ORIGINAL RESEARCH article
Front. Health Serv.
Sec. Health Policy and Management
Volume 5 - 2025 | doi: 10.3389/frhs.2025.1618955
Impact of family doctors on gradient utilization of health services among diabetic patients: Evidence from a real-world study
Provisionally accepted
- 1Johns Hopkins University, Baltimore, Maryland, United States
- 2Shanghai Municipal Center for Disease Control and Prevention (SCDC), Shanghai, China
- 3Huashan Hospital, Fudan University, Shanghai, China
- 4Shanghai Municipal Health Commisson, Shanghai, China
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Objective: The family doctor system plays a crucial role in promoting the gra dient utilization of health resources. However, empirical evidence regarding the use of health services across different levels of care by diabetic patients unde r family doctor contracts remains limited. This study aimed to investigate the i mpact of the family doctor system on the gradient utilization of health services among diabetic patients using real-world data. Methods: We conducted an eight-year cohort study in Shanghai from 2014 to 2021, with a final sample size of 491,674 participants, including 459,600 contr acted and 32,074 non-contracted patients. We employed inverse probability wei ghted regression adjustment (IPWRA) and zero-inflated negative binomial regres sion models to estimate the net effects. Among contracted patients, 52.08% we re female, with an average age of 66.31 years; in comparison, non-contracted patients were younger, and over 60% resided in urban areas. The annual numb er of outpatient and inpatient visits was 32.47 and 0.42 for contracted patients, and 34.63 and 0.35 for non-contracted patients, respectively. Results: Study results showed that, outpatient visits decreased across all levels of hospital (coef. = -7.37%, IRR=0.92 P<0.01), with a more pronounced reduct ion in secondary and tertiary hospitals compared to community health centers. This translated to a notable decrease of 2.43 days in the total number of outpa tient visits. Conversely, hospitalization rates increased, particularly in communit y health centers (coef. = 26.88%, IRR=1.30, P<0.01). Overall, the data suggest 上标 设置格式[Leiyu Shi]: 3
Keywords: Family doctor system, Contracted patients, Diabetic patients, Outpatient visits, inpatient
Received: 07 May 2025; Accepted: 06 Aug 2025.
Copyright: © 2025 Fan, Mengyun, Long and Xu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Xue Long, Huashan Hospital, Fudan University, Shanghai, China
Su Xu, Shanghai Municipal Health Commisson, Shanghai, China
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