| BackgroundWith the development of ageing and the change of disease spectrum,the main health problems faced by residents have changed from communicable diseases to chronic non-communicable diseases.The long-term nature of the treatment and rehabilitation cycle of chronic diseases determines that patients with chronic diseases have a more urgent need for continuous and lasting medical services,and the phased inpatient treatment can no longer meet their needs for basic medical services,and they prefer personalised chronic disease management services.Family doctor contracting service is based on the core of general practitioners,public health doctors and community nurses,providing continuous,convenient and effective basic medical care,public health and other personalised medical and health services to residents in the district through voluntary contracting,which can not only effectively improve the capacity of primary medical and health services,but also promote the realisation of primary care and hierarchical diagnosis and treatment system.In recent years,the introduction and implementation of a series of policies on family doctor contracting services in China have gradually improved the work of family doctor contracting services.However,there are inevitably some obstacles and shortcomings in the implementation of the policies,such as low awareness and knowledge of family doctor contracted services and poor implementation,among which the key issue is the mismatch between supply and demand.In addition to improving relevant policy measures at the macro level,identifying patients’ needs and optimising the content of family doctor contracted services are important ways to improve the management rate of chronic diseases and enhance the quality of contracted services,while quantitative analysis of chronic disease patients’ preferences for family doctor contracted services is the primary prerequisite for optimising chronic disease contracted services.This study will use discrete choice experiments to scientifically measure and analyse the preferences of chronic disease patients for family doctor contracting services,in order to provide evidence to promote the precision of family doctor contracting services and optimise family doctor contracting services.ObjectiveThis study uses Zhengzhou City,Henan Province as the sample area to understand the current situation of family doctor contracting services in Zhengzhou City through on-site surveys,and uses discrete choice experiments to measure the degree of chronic disease patients’ preference for family doctor contracting services and analyse the content of contracting services that patients expect to receive,so as to provide reference and basis for optimising policies.The specific objectives are:(1)to set the attributes and levels of preference measurement for family doctor contracting services among chronic disease patients and to quantify the preference for family doctor contracting service provision;(2)to analyse the preference of chronic disease patients for family doctor contracting services,the heterogeneity of preference among groups with different demographic characteristics and their willingness to pay;(3)to make suggestions for the improvement of family doctor contracting service provision.MothodsThis study was conducted from June to September 2022 in three counties in Zhengzhou,Huizi District,Erqi District and Xinzheng City,and two communities were selected in each county,with 50 patients with chronic diseases in each community for a total of 300 people.This study adopts a discrete choice experiment method to quantitatively analyse the preferences of chronic disease patients for family doctor contracted services.Firstly,by combing the policy content and relevant literature on family doctor contracting services,the influencing factors of family doctor contracting services for patients with chronic diseases,the contents of existing service packages provided by family doctor contracting services and the needs of patients with chronic diseases for contracting services were systematically summarised,and the attributes and factors relevant to this study were initially screened to construct a database of core attributes.Secondly,the finalised attributes and levels were subjected to an orthogonal experimental design using SPSS 25.0 software to construct the selection set and generate the questionnaire.The questionnaire consisted of two parts,general demographic characteristics and discrete choice experiment questions,and the information remained consistent between the two versions of the questionnaire,except for the choice preference questions.Finally,the data were processed and analysed using STATA 14.0 software.The general demographic information was analysed descriptively and the discrete choice experiment data were regressed using a mixed logit model to analyse the heterogeneity of preferences of patients with different characteristics of chronic diseases and to measure the willingness to pay of patients with chronic diseases based on the regression results.Results1.Results of the discrete choice experimental design: After the initial screening to determine the attributes,the attribute variables and levels of chronic disease patients’ preference for family doctor contracted