title: Patients' Willingness on Community Health Centers as Gatekeepers and Associated Factors in Shenzhen, China: A Cross-sectional Study.
abstract: 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.
authors.affiliation: From the Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei (YG, WL, SC, XD, LL, NM, YC, CH, XY, XS, TY, JL, ZL); Department of Management, School of Economics and Management, Jiangxi Science and Technology Normal University, Nanchang, Jiangxi (LL); and Center of Community Health Service Management, Fuyong People's Hospital, Shenzhen, Guangdong, China (JD).
authors.forename: Yong
authors.initials: Y
authors.lastname: Gan
authors.forename: Wenzhen
authors.initials: W
authors.lastname: Li
authors.forename: Shiyi
authors.initials: S
authors.lastname: Cao
authors.forename: Xiaoxin
authors.initials: X
authors.lastname: Dong
authors.forename: Liqing
authors.initials: L
authors.lastname: Li
authors.forename: Naomie
authors.initials: N
authors.lastname: Mkandawire
authors.forename: Yawen
authors.initials: Y
authors.lastname: Chen
authors.forename: Chulani
authors.initials: C
authors.lastname: Herath
authors.forename: Xingyue
authors.initials: X
authors.lastname: Song
authors.forename: Xiaoxv
authors.initials: X
authors.lastname: Yin
authors.forename: Tingting
authors.initials: T
authors.lastname: Yang
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.forename: Jian
authors.initials: J
authors.lastname: Deng
authors.forename: Zuxun
authors.initials: Z
authors.lastname: Lu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China; D003151:Community Health Centers; D003153:Community Health Services; D003430:Cross-Sectional Studies; D005260:Female; D020793:Gatekeeping / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult