ABSTRACT
Objective:To compare the contracting status for combination medical service( "1+1+1" contract)between elderly residents in Shanghai urban and suburban communities and its influencing factors.Methods:Total 574 outpatients aged over 60 were selected with stratified sampling and convenient sampling method from 3 urban community health service centers and 3 suburban community health service centers in Shanghai. A questionnaire survey was conducted from July to September 2017, the survey included the general information, health status, health concern, purpose of this visit, satisfaction with the center, frequency of visit, choice of first contact, willingness of referral, understanding "1+1+1" contract and preferential policies, contract signing status and reasons.Results:Total 574 questionnaires were distributed and 564 valid questionnaires were retrieved with an effective rate of 98.25%. Of the 292 participants in urban areas, 167 (57.2%) had signed the contract; of the 272 participants in the suburbs, 133 (48.9%) had signed the contract. Univariate analysis showed that self-evaluated health status, visits to the community health service center, satisfaction with the center, concerning health knowledge, long-term medication, the choice of community health center as first contact, the willingness of referral, knowing the "1+1+1" contract policy were associated with the contract-signing in urban residents (χ 2=13.05, 8.51, 13.89, 10.76, 6.26, 12.98, 24.73, 76.77, respectively; all P<0.05); while age, self-evaluated health status, the purpose of this visit, medical examination, type of chronic disease, long-term medication, the choice of community health service center as first contact, the willingness of referral, knowing the "1+1+1" contract policy were associated with the contrct-signing in suburban residents (χ 2=9.56, 14.26, 13.83, 18.30, 18.65, 11.96, 5.99, 5.46 83.44, respectively all P<0.05). Multivariate analysis showed that self-rated health status and awareness of "1+1+1" contract were independent influencing factors for contract-signing in urban residents ( P<0.05); while the awareness of "1+1+1" contract, the purpose of this visit and the frequency of physical examination were influencing factors for contract-signing in suburban residents ( P<0.05). Conclusion:The "1+1+1" signing rate in urban residents is higher than that in suburban residents due to more self health-concerns and higher awareness of the "1+1+1" contracts. It is suggested that the government attach importance to construction of the "1+1+1" contract system for suburb community health service institutions.
ABSTRACT
Objective@#To investigate the signing status of combination contract( "1+1+1" contract) for primary care among elderly residents in Shanghai communities and its influencing factors.@*Methods@#The policy of combination contract for primary care has been implemented in Shanghai since 2015, the residents signed a service contract with general practitioners in community health service center as well as with one of the secondary or tertiary hospitals ( "1+1+1" ). The questionnaire survey on the signing status of "1+1+1" contract was conducted among residents over 60 years in 6 communities in Shanghai which were selected by stratified and convenience sampling method from September 2017 to November 2017. The questionnaire was designed based on the previous research results of the qualitative interviews. The contents of the questionnaire included the basic characteristics, health status, understanding of the "1+1+1" signing policy, the status and reasons for contract signing, and so on. The date were analyzed by descriptive method, chi-square test, and binary logistic regression.@*Results@#Total 574 questionnaires were distributed and 564 valid questionnaires were retrieved with a recovery rate of 98.25%. Among all participants, 300 (53.2%) had signed and 264 (46.8%) had not signed. Univariate analysis showed that age, self-evaluated health status, chronic disease, medication, visits to the community health service center, the purpose of this visit,satisfaction with the community health service center, medical examination, concerning health knowledge, the willingness of community doctor as gatekeeper, the willingness of community referral, whether or not know the "1+1+1" contract policy, influence the rate of signing were associated with the signing of the contract (all P<0.05). Multivariate analysis showed that whether or not know the "1+1+1" contract policy, the willingness of community referral, and self-evaluation health status were independent factors affecting "1+1+1" contract signing (all P<0.05). The reason for signing the contract were convenience to visit doctor (69.00%, 207/300), and having a good relationship with family doctor (29.33%, 88/300). The reasons for not signing the contract were not understanding the policy (65.15%, 172/264), lack of help for signing (25.38%, 67/264), and restricted choice of seeking medical services (7.58%, 20/264).@*Conclusion@#Whether or not know the "1+1+1" contract policy, the willingness of community referral, and self-evaluation health status are the main influencing factors of signing "1+1+1" contract for primary care among elderly residents in Shanghai communities.