| [Purpose]To understand the current situation of the provision of medical services for primary General practitioners in China and the factors that affect their service delivery.To promote the supply of primary General practitioners and improve their service delivery behavior through policy guidance and General practitioners training.[Methods]Based on the Discrete Choice Experiment(DCE)method,the measurement attributes of the basic General practitioner service provision preference were determined through literature research,expert consultation,and personal in-depth interviews.Using SPSS orthogonal experiment to select representative sets of attribute variables and their horizontal combinations and add demographic variables to form a questionnaire.In order to alleviate the burden on General practitioners,the selection set was further randomly assigned to two different versions of the questionnaire.Using stratified random sampling method,two cities(regions)were randomly selected in the eastern,central and western regions.A total of 6community health service centers were selected in each city,and all the qualified General practitioners were given questionnaires.A total of 455 questionnaires were distributed,and411 were actually recovered.The effective rate was 90.3%.Mixed logistic regression analysis was used to analyze the service provision preference and the price(WTP)that is willing to pay for a certain attribute variable or level change,and to analyze the interaction between attribute variables and demographic variables and to analyze the sensitivity between subgroups.[Results](1)The number of General practitioners in all regions is higher than that of men.Most of them are young and middle-aged.The proportion of marital status is more than85%.The degree of education is more than 50% of the undergraduate degree,and theproportion of graduate students and above is relatively small.The professional titles are more than 50% of the intermediate level.The proportion of prescription rights for Western medicine is about 90%,and the proportion of prescription rights for Chinese medicine is46.44%,25.32%,and 42.70% respectively.The administrative task is very high.The proportion of heavy and heavy is about 80%.The average monthly salary is 4000-6000 yuan,which is 86.61%,83.20%,and 67.42% respectively.(2)Mixed logistic regression showed that the five attribute variables were statistically significant in the model(P<0.05).Among the types of services,General practitioners prefer to provide integrated Chinese and Western medicine services(?=0.502,OR=1.652),and the preference for Western medicine services is also greater than that of Chinese medicine services(?=0.233,OR=1.262).Preference for services that provide better predictive outcomes(?=0.995,OR=2.706).In terms of patient engagement,preference is given to providing more patient-participating services(?=0.366,OR=1.441).Preferring to provide inclusion Medicare services(?=0.372,OR=1.451).Preference for providing higher monthly income(?=0.0001,OR=1.000).(3)The WTP results show that the General practitioners would rather lose 3431 yuan in monthly income in order to provide better services with expected results.In order to change from providing Chinese medicine services to providing integrated Chinese or Western medicine services or Western medical services,they would rather lose 1731 yuan and 803 yuan respectively.They would rather lose a monthly income of 1283 yuan to provide a service method that is included in medical insurance.In order to provide more patient-participating services,it would rather lose 1262 yuan in monthly income.(4)The interaction shows that General practitioners with TCM prescription rights prefer to provide Chinese medicine services(OR=2.262),prefer to provide services with good expected results(OR=1.280).The choice of scientific research workload is expected to be good.Less likely to be serviced(OR=0.628).No Western medicine prescription rights are less likely to be included in the choice of health care services(OR=0.674).(5)Sensitivity analysis of regions and genders as subgroups showed that the trend ofpreferences was consistent with the overall.[Conclusions](1)GPs prefer to integrate Chinese and Western medicine services or Western medicine services when providing services,and they are less motivated to provide services for Chinese medicine.When providing services,they pay more attention to the expected therapeutic effect of treatment methods on patients,and will consider patient participation,whether it can be included in medical insurance reimbursement.And secondly,monthly income is also the main factor affecting the service provision.(2)When selecting a service delivery method,the general practitioner has the highest willingness to pay for the expected effect,followed by the type of service,whether it is included in medical insurance,and patient participation.At the same time,the weight of prescription rights and the amount of scientific research workload will affect the GP's service delivery and willingness to pay.(3)The state needs to increase investment,improve policies and regulations,optimize the allocation of general services based on patient needs,and inject large-scale Chinese and Western medicine practitioners at the grassroots level,especially in underdeveloped areas in the central and western regions.Grassroots medical institutions should reform their personnel allocation system and mechanism.Rational distribution of general practitioners' medical and administrative work to meet the growing medical service needs of grassroots community residents.(4)Efforts should be made to train general practitioners of traditional Chinese medicine and improve the treatment or welfare level of general practitioners of traditional Chinese medicine.It is also necessary to include Chinese medicine services or Chinese medicines in the scope of medical insurance reimbursement to improve the enthusiasm of general practitioners to provide Chinese medicine services.It is combined with Western medicine,and the two complement each other to give full play to their respective advantages.At the same time,they use modern science and technology to continuouslyexplore new ways to improve the service methods and dosage forms of Chinese medicine,and improve the effectiveness of Chinese medicine.(5)A major limitation of this study is that the preferences measurement model is based on the assumption that the fully rational individual realizes the utility maximization,and implies that the individual obtains all the information needed for the decision when making the decision.However,in reality,it is obviously not Completely reasonable,is a study based on ideal conditions. |
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