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BMC Health Services Research
Published in: BMC Health Services Research 1/2024

Open Access 01-12-2024 | Hypertension | Research

Can family doctor system improve health service utilization for patients with hypertension and diabetes in China? A difference-in-differences study

Authors: Luying Zhang, Peng Zhang, Wen Chen

Published in: BMC Health Services Research | Issue 1/2024

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Abstract

Background

Family doctors, serving as gatekeepers, are the core of primary health care to meet basic health needs, provide accessible care, and improve attainable health. The study objective was to evaluate the impact of the family doctor system on health service utilization among patients with hypertension and diabetes in China.

Methods

Difference-in-Differences (DID) models are constructed to estimate the net effect of the family doctor system, based on the official health management records and medical insurance claim data of patients with hypertension and diabetes in an eastern city of China.

Results

The family doctor system significantly increases follow-up visits (hypertension patients coef. = 0.13, diabetes patients coef. = 0.08, both p < 0.001) and outpatient visits (hypertension patients coef. = 0.08, diabetes patients coef. = 0.05, both p < 0.001) among the contracted compared to the non-contracted. The proportion of outpatient visits in community health centers among the contracted significantly rose (hypertension patients coef. = 0.02, diabetes patients coef. = 0.04, both p < 0.001) due to significantly more outpatient visits in community health centers and fewer in secondary and tertiary hospitals. It also significantly mitigates the increase in inpatient admissions among hypertension patients but not among diabetes patients.

