PDF(Pubmed)
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.
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.
摘要：
背景：家庭医生，作为看门人，是满足基本卫生需求的初级卫生保健的核心，提供无障碍护理，改善可达到的健康。本研究旨在评估家庭医生制度对中国高血压和糖尿病患者卫生服务利用的影响。
方法：构建差异（DID）模型来估计家庭医生系统的净效应，基于中国东部城市高血压和糖尿病患者的官方健康管理记录和医疗保险索赔数据。
结果：家庭医生系统显着增加了随访次数（高血压患者=0.13，糖尿病患者coef。=0.08，均p<0.001）和门诊就诊（高血压患者coef。=0.08，糖尿病患者coef。=0.05，两者p<0.001)与未签约者相比。在签约人群中，社区卫生中心的门诊就诊比例显着上升（高血压患者cof。=0.02，糖尿病患者coef。=0.04，均p<0.001），原因是社区卫生中心的门诊量明显增多，二级和三级医院的门诊量较少。它还显着减轻了高血压患者而不是糖尿病患者的住院人数增加。
结论：被检查的家庭医生系统加强了初级保健，通过增加随访和门诊量，促进我国门诊利用结构的合理化。
方法：构建差异（DID）模型来估计家庭医生系统的净效应，基于中国东部城市高血压和糖尿病患者的官方健康管理记录和医疗保险索赔数据。
结果：家庭医生系统显着增加了随访次数（高血压患者=0.13，糖尿病患者coef。=0.08，均p<0.001）和门诊就诊（高血压患者coef。=0.08，糖尿病患者coef。=0.05，两者p<0.001)与未签约者相比。在签约人群中，社区卫生中心的门诊就诊比例显着上升（高血压患者cof。=0.02，糖尿病患者coef。=0.04，均p<0.001），原因是社区卫生中心的门诊量明显增多，二级和三级医院的门诊量较少。它还显着减轻了高血压患者而不是糖尿病患者的住院人数增加。
结论：被检查的家庭医生系统加强了初级保健，通过增加随访和门诊量，促进我国门诊利用结构的合理化。
