan University: Med Ed. 2004;31(3):307–10.
28.
Zhang LP. Home-entry sampling by use of Kish table-study of the age structure distortion of respondents. Sociol Res. 2009;4(4):177–245.
29.
Changning District Health Bureauof Shanghai. Annual report of community health management center. 2014.
30.
Zhao Y, Zhu Y, Pan YH, et al. Study of the willingness and effect factors on the family doctors contracted with community outpatients. Chin Gen Pract. 2012;15(10):1151–3.
31.
Liang WN, Lü ZF. General medical theory and practice. Beijing: People's medical publishing house; 2012.
32.
Shi L, Macinko J, Starfield B, et al. The relationship between primary care, income inequality, and mortality in US states, 1980–1995. J Am Board Fam Pract. 2003;16(5):412–422.91.CrossRef
33.
Franks P, Fiscella K. Primary care physicians and specialists as personal physicians. Health care expenditures and mortality experience. J fam Pract. 1998;47(2):105–9.PubMed
34.
Lu W, Zhang YM, Liang H, et al. Evaluation of implementation effect based on demander’s family doctor contracted service-focusing on chronic diseases. Chin J Health Policy Res. 2016;9(8):23–30.
35.
Liao Yn LY, Zhang C. Analysis of KAP health education effect of the nutrition in Chinese and Western medicine for hypertension of the elderly in community. Chin J Gerontol. 2010;30(1):82–4.
Metadata
Title
A preliminary effect analysis of family doctor and medical insurance payment coordination reform in Changning District of Shanghai, China
Authors
Jiaoling Huang
Wei Lu
Luan Wang
Tao Zhang
Chengjun Liu
Shanshan Liu
Hong Liang
Yimin Zhang
Dongfeng Guo
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2019
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-019-0949-0

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