Study On The Relationship Between Family Doctors Signing And Medical Choice Behavior Of Residents:Moderating Effect Of Medical Insurance And Family Economic Status In Tai’an

BackgroundWith the rapid development of modern medical technology,people increasingly think high healthy demand is equal to high technology and high price high level service.They pursue medical services technology which isn’t consistent with their actual demand blindly,so the phenomenon of desperate treatment appeared.Relevant studies have shown that the family doctor can help patients increase relevant knowledge,change the bad medical habits,consciously choose more convenient and efficient primary medical institutions for treatment through health education and health promotion in the background of family doctor signing system.However,there is a lack of research on the potential mechanism between family doctor signing and residents’ medical choice behavior.ObjectiveThe aims of study are exploring the current situation of residents’ family doctor signing,medical choice behavior and its influencing factors,analyzing the moderating effect of basic medical insurance and family economic situation between family doctor signing and medical choice behavior,submitting relevant suggestions to provide reference basis for promoting family doctor contract service.MethodsThe data in this study were derived from National Natural Science Foundation of China:Optimizing design and strategy of family doctor contract service from the perspective of behavioral economics:an empirical study on urban-rural supply and demand(71974118).In this study,a multi stage random cluster sampling method was adopted to select 8,542 residents.We chose 8,343 residents aged 15 and above who selected primary or non-primary health care facilities when they had common diseases or frequently-occurring diseases.The study designed the questionnaire and conducted the survey face to face,including general sociodemographic characteristics,health status,health-related behaviors,social interactions and factors related to medical choices.EpiData3.1 was used to establish the database,and SPSS24.0 and Stata14.0 were used for descriptive analysis,chi-square test,binary Logistic regression and moderation analysis.P<0.05 means the difference is statistically significant.ResultsThis study found 96.32%of residents went to primary medical institutions when they had common diseases or frequently-occurring diseases and family doctor signing rate was 70.41%,among which,97.31%of contracted residents often go to primary medical institutions.Multivariate analysis results showed that residence,education level,medical insurance,suffers from different number of chronic diseases,self-reported health status and so on are factors that influence the residents’ medical institutions,the differences were statistically significant(P<0.05).After controlling for the above factors,residents who signed family doctors were more likely to choose primary health care institution(OR=2.10,95%CI:1.59～2.77,P<0.001).The moderating role of medical insurance showed that the participating the basic medical insurance system for urban and rural residents could guide the unsigned residents to go to primary medical institutions for common diseases(OR=0.48,95%CI:0.27～0.86,P<0.05).The moderating effect of family economic status showed that unsigned residents with high annual household income were more likely to go to non-primary medical institutions for common diseases(OR=2.06,95%CI:1.01～4.18,P<0.05)than those residents with low annual household income and signed the family doctors.Conclusion and suggestionsConclusionsThis study found that primary-level medical visiting rate of common diseases and frequently-occurring diseases has achieved the policy target level in Tai’an.Signing the family doctor can increase the rate of primary attendance.Basic medical insurance for urban and rural residents can make unsigned residents to primary medical institutions,residents who had better family economic condition and didn’t sign up the family doctor contract service tended to go to the non-primary medical institutions.Suggestions1.Vigorously promote contracted family doctor services,and guide residents to seek medical treatment in a reasonable and orderly manner.2.Improve medical insurance security to ensure urban and rural residents’ health equity.3.Strengthen guidance for high-income groups to seek medical treatment,and raise the rate of primary medical treatment for the whole population.