services were clarified through focus group discussions and expert consultations,and six attributes including long prescription time,frequency of regular follow-up visits,accessibility of drug supply,level of treatment by the family doctor team,convenience of referral services and cost of contracted services and the corresponding levels were finally determined.The finalised attributes and levels were subjected to an orthogonal experimental design using SPSS 25.0 software and combined to produce 18 choice sets,which were evenly distributed across two versions of the questionnaire,each containing 10 choice options.2.Analysis of the basic situation of the survey respondents: the majority of survey respondents were male(157),accounting for 56.9%;the age range was mainly distributed in the 60-79 years old(129),the total number of people aged 60 or above accounted for 54.3%,the majority of the elderly;the majority of the urban population(169),accounting for 61.2%.In terms of marital status,the majority were married,accounting for 72.5%;education level was mainly junior high school or below,accounting for 60.1%,followed by high school/junior high school/technical school(81 people),accounting for 29.3%;occupation was mainly self-employed/farmers,accounting for 45.7%,followed by enterprise workers(77 people),accounting for 27.9%;monthly income level was mostly between RMB 3001-5000,accounting for 42%,followed by RMB 3000.Only 5 of the survey respondents did not participate in any medical insurance,while the rest mainly participated in the basic medical insurance for urban and rural residents(152 people),accounting for 55.1%;3.Chronic diseases: In terms of chronic diseases,the number of diseases was mainly 1(143)and 2(100),accounting for 51.8% and 36.2% respectively.4.Results of the analysis of the preference of patients with chronic diseases: Patients with chronic diseases preferred long prescription time of 12 weeks(P<0.05),regular follow-up frequency of 4 times/year(P<0.05),higher accessibility of drug supply(P<0.01),higher level of treatment by the family doctor team(P<0.05),more convenient referral service(P<0.05),and contracted service cost of RMB50/year((P <0.01)for the service.5.Willingness to pay analysis: Patients with chronic diseases had the highest willingness to pay for access to drug supply and were willing to pay an additional RMB 138.321 for higher levels of drug access;the next highest willingness to pay was for the level of treatment by the family doctor team.The results of the willingness to pay for different characteristics of patients with chronic diseases show that patients over80 years old,female,junior high school or below and high school/junior high school/technical school,with a monthly income of RMB 3,001-5,000 and with one or two types of illnesses were the most willing to pay for access to medicines.6.Heterogeneity in preference for family doctor contracted services for patients with chronic diseases: patients aged 60-79 and over 80 years old prefer services with lower contracted service costs;women prefer services with lower contracted service costs,longer prescription times and more convenient referral services;patients in the junior high school and below and high school/junior high school/technical school subgroups prefer services with higher availability of medicines;patients with monthly income levels of RMB 5,001-10,000 and over RMB 10,001 prefer convenient referral services;patients with three or more chronic diseases value the frequency of regular follow-up visits and prefer high frequency of regular followup visits.Conclusions1.Heterogeneity exists in chronic disease patients’ preferences for family doctor contracting services,with different chronic disease patients with different demographic characteristics having different preferences for contracting needs and differing willingness to pay for different service attributes.2.Accessibility of drug supply is the most important attribute influencing chronic disease patients’ choice of contracted services.3.Long prescription time and the level of treatment by the family doctor team are important factors influencing chronic disease patients’ preference for contracting.The preference of chronic disease patients is influenced by the convenience of referral services only between the high and low levels,and does not value the convenience of referral services at the medium level.Suggestions1.Supply strategy: the government should clearly plan the strategic design,innovate the supply concept,clarify the demand for family doctor contracted services for patients with chronic diseases,and improve personalized contracted services.2.As for the supply system: a competition mechanism should be introduced to optimize the supply model.3.In terms of human and financial resources: the construction of family doctor teams should be strengthened and financial resources should be increased.The optimisation and improvement of the family doctor contracting service programme should start from the preference of the demand side,the policy content should be in line with the needs of the demand side,and demand-centred,while considering the supply capacity,in order to achieve the optimal model of contracting services. |
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