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

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.

The impact of family doctor system on patients' utilisation of general practitioner in primary care facilities-Evidence from Hangzhou, China.

OBJECTIVE: This study aims to examine whether participating in the contracted family doctor system increases patients' utilisation of primary care general practitioner for multiple disease outcomes in China. METHODS: Binary logistic regression models were estimated using data collected from 372 community residents in nine selected districts of Hangzhou, China. RESULTS: Findings revealed that (1) for patients with influenza, diabetes, upper respiratory infection, and gingivitis, those who participated in the contracted family doctor system were approximately 4.3 times, 98.4%, 92.5%, and 52.8% more likely to choose primary care general practitioners (GP) for their initial diagnosis, respectively, as compared with their counterparts who did not have contracted family doctors; (2) For patients with stroke or cerebrovascular disease and cholecystitis or cholelithiasis, those who had contracted family doctors were 1.111 times and 80.6% more likely to choose primary care GP for their subsequent disease maintenance, respectively, as compared to their counterparts without contracted family doctors. CONCLUSION: Our findings indicate that the contracted family doctor system not only increases the utilisation of primary care GP for patients with many chronic conditions but also promotes the overall completion of China's hierarchical medical system in the long run. Policy implications were provided to help policymakers actively construct and develop the contracted family doctor system to promote the hierarchical medical system in China.

Facilitators and barriers to implement the family doctor contracting services in China: findings from a qualitative study.

OBJECTIVE: To identify the facilitators and barriers to implement family doctor contracting services in China by using Consolidated Framework for Implementation Research (CFIR) to shed new light on establishing family doctor systems in developing countries. DESIGN: A qualitative study conducted from June to August 2017 using semistructured interview guides for focus group discussions (FGDs) and individual interviews. CFIR was used to guide data coding, data analysis and reporting of findings. SETTING: 19 primary health institutions in nine provinces purposively selected from the eastern, middle and western areas of China. PARTICIPANTS: From the nine sampled provinces in China, 62 policy makers from health related departments at the province, city and county/district levels participated in 9 FGDs; 19 leaders of primary health institutions participated in individual interviews; and 48 family doctor team members participated in 15 FGDs. RESULTS: Based on CFIR constructs, notable facilitators included national reform involving both top-down and bottom-up policy making (Intervention); support from essential public health funds, fiscal subsidies and health insurance (Outer setting); extra performance-based payments for family doctor teams based on evaluation (Inner setting); and positive engagement of health administrators (Process). Notable barriers included a lack of essential matching mechanisms at national level (Intervention); distrust in the quality of primary care, a lack of government subsidies and health insurance reimbursement and performance ceiling policy (Outer setting); the low competency of family doctors and weak influence of evaluations on performance-based salary (Inner setting); and misunderstandings about family doctor contracting services (Process). CONCLUSIONS: The national design with essential features including financing, incentive mechanisms and multidepartment cooperation, was vital for implementing family doctor contracting services in China. More attention should be paid to the quality of primary care and competency of family doctors. All stakeholders must be informed, be involved and participate before and during the process.

Enlightenment of Brazil Family Health Strategy to China / 中国卫生经济

The coverage rate of family health strategy in Brazil increased from 4.4％ to 63％ from 2000 to 2015.The promotion of family health strategy effectively improved the level of primary medical service and residents' health.Some of these experiences were worth studying in China,including improving the content of contracting services,strengthening the performance evaluation of medical services and enhancing the incentive and reserve of family health teams.

Establishment of family health assessment index system in Shanghai urban communities / 中华全科医师杂志

Objective To establish a standardized and feasible family health assessment index system based on the family practice system in Shanghai urban communities.Methods On the basis of literature review and special topic discussion, a preliminary index system framework was developed and an expert consultation questionnaire was compiled.Twenty one experts of general practice, medical specialties, health administration and public health management were invited and two rounds of improved Delphi expert consultation were conducted.The results of statistical analysis were summarized and the evaluation index system was established.Results The evaluation index system included 5 first-level indicators, 17 second-level indicators and 63 third-level indicators.The weight coefficients of first-level indicators in basic information, family structure, family function, family resources and health status of the family members were 0.199 6, 0.197 5, 0.201 7, 0.185 0, 0.216 2, respectively.In the two rounds of consultation, the positive coefficient of experts was both 100%, the degree of expert authority was 0.867 and 0.880, and the coordination coefficient was 0.294 and 0.415, respectively (P<0.05).The operational coordination coefficients were 0.320 and 0.402 (P<0.05), respectively.Conclusion The family health assessment index system constructed by the Delphi expert consultation method can provide reference for family doctors to carry out family health assessment in urban communities.

