Volume 23 Issue 12
Dec.  2025
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Article Navigation >  Chinese Journal of General Practice  > 2025  >  23(12): 2092-2096
ZHOU Shan, WANG Jinxia, LI Na, MA Li. A meta-analysis of the prevalence and influencing factors of family doctor contract service in China[J]. Chinese Journal of General Practice, 2025, 23(12): 2092-2096. doi: 10.16766/j.cnki.issn.1674-4152.004299
Citation: ZHOU Shan, WANG Jinxia, LI Na, MA Li. A meta-analysis of the prevalence and influencing factors of family doctor contract service in China[J]. Chinese Journal of General Practice, 2025, 23(12): 2092-2096. doi: 10.16766/j.cnki.issn.1674-4152.004299
shu

A meta-analysis of the prevalence and influencing factors of family doctor contract service in China

doi: 10.16766/j.cnki.issn.1674-4152.004299
  • 1.

    School of Practice and Continuing Education, Capital Medical University, Beijing 100069, China

Funds:

 22QK13

 学科带头人-02-09

  • Received Date: 2025-05-22
    Available Online: 2026-03-13
    Abstract
  •   Objective  To evaluate the current signing rate and key determinants of family doctor contracted services in China, offering insights for policy formulation and service optimization.  Methods  A comprehensive systematic review was conducted across databases including CNKI, Wanfang, VIP, PubMed, and Web of Science, covering cross-sectional studies published from 2018 to 2023. Two researchers independently screened the literature, extracted data. The studies meeting inclusion criteria were assessed using the JBI quality evaluation framework and analyzed with Stata 17.0.  Results  A total of 18 cross-sectional studies were included. The pooled signing rate of family doctor contracted services in China was 54.37% (95% CI: 41.81%-66.66%), with rates of 63.60% in urban areas and 40.80% in rural areas. The main influencing factors included advanced age (OR=1.029, 95% CI: 1.012-1.047, P < 0.001), unemployment (OR=1.517, 95% CI: 1.046-2.223, P=0.025), chronic illness (OR=1.709, 95% CI: 1.636-1.786, P < 0.001), poor economic status (OR=3.177, 95% CI: 2.552-3.955, P < 0.001), health insurance coverage (OR=1.994, 95% CI: 1.687-2.354, P < 0.001), and awareness of the service (OR=8.174, 95% CI: 7.106-9.412, P < 0.001).  Conclusion  Despite progress, the signing rate of family doctor contract service remains below the 2035 target, with a significant gap in rural areas. Policies tailored to local contexts are essential to optimize services and promote community health management.

     

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    • References(39)
  • [1]
    World Health Organization, United Nations Children's Fund. Operational fram ework for primary health care: transforming vision into action[EB/OL]. (2020-12-14)[2024-05-28]. https://www.who.int/publications/i/item/9789240017832.
    [2]
    WANG H, SHI L, HAN X, et al. Factors associated with contracted services of Chinese family doctors from the perspective of medical staff and consumers: a cross-sectional study[J]. BMC Health Serv Res, 2019, 19(1): 986. DOI: 10.1186/s12913-019-4801-y.
    [3]
    STARFIELD B, SHI L, MACINKO J. Contribution of Primary Care to Health Systems and Health[J]. Milbank Q, 2020, 83(3): 457-502.
    [4]
    PRATT C, TAYLOR R, SMITH S D. Health equity and access to health care as a social determinant of health: the role of the primary care provider[J]. Prim Care, 2023, 50(4): 549-559. doi: 10.1016/j.pop.2023.04.006
    [5]
    ALLEN L N, PETTIGREW L M, EXLEY J, et al. The role of primary health care, primary care and hospitals in advancing universal health coverage[J]. BMJ Glob Health, 2023, 8(12): e014442. DOI: 10.1136/bmjgh-2023-014442.
    [6]
    HUANG J, LIU Y, ZHANG T, et al. Can family doctor contracted services facilitate orderly visits in the referral system? A frontier policy study from Shanghai, China[J]. Int J Health Plann Manage, 2022, 37(1): 403-416. doi: 10.1002/hpm.3346
    [7]
    李杰, 李智贤, 杨士鋆, 等. 家庭医生签约服务对山东农村慢性病患者首诊机构选择的影响[J]. 中国卫生资源, 2022, 25(1): 101-105, 125.

