ArticleBMJ global health2024
Impact of family doctor system on diabetic patients with distinct service utilisation patterns: a difference-in-differences analysis based on group-based trajectory modelling.
Article in BMJ global health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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3 citing papers in PubMed.
- Sex differences in LMR ratio and coronary artery stenosis severity among patients with coronary artery disease.Frontiers in cardiovascular medicine · 2026Article
- Association between family doctor contract services and management status among patients with hypertension or diabetes in a multi-ethnic Province of China.BMC primary care · 2025Article
- Identification and trajectory of multimorbidity patterns among older people in China: a longitudinal study based on the China health and retirement longitudinal study 2011-2020 data.Frontiers in public health · 2025Article
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Abstract
introductionThis study examines the impact of China's family doctor system (FDS) on healthcare utilisation and costs among diabetic patients with distinct long-term service utilisation patterns.
methodsConducted in City A, eastern China, this retrospective cohort study used data from the Health Information System and Health Insurance Claim Databases, covering diabetic patients from 1 January 2014 to 31 December 2019.Patients were categorised into service utilisation trajectories based on quarterly outpatient visits to community health centres (CHCs) and secondary/tertiary hospitals from 2014 to 2017 using group-based trajectory models. Propensity score matching within each trajectory group matched FDS-enrolled patients (intervention) with non-enrolled patients (control). Difference-in-differences analysis compared outcomes between groups, with a SUEST test for cross-model comparison. Outcomes included outpatient visits indicator, costs indicator and out-of-pocket (OOP) expenses.
resultsAmong 17 232 diabetic patients (55.21% female, mean age 62.85 years), 13 094 were enrolled in the FDS (intervention group) and 4138 were not (control group). Patients were classified into four trajectory groups based on service utilisation from 2014 to 2017: (1) low overall outpatient utilisation, (2) high CHC visits, (3) high secondary/tertiary hospital visits and (4) high overall outpatient utilisation. After enrolled in FDS From 2018 to 2019, the group with high secondary/tertiary hospital visits saw a 6.265 increase in CHC visits (225.4% cost increase) and a 3.345 decrease in hospital visits (55.5% cost reduction). The high overall utilisation group experienced a 4.642 increase in CHC visits (109.5% cost increase) and a 1.493 decrease in hospital visits. OOP expenses were significantly reduced across all groups.
conclusionThe FDS in China significantly increases primary care utilisation and cost, while reducing hospital visits and costs among diabetic patients, particularly among patients with historically high hospital usage. Policymakers should focus on enhancing the FDS to further encourage primary care usage and improve chronic disease management.
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