Family Physician Contract Services and Impacts in China Based on Physician Agency Theory
NCT ID: NCT04073732
Last Updated: 2020-09-16
Study Results
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Basic Information
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COMPLETED
682 participants
OBSERVATIONAL
2019-09-15
2019-11-28
Brief Summary
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Physician agency theory has been used to study physician behaviors in economics and management. Family physician contract services regulate the principle-agent relationship between patients and physicians using a formal contract, and there are lots of potentials to employ the physician agency theory to study family physician contract services in China. In theoretical aspects, the present project will study the analysis frameworks and methods of family physician contract services in China under the capitation and global budget payment mechanisms after systematically reviewing Chinese and English literatures about the physician agency theory. In empirical aspects, the present project will collect data from family physician contract services and examine the effects of specific contract forms, incentives, and fees on family physician behaviors and their impacts on health status and medical expenditures of hypertensive and diabetic patients.
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Detailed Description
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2. From the empirical point of view, from the demand side, analyze the needs of the family physician contract service, the status quo, and the behavior of the visit; from the supplier, understand the behavior changes and satisfaction of the family physician (team) after the implementation of the family physician contract service Degree situation
3. From an empirical perspective, from the level of primary medical institutions, use the sample area data to analyze the impact of family physicians' signing services on the number of visits and medical expenses;
4. From an empirical perspective, using the constructed theoretical analysis framework to analyze the implementation of the Chinese family physician contract service, including incentive mechanism (income, incentive performance salary and contract service fee), family physician team composition, family bed service, etc. The impact, especially on the quality and quantity of services.
5. From the empirical point of view, taking the key monitoring population (hypertension patients as an example) as a sample, further study the family physicians' contractual services, the changes in the practice behavior of family physicians to the key monitoring population (hypertension, diabetes patients), health outcomes, medical expenses The effect is to propose policy recommendations for family physicians' contracting services and physicians' behavior in the new medical reform in the future.
Conditions
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Study Design
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ECOLOGIC_OR_COMMUNITY
CROSS_SECTIONAL
Study Groups
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family physician team
Family physician team in four regions (Beijing, Shanghai, Hangzhou and Xia'men), including general practitioners, nurses and public health personnel.
No interventions assigned to this group
Eligibility Criteria
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Inclusion Criteria
1. a family doctor (general practitioner), has a formal medical license, does not retire;
2. must be directly facing the patient, participate in the patient's diagnosis, prescription, treatment and return visits, with the outpatient service as the main treatment;
3. family doctors average weekly Must receive at least 20 patients and receive an average of no less than 2 days per week;
4. Signing informed consent.
* Residents 1) Can complete the questionnaire independently； 2）Oral participation.
Exclusion Criteria
ALL
Yes
Sponsors
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National Natural Science Foundation of China
OTHER_GOV
Peking University
OTHER
Responsible Party
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Hai Fang
Principal Investigator,Professor
Locations
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Shanghai Chiangning District health commission
Shanghai, Shanghai Municipality, China
Countries
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References
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Frolich A, Talavera JA, Broadhead P, Dudley RA. A behavioral model of clinician responses to incentives to improve quality. Health Policy. 2007 Jan;80(1):179-93. doi: 10.1016/j.healthpol.2006.03.001. Epub 2006 Apr 19.
Arrow KJ. Uncertainty and the welfare economics of medical care. 1963. Bull World Health Organ. 2004 Feb;82(2):141-9. Epub 2004 Mar 16. No abstract available.
Fang H, Liu H, Rizzo JA. Has the use of physician gatekeepers declined among HMOs? Evidence from the United States. Int J Health Care Finance Econ. 2009 Jun;9(2):183-95. doi: 10.1007/s10754-009-9060-8. Epub 2009 Apr 9.
Fang H, Rizzo JA. Managed care and physicians' perceptions of drug formulary use. Am J Manag Care. 2009 Jun;15(6):395-400.
Wilson DM, Taylor DW, Gilbert JR, Best JA, Lindsay EA, Willms DG, Singer J. A randomized trial of a family physician intervention for smoking cessation. JAMA. 1988 Sep 16;260(11):1570-4.
Avery DM Jr, Hooper DE, McDonald JT Jr, Love MW, Tucker MT, Parton JM. The economic impact of rural family physicians practicing obstetrics. J Am Board Fam Med. 2014 Sep-Oct;27(5):602-10. doi: 10.3122/jabfm.2014.05.140052.
Yip WC, Hsiao W, Meng Q, Chen W, Sun X. Realignment of incentives for health-care providers in China. Lancet. 2010 Mar 27;375(9720):1120-30. doi: 10.1016/S0140-6736(10)60063-3.
Conrad DA. The Theory of Value-Based Payment Incentives and Their Application to Health Care. Health Serv Res. 2015 Dec;50 Suppl 2(Suppl 2):2057-89. doi: 10.1111/1475-6773.12408. Epub 2015 Nov 9.
Related Links
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Related Info
Other Identifiers
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71774006
Identifier Type: -
Identifier Source: org_study_id
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