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ORIGINAL RESEARCH article

Front. Public Health
Sec. Public Health Policy
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1510311

The Analysis of Factors Influencing Patient Choice of Healthcare Providers Between Tertiary Hospitals and Community Clinics

Provisionally accepted
Silin Wu Silin Wu 1,2Zhaoxia LEI Zhaoxia LEI 3Tinglian Liu Tinglian Liu 4Lan CHEN Lan CHEN 4Yang Qin Yang Qin 2*
  • 1 Department of Clinical Medicine, North Sichuan Medical College, Nanchong, China
  • 2 Department of General Practice, the General Hospital of Western Theater Command, Chengdu , Sichuan, China, chengdu, China
  • 3 Longtan Community Health Service Centre, Chenghua District, Chengdu, Sichuan Province,, China, sichuan, China
  • 4 Shaheyuan Community Health Service Centre, Jinniu District, Chengdu, Sichuan Province, 610081, China, chengdu, China

The final, formatted version of the article will be published soon.

    Background: The uneven distribution of medical resources in China has led to persistently low utilisation rates of primary healthcare institutions. The tiered healthcare delivery system aims to optimise resource allocation and strengthen primary care, yet patient preferences for tertiary hospitals hinder its effective implementation. Understanding the factors influencing healthcare-seeking behaviours is crucial for improving policies and promoting system efficiency.Objective: To analyse the factors influencing patient choices between a tertiary hospital and a community health service centre in Chengdu and provide recommendations for advancing the tiered healthcare system.Methods: A random sampling method was used in August 2023 to survey patients at a tertiary hospital (Group A) and a community health service centre (Group B). The survey assessed demographics, health status, factors influencing provider choice, and awareness of the family doctor system. Chi-square, t-tests, or Wilcoxon rank-sum tests were used for group comparisons, while logistic regression identified factors associated with primary care visits.Results: Among 865 valid responses (Group A: 420; Group B: 445; 92.02% response rate), Group A had significantly higher education levels and household incomes (p < 0.001), while Group B had higher chronic disease prevalence and family doctor contract rates (71.5% vs. 59.3%, 44.5% vs. 25.5%; both p < 0.01). Positive factors for choosing community healthcare included better equipment and medication availability (46.9%), lower costs with higher reimbursement (45.0%), and convenient transport (41.2%). Negative factors included distrust in community care quality (39.1%) and limited familiarity with family doctors (32.8%). Logistic regression indicated that being over 60 years old (OR: 1.94, CI: 1.02–3.69) and awareness of the tiered healthcare system (OR: 2.48, CI: 1.56–3.96) were significant factors for seeking primary care.Conclusion: Patients with higher education and income prefer tertiary hospitals, while chronic disease patients are more likely to utilise community care. Low family doctor contract rates and trust in community healthcare quality remain barriers. Strengthening community resources and promoting the tiered healthcare system could improve patient participation and alleviate pressure on tertiary hospitals.

    Keywords: Medical selection behavior, hierarchical medical system, Family doctor system, Having first consultations in primary care, Influencing factors

    Received: 12 Oct 2024; Accepted: 23 Jan 2025.

    Copyright: © 2025 Wu, LEI, Liu, CHEN and Qin. 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: Yang Qin, Department of General Practice, the General Hospital of Western Theater Command, Chengdu , Sichuan, China, chengdu, China

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