Residents’ willingness to maintain contracts with family doctors: a cross-sectional study in China

Background: Most previous studies of the family doctor contract services (FDCS) evaluated its quality by using residents’ signing rates, awareness, and satisfaction. We hypothesize that renewal willingness could be another important indicator to examine the quality of FDCS.

Objective: To measure residents’ willingness to maintain contracts with family doctors and examine the influencing factors.

Design: Cross-sectional study. Participants: 11,250 residents in 31 provincial administrative regions across China.

Main Methods: A multistage stratified random sampling method was used to recruit participants. Univariate analysis, mixed-effect regression model analysis, and stepwise multivariate logistic regression analysis were performed to determine the influencing factors of residents’ willingness to maintain contracts with family doctors.

Key Results: About 71.3% participants who contracted with and received healthcare services from family doctors were willing to maintain contracts with family doctors in China. Residents registering as local households (OR = 1.192, 95% CI = 1.039–1.368), enrolled in medical insurance (OR = 1.299, 95% CI = 1.011–1.668), reporting better health (OR = 1.246, 95% CI = 1.100–1.413), with shorter walking time to the nearest healthcare center (compared with > 30 min walking time, < 15 min: OR = 1.209, 95% CI = 1.003–1.458; 15–30 min: OR = 1.288, 95% CI = 1.124–1.475), and trusting in (OR = 4.403, 95% CI = 3.849–5.036) and satisfied with (OR = 18.514, 95% CI = 16.195–21.165) their family doctors had significantly higher willingness to maintain contracts with family doctors.

Conclusions: Residents’ willingness to maintain contracts with family doctors could be another evaluation indicator of the quality of FDCS in China. Improving the accessibility and quality of healthcare services from family doctors may increase residents’ willingness to keep contracts with family doctors and promote the implementation of FDCS.