    LI J, LI Z X, YANG S Y, et al. The influence of family doctor contracted services on the choice of primary healthcare institutions for chronic disease patients in rural Shandong[J]. Chinese Health Resources, 2022, 25(1): 101-105, 125.
    [8]
    KǍMǍRǍINEN P, MIKKOLA L, NURMEKSELA A, et al. Nurse leaders' interpersonal communication competence: a mixed-method systematic review[J]. J Adv Nurs, 2024. DOI: 10.1111/jan.16184.
    [9]
    周英凤, 顾莺, 胡雁, 等. JBI循证卫生保健中心对关于不同类型研究的质量评价工具: 患病率及分析性横断面研究的质量评价[J]. 护士进修杂志, 2018, 33(3): 219-221.

    ZHOU Y F, GU Y, HU Y, et al. The joanna briggs institute critical appraisal tools for use in systematic review: prevalence study and analytical cross sectional study[J]. Journal of Nurses Training, 2018, 33(3): 219-221.
    [10]
    SHANG X, HUANG Y, LI B, et al. Residents' awareness of family doctor contract services, status of contract with a family doctor, and contract service needs in Zhejiang Province, China: a cross-sectional study[J]. Int Environ Res Public Health, 2019, 16(18): 3312. DOI: 10.3390/ijerph16183312.
    [11]
    LV B, ZHANG L, MENG K. Effect of multiple chronic conditions on family doctor contracting in the elderly in China: the moderating role of socioeconomic status[J]. BMC Public Health, 2023, 23(1): 1540. DOI: 10.1186/s12889-023-16438-5.
    [12]
    刘慧, 叶雨果, 林春滢, 等. 社会资本对成都市城市老年人家庭医生签约服务签约情况的影响[J]. 医学与社会, 2023, 36(10): 59-65.

    LIU H, YE Y G, LIN C Y, et al. Influence of social capital on signing status of family doctor contracting services among urban elderly in Chengdu[J]. Medicine and Society, 2023, 36(10): 59-65.
    [13]
    柯思思, 郭燕, 严亚琼. 武汉市居民家庭医生签约情况及影响因素分析[J]. 中国健康教育, 2022, 38(11): 1022-1027.

    KE S S, GUO Y, YAN Y Q. Status of signing a contract with family doctors and its influencing factors among residents in Wuhan City[J]. Chinese Journal of Health Education, 2022, 38(11): 1022-1027.
    [14]
    格桑卓玛, 万洋, 扎西达娃, 等. 西藏地区中老年人家庭医生服务签约及其影响因素分析[J]. 现代预防医学, 2023, 50(9): 1624-1629.

    GESANG Z M, WAN Y, ZHAXI D W, et al. Analysis on influencing factors of family doctor service signing among the middle-aged and elder in Tibet[J]. Modern Preventive Medicine, 2023, 50(9): 1624-1629.
    [15]
    潘菁, 马效恩, 徐凌忠, 等. 泰安市老年人家庭医生服务签约率现状分析[J]. 中国农村卫生事业管理, 2023, 43(3): 179-183.

    PAN J, MA X E, XU L Z, et al. Status quo of family doctor service signing rate for the elderly in Tai'an City[J]. Chinese Rural Health Service Administration, 2023, 43(3): 179-183.
    [16]
    郭红英, 陈坤, 任礼敏, 等. 佛山市高明区居民家庭医生式服务的签约现状及影响因素调查[J]. 护理研究, 2019, 33(9): 1582-1585.

    GUO H Y, CHEN K, REN L M, et al. Study on signing status quo and influencing factors of the family doctor service for residents in Gaoming district Foshan city[J]. Chinese Nursing Research, 2019, 33(9): 1582-1585.
    [17]
    刘春光, 代震, 崔丽伟, 等. 老龄化背景下山东省农村老年人家庭医生签约行为分析[J]. 中国卫生事业管理, 2022, 39(5): 362-366.

