title: Demand and Signing of General Practitioner Contract Service among the Urban Elderly: A Population-Based Analysis in Zhejiang Province, China.
abstract: This study aims to examine whether the urban elderly in the Zhejiang Province of China signed contracts with their general practitioner (GP) based on their health service needs, and to further identify the determinants of their demand and signing decisions. A community-based cross-sectional study was conducted in 16 community health service (CHS) institutions in Zhejiang Province, China. The urban elderly over 60 years of age were enrolled when visiting the sampled CHS. Baseline characteristics were compared between participants using Chi-Square tests for categorical variables. Univariate and multivariable logistic regression analyses were used to identify determinants of the GP contract service demand and signing decisions, respectively. Among the 1440 urban elderly, 56.67% had signed contracts with their GP, and 55.35% had a demand of the GP contract service. The influencing factors of demand were a history of diabetes or cardiovascular disease (OR = 1.33, 95% CI, 1.05-1.68); urban resident basic medical insurance (URBMI) vs. urban employee basic medical insurance (UEBMI) (OR = 1.96, 95% CI, 1.46-2.61); and middle-income vs. low-income (OR = 0.67, 95% CI, 0.50-0.90 for RMB 1001-3000; OR = 0.59, 95% CI, 0.39-0.90 for RMB 3001-5000). Having a demand for the GP contract service was the strongest determinant of signing decisions (OR = 13.20, 95% CI, 10.09-17.27). Other factors also contributed to these decisions, including gender, caregiver, and income. The urban elderly who had signed contracts with GPs were mainly based on their health care needs. Elderly people with a history of diabetes or cardiovascular disease, as well as those with URBMI, were found to have stronger needs of a GP contract service. It is believed that the high-income elderly should be given equal priority to those of low-income.
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou 310051, China. yrzhao@cdc.zj.cn.
authors.forename: Yanrong
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou 310051, China. jflin@cdc.zj.cn.
authors.forename: Junfen
authors.initials: J
authors.lastname: Lin
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou 310051, China. ywqiu@cdc.zj.cn.
authors.forename: Yinwei
authors.initials: Y
authors.lastname: Qiu
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou 310051, China. qyang@cdc.zj.cn.
authors.forename: Qing
authors.initials: Q
authors.lastname: Yang
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou 310051, China. xywang@cdc.zj.cn.
authors.forename: Xinyi
authors.initials: X
authors.lastname: Wang
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou 310051, China. xpshang@cdc.zj.cn.
authors.forename: Xiaopeng
authors.initials: X
authors.lastname: Shang
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou 310051, China. chinaxuxiaoping@163.com.
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Xu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002681:China; D003153:Community Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D058005:General Practitioners / Q000458:organization & administration / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006299:Health Services for the Aged / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis
keywords: Keywords: health service needs and demands; general practitioners; the elderly