Effect of family physician contract service on patients’ perceived quality of primary child healthcare in urban China: Analysis using propensity score matching

Abstract

Objectives

The family physician contract service (FPCS) policy has been implemented for several years within primary healthcare (PHC) institutions in China. However, the specific impact of the FPCS on patients’ perceived quality of primary child healthcare remains unclear. Therefore, this study investigates the effect of the FPCS on the perceived quality of primary child healthcare in urban China.

Study design

A cross-sectional survey was conducted across twelve community health centers (CHCs) in four provinces of urban China in April 2022.

Methods

A multistage stratified convenience sampling method was employed to recruit parents of children under the age of 16 who had visited CHCs at least once to participate in the study. A validated Mandarin Chinese version of the Primary Care Assessment Tool (PCAT) was utilized to gather information from parents regarding their experiences with primary child healthcare services. To address selection and confounding bias, propensity score matching (PSM) was applied to estimate the average treatment effect on the treated (ATT), followed by a weighted one-way analysis of variance to compare each primary care attribute score reported by the two groups.

Results

A total of 7429 respondents were surveyed, with 1976 (26.6 %) in the contracted group and 5453 (73.4 %) in the control group. Following PSM, 3942 participants (1971 in each group) were analyzed, revealing significant pre-matching disparities in demographic and health characteristics, which were balanced post-matching. The analysis indicated that the average total PCAT score notably increased by 6.44 points for those with a contract with a family physician team, with a reduction of 6.25 points would occur if contracted participants discontinued their contract. Each domain score of primary care attributes was significantly higher in the contracted group compared to the control group, both before and after PSM, with notable differences in first-contact utilization, accessibility, continuity of care, coordination of services, and community orientation.

Conclusions

This study underscores the importance of family physician contract services in enhancing the quality of primary child healthcare and emphasizes the need for policy interventions to broaden access and equity in health service provision.