Research On The Potential And Intention Of Private Clinics To Provide Family Doctor Services

Objective This study was based on sample surveys in Shandong,Hunan and Yunnan provinces,to describe the current status of individual clinic and the professional quality level of self-employed doctors in the sample area,summarize the characteristics of individual clinics and self-employed doctors,find the advantages and shortcomings of individual clinics providing family doctor services,combine the willingness of self-employed doctors to transform family doctors,put forward feasible suggestions,provide scientific basis for building a diverse family doctor service delivery system.Methods Literature research was done to summarize the service area and functions of individual clinics in the UK,the United States,Germany and other countries,and provide reference for the functional positioning of individual clinics in China.Random sampling was adopted to select two districts and two counties from each of the three provinces of Shandong,Hunan and Yunnan,and carry out a questionnaire survey of 951 self-employed doctors.According to the sample survey data,descriptive statistical methods are used to describe the basic situation of urban and rural individual clinics and self-employed doctors,summarize the general characteristics of individual clinics and self-employed doctors,and explore the potential of providing family doctors services.Establish a structural equation model for the decision-making process of self-employed doctors,analyze the willingness and influencing factors of providing family doctor services,and find the decision-making influence path of relevant factors.Result1.Basic operation of individual clinics:The average operating time of the clinics was 10.18 years,with an average of 1.96 licensed physicians,1.39 registered nurses,and 19.11 patients per day,the medical subjects were mainly internal medicine and traditional Chinese medicine,78.65%of clinics cannot use Medicare,and 70.97%of the clinics have a monthly operating income of less than 20,000yuan.Individual clinics in urban and rural areas have differences in medical insurance qualification,number of licensed doctors(P<0.05),while the difference between daily clinic visits and monthly income is not significant.2.Basic information of self-employed doctors:The average age of self-employed doctors was 56 years old,the medical education level was mainly junior college(45.01%),the professional and technical qualifications were mainly practicing/assistant physician(44.69%)and attending physician(40.69%),the scope of practice was mainly internal medicine(59.1%)and traditional Chinese medicine(27.13%),and the average medical career was 30.67 years.In different age groups,there were differences in the educational level and professional title structure of self-employed doctors(P<0.001),while there were no significant differences in the educational level of self-employed doctors between urban and rural areas,and the differences in the professional title structure and years of medical service between urban and rural areas were significant(P<0.001).3.Willingness of self-employed doctors to provide family doctor services and influencing factors:The mean score of intention of self-employed doctors to provide family doctor services in the surveyed area was 3.48±0.92,which was slightly higher than the average.Behavioral attitude,subjective norms and perceived behavioral control have a direct impact on the intention of the family doctor in transition(P<0.001),and behavioral attitude has the largest impact on behavioral intention(b=0.65),followed by subjective norms(b=0.24)and perceived behavioral control(b=0.12),which can explain 65%of variance variation of behavioral intention(R~2=0.65).Conclusion:Individual clinic operation stability,have a certain quantity of health human resources,services still have improve space,and the educational background and professional title of self-employed doctors have reached the average level of licensed doctors in public primary medical service institutions.In addition,the characteristics of self-employed meet the requirements of the family doctor service,so we hold the view that individual clinic have the potential to provide family doctors services.However,the participation willingness of self-employed doctors is at a medium level.If self-employed doctors are to be mobilized to provide family doctor services in the future,their attitudes and subjective norms towards family doctors are the focus of intervention.