Top

BMC Health Services Research

Published in:

Open Access 01-12-2019 | Research article

Satisfaction with service coverage and drug list may influence patients’ acceptance of general practitioner contract service: a cross-sectional study in Guangdong, China

Authors: Aiyun Chen, Shanshan Feng, Wenxi Tang, Liang Zhang

Published in: BMC Health Services Research | Issue 1/2019

Abstract

Background

General practitioner (GP) system is proved to be effective in over 50 countries worldwide. Guangdong province, as a reform pilot in China, initiated its patient-GP contract service reform in 2014. This study is designed to assess the patients’ acceptance of General Practitioners Contract (GPC) reform and explore its influencing factors.

Methods

This survey interviewed 1010 participants from 16 primary health centers (PHCs) chosen from 4 pilot cities in Guangdong during July and December in 2015. Data were collected through face-to-face interviews. The questionnaire was developed to discover the acceptance of GPC and covered three parts: respondents’ socio-demographic characteristics, health service utilization, and the patients’ assessment of primary health care centers. A binary logistic regression model was used to measure the influencing factors of respondents’ acceptance of GPC policy.

Results

A total of 611(60.5%) participants accepted GPC policy. Compared to patients visited PHCs over 7 times in the previous year, those visited PHCs fewer times reported lower acceptance of GPC policy (OR:0.68, 95% CI:0.49–0.96 for visits ≤3 times and OR:0.57, 95% CI:0.38–0.84 for visits = 4–6 times). Patients’ satisfaction with medical service coverage was positively associated with patients’ acceptance of GPC (OR: 1.72, 95% CI:1.01–3.98 for the satisfied versus the dissatisfied; OR: 1.38, 95% CI:0.92–3.30 for neutral versus the dissatisfied), and the satisfaction with drug list also positively influenced patients’ acceptance of GPC policy (OR: 1.44, 95% CI:1.26–2.73 for the satisfied versus the dissatisfied; OR:1.61, 95% CI:1.36–2.99 for neutral versus the dissatisfied). Meanwhile, age and education had positive impacts on the acceptance of the GPC policy.

Conclusion

This study finds out that patients’ satisfaction with medical service coverage and drug list are the influencing factors for the acceptance of GPC policy. Therefore, improvement of medical service accessibility such as better follow-up of patients with chronic diseases and enhanced referral service, as well as the expansion of drug list, will improve patients’ acceptance of GPC policy. It also finds that patients using more primary health service are inclined to accept GPC policy, so more attractive and high-quality service should be provided in PHCs.

Available only for authorised users

Lakhani M, Baker M. Good general practitioners will continue to be essential. BMJ. 2006 Jan 7;332(7532):41–3. https://doi.org/10.1136/bmj.332.7532.41.CrossRefPubMedPubMedCentral

Comino EJ, Davies GP, Krastev Y, Haas M, Christl B, Furler J, Raymont A, Harris MF. A systematic review of interventions to enhance access to best practice primary health care for chronic disease management, prevention and episodic care. BMC Health Serv Res. 2012 Nov 21;12:415. https://doi.org/10.1186/1472-6963-12-415.CrossRefPubMedPubMedCentral

Hutchison B, Levesque JF, Strumpf E, Coyle M. Primary health Care in Canada: Systems in Motion. Milbank Q. 2011 Jun;89(2):256–88. https://doi.org/10.1111/j.1468-0009.2011.00628.x. CrossRefPubMedPubMedCentral

Shi L. The impact of primary care: a focused review. Scientifica (Cairo). 2012;2012:432892. https://doi.org/10.6064/2012/432892.CrossRefPubMedPubMedCentral

Zarei E. Service quality of hospital outpatient departments: patients’ perspective. Int J Health Care Qual Assur. 2015;28(8):778–90. https://doi.org/10.1108/IJHCQA-09-2014-0097.CrossRefPubMed

Hespe C, Rychetnik L, Peiris D, Harris M. Informing implementation of quality improvement in Australian primary care. BMC Health Serv Res. 2018 Apr 16;18(1):287. https://doi.org/10.1186/s12913-018-3099-5.CrossRefPubMedPubMedCentral

Thomas SL, Wakerman J, Humphreys JS. Ensuring equity of access to primary health care in rural and remote Australia - what core services should be locally available? Int J Equity Health. 2015;14:111. https://doi.org/10.1186/s12939-015-0228-1.CrossRefPubMedPubMedCentral

Carey TA, Wakerman J, Humphreys JS, Buykx P, Lindeman M. What primary health care services should residents of rural and remote Australia be able to access? A systematic review of “core” primary health care services. BMC Health Serv Res. 2013;13:178. https://doi.org/10.1186/1472-6963-13-178.CrossRefPubMedPubMedCentral

Sagrado S. Primary care in France. Semergen. 2016;42(1):58–62. https://doi.org/10.1016/j.semerg.2015.07.004. CrossRef

10.

Feng XL, Martinez-Alvarez M, Zhong J, Xu J, Yuan B, Meng Q, Balabanova D. Extending access to essential services against constraints: the three-tier health service delivery system in rural China (1949-1980). Int J Equity Health. 2017;16(1):49. https://doi.org/10.1186/s12939-017-0541-y. CrossRefPubMedPubMedCentral

11.

Li X, Lu J, Hu S, Cheng K, De-Maeseneer J, Meng Q, Mossialos E, Xu D, Yip W, Zhang H. The primary health-care system in China. Lancet. 2017;390(10112):2584–94. https://doi.org/10.1016/S0140-6736(17)33109-4.CrossRefPubMed

12.