    LIU C G, DAI Z, CUI L W, et al. Analysis of the family doctor contracting behavior of the rural elderly in Shandong province under the Back-wound of aging[J]. Chinese Health Service Management, 2022, 39(5): 362-366.
    [18]
    唐静, 谷月, 刘莎, 等. 盐城市大丰区农村老年人签约家庭医生状况及其影响因素[J]医学与社会, 2021, 34(4): 46-51.

    TANG J, GU Y, LIU S, et al. Status of signing a contract with family doctor among the rural elderly in Dafeng district of Yancheng city and its influencing factors[J]. Medicine and Society, 2021, 34(4): 46-51.
    [19]
    YANG S, LI J, FU P, et al. Do older people with cardiovascular-metabolic multimorbidity prefer to sign contracts for family doctor services? Evidence from a cross-sectional study in rural Shandong, China[J]. BMC Geriatr, 2021, 21(1): 579. DOI: 10.1186/s12877-021-02543-w.
    [20]
    吴舒窈, 何明, 陈荔萍, 等. 上海市中心城区居民社区预约就诊现况及影响因素研究[J]. 中国全科医学, 2021, 24(13): 1650-1655.

    WU S Y, HE M, CHEN L P, et al. Prevalence and associated factors of use of appointment-based community health services in residents from acentral district of Shanghai[J]. Chinese General Practice, 2021, 24(13): 1650-1655.
    [21]
    郑晓辉, 李美婷, 赖定忠, 等. 广州市荔湾区居民家庭医生签约服务现状及影响因素分析[J]. 中国公共卫生管理, 2022, 38(4): 496-499, 506.

    ZHENG X H, LI M T, LAI D Z, et al. Analysis of the status and influencing factors of family doctor contract service in Liwan District, Guangzhou City[J]. Chinese Journal of Public Health Management, 2022, 38(4): 496-499, 506.
    [22]
    范阳东, 江蕾, 柳薇, 等. 广州市家庭医生签约现状及影响因素研究[J]. 中华全科医学, 2021, 19(1): 80-82, 166.

    FAN Y D, JIANG L, LIU W, et al. Status of family doctor contract signing in Guangzhou and its influencing factors[J]. Chinese Journal of General Practice, 2021, 19(1): 80-82, 166.
    [23]
    何俊曦, 李跃平. 福建省农村居民家庭医生签约服务知晓、签约及意愿调查[J]. 中国农村卫生事业管理, 2019, 39(1): 51-56.

    HE J X, LI Y P. Awareness, signing situation and willingness of family doctors' contract services in rural areas of Fujian Province[J]. Chinese Rural Health Service Administration, 2019, 39(1): 51-56.
    [24]
    董婷婷, 杨永红, 冉毅, 等. 重庆市巴南区慢病人群家庭医生签约服务影响因素分析[J]. 保健医学研究与实践, 2020, 17(2): 30-34.

    DONG T T, YANG Y H, RAN Y, et al. Analysis of factors influencing attitude towards family physician contract services among chronic patients in Banan District, Chongqing[J]. Health Med Res & Prac, 2020, 17(2): 30-34.
    [25]
    孙倩, 王文汇, 马广斌, 等. 健康中国战略下潍坊市家庭医生签约服务状况调查[J]. 社区医学杂志, 2022, 20(19): 1076-1081.

    SUN Q, WANG W H, MA G B, et al. Investigation on the status of contracted services for family doctors in Weifang under the healthy China strategy[J]. Journal of Community Medicine, 2022, 20(19): 1076-1081.
    [26]
    巫云辉, 陈谨, 王皓翔, 等. 患方视角下的家庭医生签约服务现况调查分析[J]. 中国社区医师, 2021, 37(35): 187-188, 191.

    WU Y H, CHEN J, WANG H X, et al. Investigation and analysis of contracted services of family doctors from the perspective of patients[J]. Chinese Community Doctors, 2021, 37(35): 187-188, 191.
    [27]
    陈奕君, 王雷霞, 阎春生, 等. 甘肃省重点人群家庭医生服务签约现状及影响因素研究[J]. 现代预防医学, 2018, 45(19): 3550-3553.