The Changning model in the exploration and reform of Chinese family doctor system / 中国卫生政策研究

Exploring the Chinese family doctor system is an important policy issue in the process of deepening the medical and health care system reform in China. Changning District is the first comprehensive reform pilot area of community health service in the country,and the first demonstration area to explore the family doctor system reform. Since 2008,Changning began to gradually explore the family doctor system, and it has accumulated a lot of experi-ences which can be copied and extended in signing services to improve the family doctor,the full establish a compre-hensive system of hierarchical diagnosis and treatment system,the formation of the reasonable medical order that first primary diagnosis,two-way referral,upper and lower linkage,acute and chronic treatment. The four articles of this topic are from a survey from 10th anniversary of the comprehensive reform of the family doctor system in Changning District,Respectively from the service model,government coordination,performance appraisal and continuing educa-tion,to demonstrate the effectiveness of the policy and practice of the comprehensive reform about family doctor sys-tem in Changning District. With the implementation of the family doctor service on-site promotion meeting, the Changning model of Chinese family doctor system will provide valuable experience to explore and deepen the reform of the family doctor system.

The government collaboration and medical insurance to boost:"The Four medical linkage"under the protection of family doctor service / 中国卫生政策研究

The government coordinated governance is the necessary support and important direction of China's medical reform. During the development process of the family doctor system in Changning District of Shanghai, the coordinated governance of health, medical insurance, civil affairs, finance and other departments for the difficulties of the crowd, through"the four medical linkage"basic medical security health collaborative governance by the"basic medical insurance+basic medical services+government medical assistance+social or-ganization medical help"for the poor people, made the system realize the sustainable development of incentive compatibility. The ten years of reform and policy practice shows that to precisely determine the service population by the Health and Family planning Commission and Civil Affairs Bureau,the policy coordination to pay the fami-ly doctors contract service fee by health insurance and Finance Bureau, the medical resources integration support by community family doctor studio, Community health construction and sharing constitute the developing direc-tion of family doctor service model in China.

The Effect of Having Usual Source of Care on the Choice among Different Types of Medical Facilities / 보건행정학회지

BACKGROUND: Concentration of patients to large hospitals is serious problem in Korea. The purpose of this paper is to propose appropriate policy direction to relieve concentration of patients to large hospitals. It is focused on evaluation of the possibility of family doctor system as a policy alternative to relieve concentration of patients to large hospital by empirically analyzing the effect of usual source of care (USC) on large hospitals medical care use. METHODS: Korea Health Panel conducted 2009, 2012, 2013 by KIHASA (Korea Institute for Health and Social Affairs) and NHIS (National Health Insurance Service) was used for analysis. For dependent variables, first, the ratio of the amount of using large hospital to total amount of using medical care, and second, the amount of using large hospital are estimated. Independent variables are having an USC and type of USC. Panel analysis was done with above variables. RESULTS: Main results are as follows. First, having an USC increases using large hospital. Second, having a domestic clinic type USC decreases using large hospital and ratio of using large hospital. Third, the effect of domestic clinic type USC is greater in older group, less income group, worse health status group, not having private insurance group, and having chronic disease group. CONCLUSION: These results show that family doctor program can be a policy alternative to relieve concentration of patients to large hospital. Nonetheless, primary care system in Korea is unsatisfied. It is recommended to reinforce primary care system and family doctor system to relieve concentration of patients to large hospitals.

Comprehensive evaluation of community health services in Shanghai / 中华医院管理杂志

The study introduced the general evaluation indicator system for community health services in Shanghai and its characteristics,analyzing the results of the comprehensive evaluation from the aspects of regions and institutions.From six aspects of financial input,human resource construction, operation mechanism,family doctor system,information system construction and the application of the comprehensive evaluation results,the paper recommended on deepening the reform of community health services.

Ethics Principle Analysis and Policy Recommendations of the Family Doctor System in China / 中国医学伦理学

Establishing and perfecting the family doctor system should adhere to the following ethical princi-ples:the principle of public welfare, fairness and efficiency principle, the combination of comprehensive care prin-ciple, attaches great importance to the precautionary principle, the principle of family support, social participation principle. In the horizon, life ethics, puts forward suggestions for the development of family doctor system:impro-ving humanism quality of family physicians,calling the humanistic concern in the process of family doctor service increasing the government's policy support,increase the health resources into, adjust the health insurance policies, guide the community residents in the family doctor first.

Progress and bottlenecks of family doctor system in Shanghai / 中国卫生政策研究

Shanghai began to strengthen the community health service system in 1997 , and had officially en-tered the period of “connotation construction” with the core policy of family doctor system in 2011 after the period of“service framework and network establishment” and“operational mechanism reform”. Through summarizing the poli-cy files related the family doctor system and based on 2013 report on monitoring and evaluation of family doctor system in Shanghai, the paper presented the progress of the system from aspects of system coverage, signature relationship, service mode and operational mechanism, and analyzed the development bottlenecks of the system from aspects of the policy itself, service principal, service supervision and service objects. Finally, the paper proposed some suggestions in order to give some references for further development of national general practitioner system.