Can family doctor contracted services facilitate orderly visits in the referral system? A frontier policy study from Shanghai, China

Abstract

Background: China committed to establishing a family doctor (FD)-based referral system following the medical reform in 2009. This paper explored the effect of FD on establishing the anticipated system. Methods: Two waves of survey were conducted in Shanghai, China. 2754 and 1995 individuals were sampled in 2013 and 2016 respectively. We compared orderly visiting behaviour between contracted and non-contracted residents. Logistic regression models were performed to further test the effect of FD on orderly visits. Results: More contracted residents first-contacted community health service centres (CHSCs; 45.48%) than non-contracted residents (28.93%). Contracted residents were also more likely to refer to specialists via CHSCs than the non-contracted (9.84% vs. 2.60%). The odds ratio (OR) for first-contact at CHSCs by contract status was 1.569 in 2013, but increased to 1.675 in 2016. Being contracted with a FD was associated with referral behaviour, but the OR declined from 2.692 to 2.487 over years. Conclusion: The survey from Shanghai showed that FD had a significant effect on attracting first-contact at CHSCs and referral via CHSCs; however, the effect on the latter decreased. The effectiveness of the FD role on referral behaviour requires a well-established referral system, which has not yet been completely achieved in China.