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

Inquiry: a journal of medical care organization, provision and financing

article

Jiaoling Huang¹  Luan Wang²  Shanshan Liu³  Tao Zhang⁴  Chengjun Liu⁵  Yimin Zhang³ 

[1] Shanghai Jiao Tong University School of Medicine;Shanghai Sixth People’s Hospital East Affiliated to Shanghai University of Medicine & Health Sciences;Pudong Institute for Health Development;Jinyang Community Health Service Center of Pudong New Area;Fudan University;Eye and Dental Diseases Prevention & Treatment of Pudong New Area

关键词: primary care;    family doctor;    gate-keeper;    health management;    medical expense;   

DOI  :  10.1177/00469580211009667

来源: Sage Journals

【 摘 要 】

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 (β 5  = 0.26, 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.

【 授权许可】

Unknown