Feng S, Shi L, Zeng J, Chen W, Ling L. Comparison of primary care experiences in village clinics with different ownership models in Guangdong Province, China. PLoS One. 2017;12(1):e0169241. https://doi.org/10.1371/journal.pone.0169241.CrossRefPubMedPubMedCentral

13.

Center for Health Statistics and Information. An analysis report of National Health Services Survey in China, vol. 2017; 2016. p. 36–41.

14.

The State Council of the People's Republic of China. Guidance on establishing a general practitioner system. 2016. http://www.nhc.gov.cn/tigs/s3578/201606/21e172eaa7764407a06b9f4e82805a7c.shtml. Accessed 6 June 2016.

15.

Zhao J, Zhang X, Wang M, Zhao J. Residents' willingness for renewing the contract of family doctor service in Xicheng District of Beijing and its influencing factors. Chin Gen Pract. 2015;18(28):3417–6.

16.

Jing L, Shu Z, Sun X, John FC, Lou J, Xie C. Factors influencing Patients' Contract choice with general practitioners in Shanghai: a preliminary study. Asia Pac J Public Health. 2015;27:77S–85S.CrossRefPubMed

17.

Zhang Y, Zhang T, Wang Z. Status of signing on family doctor Service for Residents in Desheng area of Beijing and its influencing factors. Chin Gen Pract. 2013;16(11A):3715–8.

18.

Chen F, Xu X, Yang Z, Tan H, Zhang L. The willingness-to-pay for general practitioners in contractual service and influencing factors among empty nesters in Chongqing, China. Int J Environ Res Public Health. 2015;12(8):9330–41. https://doi.org/10.3390/ijerph120809330.CrossRefPubMedPubMedCentral

19.

Wang N, Gu Y, Liu L, Chen D, Shen Q, Zhong Y. The status and countermeasures of general practitioner contract service in Zhejiang Province. Health Econ Study. 2015;(3):15–7.

20.

Wu J, Zhang S, Chen H, Lin Y, Dong X, Yin X, Lu Z, Cao S. Patient satisfaction with community health service centers as gatekeepers and the influencing factors: a cross-sectional study in Shenzhen, China. PLoS One. 2016;11(8):e0161683. https://doi.org/10.1371/journal.pone.0161683.CrossRefPubMedPubMedCentral

21.

National Bureau of Statistics of China. China Statistics Yearbook 2017. 2017. www.stats.gov.cn/tjsj/ndsj/2017/indexch.htm

22.

Shi L, Starfield B, Xu J, Politzer RM, Regan J. Primary care quality: community health center and health maintenance organization. South Med J. 2003;96(8):787–95.CrossRefPubMed

23.

Li W, Wang D, Gan Y, Zhou Y, Chen Y, Li J, Kkandawire N, Hu S, Qiao Y, Lu Z. Factors influencing government insurance scheme beneficiary acceptance of the gatekeeper policy: a cross-sectional study in Wuhan, China. BMC Health Serv Res. 2018 Apr 4;18(1):241. https://doi.org/10.1186/s12913-018-3010-4.CrossRefPubMedPubMedCentral

24.

Zhou Z, Su Y, Campbell B, Zhou Z, Gao J, Yu Q, Chen J, Pan Y. The financial impact of the ‘zero-markup policy for essential drugs’ on patients in county hospitals in Western rural China. PLoS One. 2015;10(3):e0121630. https://doi.org/10.1371/journal.pone.0121630.CrossRefPubMedPubMedCentral

25.

Zou Y, Zhang X, Hao Y, Shi L, Hu R. General practitioners versus other physicians in the quality of primary care: a cross-sectional study in Guangdong Province, China. BMC Fam Pract. 2015;16:134. https://doi.org/10.1186/s12875-015-0349-z.CrossRefPubMedPubMedCentral

26.

Guan X, Hu H, Man C, Shi L. A survey of availability, price and affordability of essential medicines from 2011 to 2016 in Chinese secondary and tertiary hospitals. Int J Equity Health. 2018;17(1):158. https://doi.org/10.1186/s12939-018-0870-5. CrossRefPubMedPubMedCentral

27.

Xu S, Bian C, Wang H, Li N, Wu J, Li P, Lu H. Evaluation of the implementation outcomes of the essential medicines system in Anhui county-level public hospitals: a before-and-after study. BMC Health Serv Res. 2015;15:403. https://doi.org/10.1186/s12913-015-1073-z.CrossRefPubMedPubMedCentral

28.

Mcphail S, Haines T. Response shift, recall bias and their effect on measuring the change in health-related quality of life amongst older hospital patients. Health Qual Life Outcomes. 2010;8:65. https://doi.org/10.1186/1477-7525-8-65.CrossRefPubMedPubMedCentral

Title: Satisfaction with service coverage and drug list may influence patients’ acceptance of general practitioner contract service: a cross-sectional study in Guangdong, China
Authors: Aiyun Chen
Shanshan Feng
Wenxi Tang
Liang Zhang
Publication date: 01-12-2019
Publisher: BioMed Central
Published in: BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-019-4053-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Satisfaction with service coverage and drug list may influence patients’ acceptance of general practitioner contract service: a cross-sectional study in Guangdong, China

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2019

Correction to: The cost-effectiveness of incentive-based active case finding for tuberculosis (TB) control in the private sector Karachi, Pakistan

Renouncing care in French Guiana: the national health barometer survey

Physician and pharmacist satisfaction and clinical needs for the real-time medication surveillance program in South Korea

Wait lists and adult general surgery: is there a socioeconomic dimension in Canada?

A multistage mixed methods study protocol to evaluate the implementation and impact of a reconfiguration of acute medicine in Ireland’s hospitals

Process evaluation of a behaviour change approach to improving clinical practice for detecting hereditary cancer