Li Wenzhen, Wang Dongming, Gan Yong, Zhou Yanfeng, Chen Yawen, Li Jing, Kkandawire Naomiem, Hu Sai, Qiao Yan, Lu Zuxun
Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, People's Republic of China.
Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
BMC Health Serv Res. 2018 Apr 4;18(1):241. doi: 10.1186/s12913-018-3010-4.
Gatekeeper policy, requiring a patient to visit a primary care provider first, and the patient needs to get his or her primary care provider's referral before seeing a specialist or going to a hospital, has been implemented in China for about ten years, and it is necessary to assess the patients' acceptance of gatekeeper policy and to explore the factors influencing patients' acceptance.
A cross-sectional study with 1162 respondents was conducted between July and September 2015 at four community health centers (CHCs) in Wuhan, China. Face-to-face interview was used to collect information on demographics, acceptance of the gate keeper policy and satisfaction with community health services. Patients' satisfaction with community health service was evaluated using the European Patients Evaluate General/Family Practice scale and binary logistic regression model was used to examine the factors influencing patients' acceptance of community health services as gate keepers.
A total of 512 (43.06%) patients accepted gatekeeper policy. Mandatory reimbursement provision (OR: 1.63, 95% CI: 1.23-2.15), patient satisfaction with the aspects of medical care (OR: 1.92, 95% CI: 1.12-3.29) and organization of care (OR: 1.66, 95% CI: 1.05-2.62) were associated with acceptance of gatekeeper policy, after adjusting for potential confounders. Moreover, young people (OR: 0.35, 95%CI: 0.22-0.56) seemed to be more reluctant to accept the policy, when compared with the elder.
Our study suggests that mandatory reimbursement provision greatly affects patients' acceptance of gatekeeper policy, therefore, the policy-maker should pay attention to the negative effect of its mandatory reimbursement provision on patients' acceptance of the policy. However, improving the aspects of medical care and organization of care will contribute to implementation of gatekeeper policy.
守门人政策要求患者先就诊于基层医疗服务提供者，且患者在看专科医生或前往医院之前需要获得其基层医疗服务提供者的转诊，该政策在中国已实施约十年，有必要评估患者对守门人政策的接受程度，并探索影响患者接受程度的因素。
2015年7月至9月间，在中国武汉的四个社区卫生中心对1162名受访者进行了一项横断面研究。采用面对面访谈收集人口统计学信息、对守门人政策的接受程度以及对社区卫生服务的满意度。使用欧洲患者评估综合/家庭医疗量表评估患者对社区卫生服务的满意度，并使用二元逻辑回归模型检验影响患者接受社区卫生服务作为守门人的因素。
共有512名（43.06%）患者接受守门人政策。在调整潜在混杂因素后，强制报销规定（比值比：1.63，95%置信区间：1.23 - 2.15）、患者对医疗护理方面的满意度（比值比：1.92，95%置信区间：1.12 - 3.29）以及护理组织方面的满意度（比值比：1.66，95%置信区间：1.05 - 2.62）与接受守门人政策相关。此外，与老年人相比，年轻人（比值比：0.35，95%置信区间：0.22 - 0.56）似乎更不愿意接受该政策。
我们的研究表明，强制报销规定极大地影响了患者对守门人政策的接受程度，因此，政策制定者应关注其强制报销规定对患者接受政策的负面影响。然而，改善医疗护理和护理组织方面将有助于守门人政策的实施。
