Patients' Willingness on Community Health Centers as Gatekeepers and Associated Factors in Shenzhen, China: A Cross-sectional Study.

The gate-keeping function of primary healthcare facilities has not been fully implemented in China. This study was aiming at assessing the willingness on community health centers (CHCs) as gatekeepers among a sample of patients and investigating the influencing factors. A cross-sectional survey was conducted in 2013. A total of 7761 patients aged 18 to 90 years from 8 CHCs in Shenzhen (China) were interviewed using a structured questionnaire. Descriptive and multivariable logistic regression analyses were used to analyze the characteristics of patients, their willingness on the gatekeeper policy, and identify the associated factors. On willingness of patients to select CHCs as gatekeepers, 70.03% of respondents were willing, 18.95% were neutral, and 9.02% were unwilling. Multivariable analysis indicated that female patients (odds ratio [OR] = 1.15, 95% confidence interval [CI]: 1.02–1.30); patients with health insurance (OR = 1.21, 95% CI: 1.07–1.36); patients who lives near CHC (OR = 1.89, 95% CI: 1.17–3.05); and patients who were more familiar with the gatekeeper policy (OR = 2.09, 95% CI: 1.85–2.36), had higher level of willingness on the policy. Conversely, reporting with good health status was independently associated with the decreased willingness on gatekeeper policy (OR = 0.69, 95% CI: 0.53–0.90). The findings indicated that patients’ willingness on CHCs as gatekeepers is high. More priority measures, such as expanding medical insurance coverage of patients, strengthening the propaganda of gatekeeper policy, and increasing the access to community health service, are warranted to be taken. This will help to further improve the patients’ willingness on CHCs as gatekeepers. It is thus feasible to implement the gatekeeper policy among patients in China.

中国基层医疗卫生机构的守门人功能尚未完全落实。本研究旨在评估一部分患者对社区卫生中心（CHC）作为守门人的意愿，并调查相关影响因素。 2013年进行了一项横断面调查。使用结构化问卷对来自中国深圳8个社区卫生中心的7761名18 - 90岁的患者进行了访谈。采用描述性分析和多变量逻辑回归分析来分析患者的特征、他们对守门人政策的意愿，并确定相关因素。 在患者选择社区卫生中心作为守门人的意愿方面，70.03%的受访者愿意，18.95%持中立态度，9.02%不愿意。多变量分析表明，女性患者（优势比[OR]=1.15，95%置信区间[CI]：1.02 - 1.30）；有医疗保险的患者（OR = 1.21，95% CI：1.07 - 1.36）；居住在社区卫生中心附近的患者（OR = 1.89，95% CI：1.17 - 3.05）；以及对守门人政策更熟悉的患者（OR = 2.09，95% CI：1.85 - 2.36），对该政策的意愿更高。相反，自报健康状况良好与对守门人政策的意愿降低独立相关（OR = 0.69，95% CI：0.53 - 0.90）。 研究结果表明，患者对社区卫生中心作为守门人的意愿较高。有必要采取更多优先措施，例如扩大患者的医疗保险覆盖范围、加强守门人政策的宣传以及增加获得社区卫生服务的途径。这将有助于进一步提高患者对社区卫生中心作为守门人的意愿。因此，在中国患者中实施守门人政策是可行的。