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. 2021 Jan-Dec:58:469580211009667.
doi: 10.1177/00469580211009667.

The Path Analysis of Family Doctor's Gatekeeper Role in Shanghai, China: A Structural Equation Modeling (SEM) Approach

Jiaoling Huang  1 , Luan Wang  2 , Shanshan Liu  3 , Tao Zhang  4 , Chengjun Liu  5   6 , Yimin Zhang  3
Affiliations

The Path Analysis of Family Doctor's Gatekeeper Role in Shanghai, China: A Structural Equation Modeling (SEM) Approach

Jiaoling Huang et al. Inquiry. 2021 Jan-Dec.

Abstract

Studies globally have provided substantial evidence that PHC could conduct doctor-visiting behaviors, control medical expense, and improve population health. This study aimed to map how family doctor (FD) in Shanghai achieved gate-keeper goals including health management, medical expense control, and conducting ordered doctor-visiting behavior. A total of 2754 and 1995 valid questionnaires were collected in 2013 and 2016 respectively in Shanghai. The data were analyzed using structural equation modeling (SEM). Invariance analysis was also performed for 2 waves of data. We found that the coefficient of cognition on health management (β5 = 0.26, P < .05) was larger than that of signing with FD (β4 = 0.06, P < .05). SEM model also showed that first-contact at community health service center (CHSC) had a positive effect on health management (β6 = 0.30, P < .05), and the latter also affected health management results positively (β8 = 0.39, P < .05), suggesting that the path for FD was through first-contact and health management. Besides, the gate-keeper role of medical expense control was significant through the first-contact (β10 = -0.12, P < .05) mediation rather than health management (β9 = 0.03, P > .05). The model fit was acceptable (RMSEA = 0.033). A "cognition-behavior-outcomes (health and medical expense)" path of FD's gate-keeper role was found. It is necessary to consolidate FD contracted services rather than reimbursement discount the latter of which is proved to be unsustainable.

Keywords: family doctor; gate-keeper; health management; medical expense; primary care.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Theoretical model.
Figure 2.
Figure 2.
The SEM model of FD gate-keeper role path.
See this image and copyright information in PMC

References

    1. Liu Q, Wang B, Kong Y, Cheng KK. China’s primary health-care reform. Lancet. 2011;377:2064-2066. - PubMed
    1. Tang S, Tao J, Bekedam H. Controlling cost escalation of healthcare: making universal health coverage sustainable in China. BMC Health Serv Res. 2012;12:S8. - PMC - PubMed
    1. Huang J, Liu S, He R, et al. Factors associated with residents’ contract behavior with family doctors in community health service centers: a longitudinal survey from China. PLoS One. 2018;13:1-16. - PMC - PubMed
    1. Tan X, Zhang Y, Shao H. Healthy China 2030, a breakthrough for improving health. Glob Health Promot. 2018;26:96-99. - PubMed
    1. Rawaf S, Maeseneer DJ, Starfield B. From Alma-Ata to Almaty: a new start for primary health care. Lancet. 2008;372:1365-1367. - PubMed

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