A Positive Analysis Of The Mechanism Of Community Doctor As Gatekeeper--A Case Study From Nanjing

1. ObjectiveThe study aims to examine the implementation progress of mechanism of community doctor as gatekeeper in Nanjing, evaluate the effects and investigate associated problems; to identify implementation feasibility and desired conditions;and finally to provide evidence-based information for policymakers.2. Data and Methods(1)Data:The resources are originally from secondary data and the data based on field study.(2)Field study:Based on the principle of typical sampling and cluster sampling,397 residents in the community were investigated.(3)Methods:Four main analysis methods have been implemented in the research, which are Literature Reviews, Positive Analysis, Statistic Analysis, and Qualitative Analysis. Statistic Analysis included x2 test and logistic regression.3. Results(1) The mechanism of community doctor as gatekeeper helped to increase the patients' visit to community health facilities, improve residents'access to basic medical services and contain the increasing outpatient cost.(2) The preferential policy for community health facilities in health insurance scheme, helped to change patients'behaviors on seeking healthcare. Unfortunately, as the mechanism is excluded from medical insurance for urban workers, the role cannot be brought into full play(3) The rates of awareness on the concept and the policy of the mechanism of GP are 72.80% and 42.57% respectively. The rate of willingness to accept the mechanism is 69.77%. According to the logistic model, the main influencing factors on the willingness are the residents' understanding of the policy and the capacity of community health facilities.(4) Some barriers existed during implementing the mechanism, such as low capacity of CHCs, the gap between the mechanism and the medical insurance schemes, imperfect incentive and constraint mechanism on related stakeholders, lack of clarity on responsibility of stakeholders and low pooling level for medical insurance.4.ConclusionsThe implementation feasibility of the mechanism has been justified, but some criteria need to be met, such as comprehensive community health system, preferential policy in health insurance scheme, improved capacity in health care provision, coordination and cooperation among stakeholders and perfect information system. There are some barriers to implementation, so, it is better to expand the mechanism step by step, rather than quickly and in large scale in a short time.5.SuggestionsRespective function and responsibilities of community between health facilities and hospitals must be further defined; capacity of community health facilities needs to be improved; the role of medical insurance sector need to be consolidated in improving the mechanism; inter-sectoral cooperation need to be reinforced, especially between health sector and health insurance sector; information system needs to be improved and integrated between community health facilities and higher-level hospitals.