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The willingness of patients to make the first visit to primary care institutions and its influencing factors in Beijing medical alliances: a comparative study of Beijing’s medical resource-rich and scarce regions

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      To improve the efficiency of the use of medical resources, China has implemented medical alliances (MAs) to implement a hierarchical diagnosis and treatment system. The willingness to undertake a first visit to primary care institutions (PCIs) is an important indicator of the effect of this system. Beijing has also built MAs since 2013, but to date, there have been few studies on the first visit to PCIs in Beijing. The purpose of this study is to analyze patients’ willingness to make their first visit to PCIs and its influencing factors to provide references for the realization of a hierarchical diagnosis and treatment system.


      Two relatively different districts with large differences in resources in Beijing, D and F, were selected, and a self-reported questionnaire and convenience sampling method were applied. A cross-sectional survey was administered to 1221 patients of MAs. The chi-square test and binary logistic regression were used to analyze the influencing factors of patients’ willingness to undertake a first visit to a PCI.


      Fewer patients in District D received medical alliance services (44.42%) than those in District F (59.25%), but patients in District D had a higher degree of satisfaction with the services they received (72.04%) than those in District F (28.96%). Patients in District D had a higher willingness to undertake a first visit (64.00%) than those in District F (58.18%). Patients of an older age, low medical expenses, participation in urban employees’ basic medical insurance, a high understanding of MAs and high satisfaction with medical services were indicators of being more willing to choose primary care institutions for their first visit.


      The different medical resources and MA constructions in the two districts have resulted in a difference between the two districts in terms of the willingness of individuals to make their first visit to PCIs. Strengthening the service capabilities of PCIs remains a priority. The government should propose solutions to solve the problems encountered in practice and actively promote the realization of MAs and hierarchical diagnosis and treatment.

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      The online version of this article (10.1186/s12913-019-4184-0) contains supplementary material, which is available to authorized users.

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      Most cited references 32

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      Can this patient read and understand written health information?

      Patients with limited literacy are at higher risk for poor health outcomes; however, physicians' perceptions are inaccurate for identifying these patients. To systematically review the accuracy of brief instruments for identifying patients with limited literacy. Search of the English-language literature from 1969 through February 2010 using PubMed, Psychinfo, and bibliographies of selected manuscripts for articles on health literacy, numeracy, reading ability, and reading skill. Prospective studies including adult patients 18 years or older that evaluated a brief instrument for identifying limited literacy in a health care setting compared with an accepted literacy reference standard. Studies were evaluated independently by 2 reviewers who each abstracted information and assigned an overall quality rating. Disagreements were adjudicated by a third reviewer. Ten studies using 6 different instruments met inclusion criteria. Among multi-item measures, the Newest Vital Sign (English) performed moderately well for identifying limited literacy based on 3 studies. Among the single-item questions, asking about a patient's use of a surrogate reader, confidence filling out medical forms, and self-rated reading ability performed moderately well in identifying patients with inadequate or marginal literacy. Asking a patient, "How confident are you in filling out medical forms by yourself?" is associated with a summary likelihood ratio (LR) for limited literacy of 5.0 (95% confidence interval [CI], 3.8-6.4) for an answer of "a little confident" or "not at all confident"; a summary LR of 2.2 (95% CI, 1.5-3.3) for "somewhat confident"; and a summary LR of 0.44 (95% CI, 0.24-0.82) for "quite a bit" or "extremely confident." Several single-item questions, including use of a surrogate reader and confidence with medical forms, were moderately effective for quickly identifying patients with limited literacy.
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        The aim of this study is to describe the magnitude of educational inequities in the use of health care services, by people aged 50+, in 12 European countries, controlling for country-level heterogeneity. We consider four services: having seen or talked to 1) a general practitioner (GP) or 2) specialist, 3) having been hospitalized, and 4) having visited a dentist (only for prevention). Data derived from the SHARE (Survey of Health, Ageing and Retirement in Europe) project, a cross-national panel that collects information from individuals aged 50 and over. A Fixed Effects approach is applied, which is a valuable alternative to the application of conventional multilevel models in country-comparative analysis. The main findings of this study confirm that there is substantial educational inequity in the use of health care, although relevant differences arise between services. A clear pro-educated gradient is found for specialists and dentist visits, whereas no evidence of educational disparities was found for GP use. On the other hand, less clear results emerge regarding hospitalizations. However, the analysis shows that micro-level dimensions, i.e. individual needs and predisposing and enabling population characteristics, and macro level factors, i.e. health care system and welfare regime, interact to determine people's use of health services. It can be concluded that people with more education level have more resources (cognitive, communicative, relational) that allow them to make more informed choices and take more effective actions for their health goals, however, the institutional context may modify this relationship.
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          Do patients choose community health services (CHS) for first treatment in China? Results from a community health survey in urban areas.

          In recent years, the government has paid more attention to the development of community health service (CHS) in urban areas in China. Therefore, determining if it plays important roles and establishing methods to evaluate the effects of CHS are critical emphases in research. This study measured the effects of CHS through the choices of patients and their evaluation of CHS, and aimed to contribute to the development of primary health services. Face-to-face interviews were performed using the questionnaire with a random sample of 865 patients in CHS institutions from five provinces in China. Pearson's Chi square tests and binary logistic regression were used to analyze influencing factors that are associated with the patients' choices and evaluations. A total of 62.2 % of the patients would choose CHS for their first treatment. Patient choice was mainly affected by the following: (1) social demographic factors of the patients, namely, age, educational level, medical insurance, and survey areas; (2) evaluation of CHS by the patients: convenience, reasonable charges, and attitude of the doctors. In addition, the patients showed more satisfaction with convenience, waiting time, and communication with doctors, and less satisfaction with the medical charges, drug costs, and medical equipment of CHS. Through the results, we suggest that the government should provide more regard to the convenience, reasonable charges, and the attitude of the doctors as important factors to attract the patients to CHS. The government should also exert efforts to reduce the medical charges (especially the drug costs) for CHS.

            Author and article information

            ISNI 0000 0004 0369 153X, GRID grid.24696.3f, Department of Social Medicine and Health Management, , School of Public Health, Capital Medical University, ; Beijing, 100069 China
            BMC Health Serv Res
            BMC Health Serv Res
            BMC Health Services Research
            BioMed Central (London )
            7 June 2019
            7 June 2019
            : 19
            31174523 6556011 4184 10.1186/s12913-019-4184-0
            © The Author(s). 2019

            Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

            Funded by: FundRef, Beijing Social Science Fund;
            Award ID: 17SRB005
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            Research Article
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            © The Author(s) 2019


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