Can social capital play a role in contracting services of family doctors in China? Reflections based on an integrative review

A spatial feature analysis of primary health care utilization in a large city in China and its implications for family doctor contract service policy

BACKGROUND

Family doctor contract policy is now run by the State Council as an important move to promote the hierarchical medical system. Whether the family doctor contract policy achieves the initial government's goal should be measured further from the perspective of patient visits between hospitals and community health centers, which are regarded as grass medical agencies.

METHODS

The spatial feature measurement method is applied with ArcGIS 10.2 software to analyze the spatial aggregation effect of patient visits to hospitals or community health centers among 20 districts of one large city in China and analyze the family doctor contract policy published in those areas to compare the influence of visit tendencies.

RESULTS

From year 2016-2020, visits to hospitals were in the high-high cluster, and the density was spatially overflow, while there was no such tendency in visits to community health centers. The analysis of different family doctor contract policy implementation times in 20 districts reflects that the family doctor contract policy has a very limited effect on the promotion of the hierarchical medical system, and the innovation of the family doctor contract policy needs to be considered.

CONCLUSIONS

A brief summary and potential implications. A multi-integrated medical system along with family doctor contract policy needs to be established, especially integrated in leadership and governance, financing, workforce, and service delivery between hospitals and community health centers, to promote the hierarchical medical system.

Factors related to the internal social capital of elderly-caring social organizations: a cross-sectional study in Chongqing, China

BACKGROUND

Aging has given birth to the demand for high-quality elderly care service and social organizations (ESOs) are gradually taking on a supportive role in the field of elderly care services.. In view of this, our study is designed to examine influencing factors of social capital within the elderly-caring social organizations.

METHOD

The study was conducted in four districts of Chongqing Province and a multi-stage random sampling method was used to sample 80 ESOs as subjects for the research. Through a meticulously crafted questionnaire, we gathered valuable data on internal social capital, basic information about the organization, and other variables. Univariate and Binary Logistic Regression analysis were performed on the data to explore the factors associated with social capital within the elderly-caring social organizations using IBM SPSS version 26.0.

RESULT

The results showed that 67(83.8%) OF ESOs surveyed were A-type institutions and 13(16.3%) B-type institutions. Among them, 49(61.3%) institutions covered an area of more than 50m2.The institutions of ≤ 2 years were 33(41.3%), 21(26.3%) were established for ≤ 3 ≤ 8 years, and residual 26(32.5%) were institutions ˃ 8 years old. ESOs that possessed 4-6 management employees were 52.422 times more likely to score high for social support (p<0.05, OR = 52.422). Accommodating special care objects and hiring 16-30 employees were significantly linked to the shared language and shared vision dimension (p<0.001, OR = 0.8) and (p<0.05, OR = 8.672), respectively. and the overall social capital dimension (p<0.01, OR = 0.221) (p<0.05, OR = 5.730).

CONCLUSION

ESOs with different basic conditions have different amounts of social capital. Factors such as the presence of special care and volunteer staff, a certain number of full-time staff as well as types of services rendered are accompanied with the higher internal social capital of ESOs.

What factors affect Beijing residents' contracts with family doctors? A comparative study of Beijing's urban and suburban areas

Objective

To improve the health of residents and promote hierarchical diagnosis and treatment to achieve an orderly pattern of medical treatment, Beijing implemented family doctor contract services (FDCSs) in 2011. The aims of this study were to analyze the current status of Beijing residents' contracts with family doctors (FDs), compare the differences in contracting between urban and suburban residents, and explore the factors that affect residents' contract behavior.

Methods

From August 2020 to October 2020, a stratified sampling method was adopted to select residents from community health centers (CHCs) in districts D (urban area) and S (suburb) of Beijing to conduct a questionnaire survey. Chi-square tests, rank sum tests and logistic regression analyzes were used to analyze the current status and influencing factors of residents' contracting with FDs.

Results

A total of 4,113 valid questionnaires were included in the final analysis. District D was rich in medical resources, and the FD contract rate of residents there (93.09%) was significantly higher than that of residents in district S (78.06%; p < 0.05). Residents' district (OR = 1.55, 95% CI = 1.18-2.05), understanding of FDCS policies (OR = 4.13, 95% CI = 3.63-4.69), preferred medical institutions (OR = 0.58, 95% CI = 0.42-0.79 for tertiary hospitals in the district; OR = 0.36, 95% CI = 0.22-0.59 for urban medical institutions in Beijing), age, education level, average annual medical expenses and medical insurance type were factors that influenced residents' contracts with FDs (p < 0.05).

Conclusion

This study shows that residents who are located in districts with rich medical resources, prefer CHCs as their first choice, have a better understanding of FDCS policies, and are more inclined to contract with FDs than other residents. It is recommended that the number and quality of FDs in suburban areas be increased and that medical staff strengthen publicity about FDCSs and actively encourage residents to contract with FDs.