Background: Family doctor contract service is an important instrument to carry out the hierarchical medical system in China. As the capital of China, Beijing's family doctor contract services are leading the country. This study aims to research the status of family doctor contract services in the suburbs of Beijing, the contract awareness, the degree of trust and the emerging ethical problems between doctors and patients, so as to evaluate the influences of the contract awareness and trust degree of the contract parties on the subjects’ renewal intention. We expect to explore the feasible ways to solve the obstacle to building doctor-patient mutual trust in family doctor contract services in the suburbs of Beijing.
Methods: First, the members of the research team analyzed the statistical data on the services contracted by family doctors. Then, we applied the multi-stage stratified random sampling method to chose a sample of 202 medical staff in the family doctor teams and 197 residents from 4 suburb areas in Beijing. A semi-structured individual in-depth interview method was used to conduct face-to-face interview with 36 medical staff in the family doctor teams.
Results: The number of teams and personnel contracted by family doctors has increased year by year, and the resident contracting rate has slowly increased since then a decline in 2015. In 2018, the contracting rate of residents dropped. In that year, the average contracting rate for family doctor services in Beijing was 33.86%. The self-evaluation of the contracted residents on the family-doctor signing service system shows that only 68 (34.5%) contracted residents know a lot about it, while 11 (5.6%) signed residents said they did not understand the system at all. Thirty-two percent of the medical staff surveryed by the questionnaire said the attributes of the relationships between the two parties was a trust relationship, but 50.5% of the medical staff and 68.0% of the contacted residents still said that the nature of both parties just was a relationship of diagnosis and treatment. In addition, only 16.3% of the contracted residents are active in performing the contract, and 2% of the signed are very active. From the perspective of medical staff in family doctor teams, the contracting residents' trust in family doctors’ contracting services and medical staff is underestimated. Moreover, for maintaining a long-term and stable contracting service relationship, the willingness of the residents is significantly higher than that of family doctors in providing such services.
Conclusions: This study evaluates the status of contract awareness, the mutual trust between doctors and patients, and the willingness to renew the contracts. It also points out that the family doctor contracting service system hinders the construction of doctor-patient mutual trust. The governments and relevant medical institutions should respect the choices of the residents to enter such contracts at their proper times and places. Meanwhile, they should reasonably define and standardize the content of family doctor contracting service programs to improve the sense of gain of both parties. Futhermore, relevant organizations should take practicable measures to address the lack of staff in the family doctor teams, reduce the nonmedical workload of medical staff, and ensure the implementation of the services contracted family doctors, and draft effective incentives to improve the initiatives of both parties.