Compared the factors affecting CFDS from the perspective of patients and medical staff, we found that the factors of national policy and community health service agency are two important common factors affecting CFDS.
The results showed that the national government factor is the main trigger that affects CFDS. The government, as the dominant force in the establishment and operation of contracted services, is obligated to ensure the smooth progress of CFDS, to guarantee the fairness and accessibility of services, and to be the conductor of the contracted services policy.
The government has developed universal health insurance coverage, basic public health service plans, and the national essential drug system, all of which have improved access to and affordability of primary health care . From the perspective of the national government, it is very important to increase financial support for primary health facilities and special funds. At the same time, the government should play its part in macroeconomic regulation and control and combine related departments such as finance and social security to increase support for the inclination to support of the community medical institutions, and guide the insured personnel to give priority to primary clinics. In addition, public health services such as health management and health education conducted by family doctors should be included in the scope of medical insurance. CFDS should be linked with medical insurance, giving play to family doctors’ gatekeeper role in terms of medical insurance control fees and health management.
The results showed that the community health service institutions factor ranks second. The community health service agency is the executor of the contracted services policy. The extent of its power of execution directly determines the direction of CFDS, and the completeness of the hardware and software facilities of a community health service organization is the basis of its power of execution. Therefore, the degree of development of its informatization, medical facilities and equipment within the institution, and performance assessment and incentive mechanisms are all necessary conditions for the promotion of contracted services. At the same time, the supporting hardware facilities of the community health service institutions, including equipment and drugs, are insufficient, which impedes the development of CFDS. However, family doctor team members, as important stakeholders of the medical alliance, can mobilize their enthusiasm and achieve the sustainable development of contracted services only if they are allowed to obtain reasonable benefits from contracted service operations . Therefore, some suggestions are put forward from the perspective of community health institutions. First, community health institutions should speed up the development of a unified information platform to achieve dynamic management of contracted patients /consumers’ information and analysis of the dynamics of consumers through real-time data monitoring. At the same time, community health agencies should increase investment in hardware facilities, thereby making medical services more accessible to patients/consumers, changing their views on primary medical care and increasing satisfaction with primary health services . The most important point is that salary not only helps employees fulfill basic survival needs but is also a way of recognizing and respecting employee performance and contributions . Therefore, community health agencies should establish a sound supporting performance appraisal system and incentive mechanism, so as to increase employees’ enthusiasm toward their work, helping them better serve patients/consumers.
Consumers-related factors have a great impact on contracted services. As important stakeholders involved in the reform of China’s health care and CFDS, patients/consumers are mainly concerned with medical technology, medical expenses, emotional support, and respect. With the development of the medical system and the improvement of the economic level, patients/consumers’ demands for overall medical services have been increasingly met, and service quality is a key factor in attracting patients/consumers. Therefore, the service quality of community health service centers and the level of medical technology should be improved. This will increase patients/consumers’ sense of identity and belonging, and improve their satisfaction. Therefore, community health organizations should strengthen the talent team construction of family doctors in all aspects, conduct regular training for family doctor teams, and attract graduates of general medicine or specialists in second and third-level hospitals who have undergone standardized training. At the time of diagnosis, the team of family doctors should pay attention to service attitude, reduce the distance between themselves and patients, and provide humanistic care.
Factors related to contracted doctors are also influencing factors of CFDS. Family doctors and team members are the flag-bearers of CFDS, and their service capabilities, willingness, and attitudes all influence its smooth development. According to the “Guiding Opinions of the State Council on Establishing the General Practitioner System,” training qualified family doctors by vigorously carrying out transfer training for community doctors and raising the academic qualification level of community doctorscan also reduce the workload of existing family doctors and teams, thus providing more effective help for each resident.
This study has two limitations. First, the sample size of the study is small; a typical survey needs to select a sample representative of a typical unit, so there is a higher requirements for judgement ability of the researchers, otherwise it may cause investigation conclusion has the certain bias tendency, and the results of typical survey in general is not easy to calculate the overall situation.