Introducing family medicine in a pluralistic health care system: how patients and doctors see it.
BACKGROUND
The health care systems in many countries are focused on specialist care. In those countries that have recently changed to a primary care-based system, some doctors and patients were dissatisfied with the change.


OBJECTIVE
To explore the opinions of the general public and the doctors on the change to a family medicine (FM)-based health care system.


METHODS
Qualitative study with focus groups of doctors working in different practice settings. Quantitative study with questionnaires sent to all doctors registered in Hong Kong and a telephone survey targeting the general public aged ≥18.


RESULTS
Doctors in the focus groups generally supported a FM-based health care system. They were concerned that there were not enough family doctors for such a system and the patients' current free choice of any doctor for primary care would impede its success. Thousand six hundred and forty-seven adults took part in the telephone survey (response rate 67.6%) and 2310 doctors (22.8%) responded to the questionnaire. Nearly 95% of the general public respondents agreed to the FM system though only 66.3% of them had ever heard of the term family doctor. About 65% of the doctors supported this system but only 33% agreed that the system would work. The specialist-doctors were less supportive of mandatory referral than the non-specialists, while the public was equally divided on this issue.


CONCLUSIONS
The public accepts the FM-based system but needs education on the benefits of primary health care. Direct access to the specialist would be the greatest barrier. Government involvements are essential for the reform.
Wun
Y T
YT
Family Medicine Unit, The University of Hong Kong, Hong Kong, China.
Lam
Tai Pong
TP
Lam
K F
KF
Goldberg
D
D
Li
D K T
DK
Yip
K C
KC
D000328:Adult; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003695:Delivery of Health Care / Q000379:methods*; D005194:Family Practice / Q000379:methods*; D005260:Female; D017144:Focus Groups; D018166:Health Care Reform / Q000379:methods*; D006291:Health Policy / Q000639:trends; D006723:Hong Kong; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000379:methods*; D036301:Qualitative Research; D013038:Specialization / Q000639:trends; D055815:Young Adult