Conclusions

The examined family doctor system strengthens primary care, both by increasing follow-up visits and outpatient visits and promoting a rationalized structure of outpatient utilization in China.
Literature
1.
World Health Organization. Primary health care.|.*2020*2020.; 2020.
2.
Yip WN, Fu HQ, Chen AT, Zhai TM, Jian WY, Xu RM, Pan J, Hu M, Zhou ZL, Chen QL et al. 10 years of health-care reform in China: progress and gaps in Universal Health Coverage. LANCET 2019, 394(10204):1192–1204.
3.
World Health Organization. Operational Framework for Primary Health Care.|.*2020*2020.; 2020.
4.
Yuan SS, Wang F, Li X, Jia M, Tian MM. Facilitators and barriers to implement the family doctor contracting services in China: findings from a qualitative study. BMJ OPEN 2019, 9(10).
5.
Friedberg MW, Rosenthal MB, Werner RM, Volpp KG, Schneider EC. Effects of a Medical Home and Shared Savings Intervention on Quality and Utilization of Carevol 175, pg 1362, (2015). JAMA INTERN MED 2015, 175(8):1426.
6.
Ha NT, Harris M, Preen D, Robinson S, Moorin R. Identifying patterns of general practitioner service utilisation and their relationship with potentially preventable hospitalisations in people with diabetes: the utility of a cluster analysis approach. DIABETES RES CLIN PR. 2018;138:201–10.CrossRef
7.
Yang BH, Messom R. Association between potential primary care emergency service and general practitioner care utilisation inNew South Wales. EMERG MED AUSTRALAS. 2021;33(1):52–7.CrossRefPubMed
8.
Almeida A, Vales J. The impact of primary health care reform on hospital emergency department overcrowding: evidence from the Portuguese reform. INT J HEALTH PLAN M. 2020;35(1):368–77.CrossRef
9.
Gyulai A, Nagy A, Pataki V, Tonte D, Adany R, Voko Z. General practitioners can increase participation in cervical cancer screening - a model program in Hungary. BMC FAM PRACT 2018, 19.
10.
Bayati M, Keshavarz K, Lotfi F, KebriaeeZadeh A, Barati O, Zareian S, Amiri A, Delavari S. Effect of two major health reforms on health care cost and utilization in Fars Province of Iran: family physician program and health transformation plan. BMC HEALTH SERV RES 2020, 20(1).
11.
Huang PT, Kung PT, Kuo WY, Tsai WC. Impact of family physician integrated care program on decreasing utilization of emergency department visit and hospital admission: a population-based retrospective cohort study. BMC HEALTH SERV RES 2020, 20(1).
12.
Fung C, Wong C, Fong D, Lee A, Lam C. Having a family doctor was associated with lower utilization of hospital-based health services. BMC HEALTH SERV RES 2015, 15.
13.
The Central People’s Government of the People’s Republic of China. Opinions on Deepening the Reform of the Medical and Health System.|.*2020*2020.; 2009.
14.
National Medical Reform Office. Notice on Promoting Guidance for Family Doctor Contract Services.; 2016.
15.
Shang XP, Huang YM, Li BE, Yang Q, Zhao YR, Wang W, Liu Y, Lin JF, Hu CG, Qiu YW. Residents’ Awareness of Family Doctor Contract Services, Status of Contract with a Family Doctor, and Contract Service Needs in Zhejiang Province, China: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019, 16(18).
16.
Liang WWCWP. Development Report on Health Reform in China 2020. Beijing: Social Sciences Academic Press (China); 2020.
17.
World Health Organization. Healthy China: Deepening Health Reform in China. Washington, DC: World Bank and World Health Organization; 2019.
18.
Li M, Gao Y, Mao Q. Study on the Impact of Family Doctor Contracting Service on Health Service utilization of chronic patients. Health Econ Res. 2019;2(36):38–42.
19.
Qiu B, Huang J, Liang H. A comparative study on the health services utilization and satisfaction of the family doctor service. Chin J Health Policy. 2016;1(9):31–6.
20.
Wang Y, Wang J, Maitland E. Growing old before growing rich: inequality in health service utilization among the mid-aged and elderly in Gansu and Zhejiang Provinces, China. Bmc Health Serv Res. 2012;12(12):302–13.CrossRefPubMedPubMedCentral
21.
Zheng QM, Shi L, Pang TT, Leung W. Utilization of community health care centers and family doctor contracts services among community residents: a community-based analysis in Shenzhen, China. BMC FAM PRACT 2021, 22(1).
22.
Huang JL, Liu Y, Zhang T, Wang L, Liu SS, Liang H, Zhang YM, Chen G, Liu CJ. Can family doctor contracted services facilitate orderly visits in the referral system? A frontier policy study from Shanghai, China. INT J HEALTH PLAN M. 2022;37(1):403–16.CrossRef
23.
Yu Y, Ye AZ, Chen C, Dai WD, Liu X. The impact of family doctor system on patients’ utilisation of general practitioner in primary care facilities-Evidence from Hangzhou, China. INT J HEALTH PLAN M 2022.
24.
Huang JL, Lu W, Wang L, Zhang T, Liu CJ, Liu SS, Liang H, Zhang YM, Guo DF. A preliminary effect analysis of family doctor and medical insurance payment coordination reform in Changning District of Shanghai, China. BMC FAM PRACT 2019, 20.
25.
Wu R. The effects of Contract Service Status from General Practitioner on the Utilization of Health Services among Community residents in Pukou District, Nanjing City. Med Soc. 2019;2(32):9–15.
26.
Klein J, von Dem Knesebeck O. Social disparities in outpatient and inpatient care. An overview of current findings in Germany. BUNDESGESUNDHEITSBLA. 2016;59(2):238–44.CrossRef
27.
Qian Y, Zhou Z, Yan J, Gao J, Wang Y, Yang X, Xu Y, Li Y. An economy-ralated equity analysis of health service utilization by women in economically underdeveloped regions of western China. INT J EQUITY HEALTH. 2017;16(1):186.CrossRefPubMedPubMedCentral
28.
Li C, Tang C, Wang H. Effects of health insurance integration on health care utilization and its equity among the mid-aged and elderly: evidence from China. INT J EQUITY HEALTH. 2019;18(1):166.CrossRefPubMedPubMedCentral
29.
Rao M, Katyal A, Singh PV, Samarth A, Bergkvist S, Kancharla M, Wagstaff A, Netuveli G, Renton A. Changes in addressing inequalities in access to hospital care in Andhra Pradesh and Maharashtra states of India: a difference-in-differences study using repeated cross-sectional surveys. BMJ OPEN 2014, 4(6).
30.
Stokes J, Kristensen SR, Checkland K, Bower P. Effectiveness of multidisciplinary team case management: difference-in-differences analysis. BMJ OPEN 2016, 6(4).
31.
Keeble E, Bardsley M, Durand MA, Hoomans T, Mays N. Area level impacts on emergency hospital admissions of the integrated care and support pioneer programme in England: difference-in-differences analysis. BMJ OPEN 2019, 9(8).
32.
33.
Elek P, Molnar T, Varadi B. The closer the better: does better access to outpatient care prevent hospitalization? EUR J HEALTH ECON. 2019;20(6):801–17.CrossRefPubMedPubMedCentral
34.
Adhikari SR. An assessment of a substitute or complement for inpatient and outpatient care of visceral leishmaniasis in Nepal. J VECTOR DIS. 2012;49(4):242–8.
35.
WICKIZER TM, WHEELER J, FELDSTEIN PJ. Have hospital inpatient cost containment programs contributed to the growth in outpatient expenditures - analysis of the substitution effect associated with hospital utilization review. MED CARE. 1991;29(5):442–51.CrossRefPubMed
36.
Yip W, Hsiao W, Meng QY, Chen W, Sun XM. Realignment of incentives for health-care providers in China. Lancet. 2010;375(9720):1120–30.CrossRefPubMed
37.
Huang Y, Feng L, Li Z. Studying on the Status of General practitioners’ services and its influencing factors sampled with Longhua District of Shenzhen. Chin Health Service Manage. 2018;2(31):49–51.
38.
Liu Q, Zhong W, Wang Z. Demands for Family Physician Service among Community Elderly in Wuhan City and Influcing factors. 2018, 2(31):49–51.
39.
Li Q, Huang W, Miao C. Study on urban residents’ willingness of family doctor contract and its influencing factors in Xuzhou. 2018, 3(21):262–6.
40.
Huang J, Zhu Q, Guo J. Can Health Disparity be eliminated? The role of Family Doctor played in Shanghai, China. INT J ENV RES PUB HE 2020, 17(15).
41.
Tang B, Wang Y, Gao Y, Wu S, Li H, Chen Y, Shi Y. The Effect of Boarding on the Mental Health of Primary School students in Western Rural China. INT J ENV RES PUB HE 2020, 17(21).
42.
Mercer SW, Siu JY, Hillier SM, Lam CL, Lo YY, Lam TP, Griffiths SM. A qualitative study of the views of patients with long-term conditions on family doctors in Hong Kong. BMC FAM PRACT. 2010;11:46.CrossRefPubMedPubMedCentral
43.
Fu P, Wang Y, Liu S, Li J, Gao Q, Zhou C, Meng Q, Sylvia S. Analysing the preferences for family doctor contract services in rural China: a study using a discrete choice experiment. BMC FAM PRACT. 2020;21(1):148.CrossRefPubMedPubMedCentral
44.
World Health Organization. WHO global strategy on people-centred and integrated health services interim report. Geneva, Switzerland: WHO Document Production Services; 2015.
45.
Huang SS, Yin AT, Liu QQ, Sun XH. Can the implementation of family doctor contracted service enable the elderly to utilize primary health care services more equally? Empirical evidence from Shandong, China. BMC Prim CARE 2022, 23(1).
Metadata
Title
Can family doctor system improve health service utilization for patients with hypertension and diabetes in China? A difference-in-differences study
Authors
Luying Zhang
Peng Zhang
Wen Chen
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2024
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-024-10903-6

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