    CHEN Y J, WANG L X, YAN C S, et al. Status and influencing factors of family doctor service for key population, Gansu[J]. Modern Preventive Medicine, 2018, 45(19): 3550-3553.
    [28]
    吴瑶琴, 李红美, 陈安琪, 等. 江苏省居民家庭医生服务签约情况及影响因素分析[J]现代预防医学, 2020, 47(4): 631-634.

    WU Y Q, LI H M, CHEN A Q, et al. Study on signing status and influencing factors of the family doctor service for residents-taking Jiangsu Province as an example[J]. Modern Preventive Medicine, 2020, 47(4): 631-634.
    [29]
    王俊杰, 时松和, 宋瑞, 等. 河南省老年人签约家庭医生现状及影响因素分析[J]. 现代预防医学, 2019, 49(16): 2963-2968.

    WANG J J, SHI S H, SONG R, et al. Analysis on the current situation and influencing factors of family physi-cian contracting service for the elderly in Henan Province[J]. Modern Preventive Medicine, 2019, 49(16): 2963-2968.
    [30]
    张翠萍, 岳林琳, 丁玲, 等. 潍坊市社区居民家庭医生签约服务的签约现状及其影响因素[J]. 医学与社会, 2020, 33(9): 30-34.

    ZHANG C P, YUE L L, DING L, et al. Status quo of family doctor's contracting service for community residents and its influencing factors in Weifang city[J]. Medicine and Society, 2020, 33(9): 30-34.
    [31]
    王荣英, 张金佳, 赵稳稳, 等. 石家庄市社区居民对社区卫生服务的满意度及家庭医生签约现状调查[J]. 中国全科医学, 2018, 21(31): 3896-3900.

    WANG R Y, ZHANG J J, ZHAO W W, et al. Satisfaction with community health services and use of contracted family doctor services among Shijiazhuang's community-dwelling residents[J]. Chinese General Practice, 2018, 21(31): 3896-3900.
    [32]
    黄蛟灵, 梁鸿, 张伟胜, 等. 上海市虹口区居民家庭医生签约行为的影响因素分析[J]. 中国全科医学, 2019, 22(6): 687-691.

    HUANG J L, LIANG H, ZHANG W S, et al. Influencing factor analysis of signing a contract with a family doctor among residents in Hongkou district, Shanghai[J]. Chinese General Practice, 2019, 22(6): 687-691.
    [33]
    白润娟, 陈佳琦, 张晓岚, 等. 兰州市家庭医生签约服务开展现状研究[J]. 西部中医药, 2021, 34(3): 101-104.

    BAI R J, CHEN J Q, ZHANG X L, et al. Study on current state of the signing service of family doctors in Lanzhou city[J]. Western Journal of Traditional Chinese Medicine, 2021, 34(3): 101-104.
    [34]
    张霄艳, 张晓娜, 方鹏骞. 我国家庭医生签约率的meta分析[J]. 中国卫生统计, 2019, 36(2): 255-257, 260.

    ZHANG X Y, ZHANG X N, FANG P Q. Meta-analysis of the contract rate of family physician in our country[J]. Chinese Journal of Health Statistics, 2019, 36(2): 255-257, 260.
    [35]
    邓锦绣. 广州市越秀区社区家庭医生服务满意度及影响因素[D]. 广州: 华南理工大学, 2020.

    DENG J X. An evaluation research of satisfaction level and the influencing factor on family doctor service in Guangzhou Yuexiu district[D]. Guangzhou: South China University of Technology, 2020.
    [36]
    ZHAO N, GU M, LI J, et al. Factors influencing contracting of residents with family doctors in China: a national cross-sectional survey[J]. BMC Health Serv Res, 2024, 24(1): 213. DOI: 10.1186/s12913-024-10606-y.
    [37]
    王宾. 农村基本医疗卫生服务供给问题与对策研究: 基于对D镇的调查[D]. 保定: 河北大学, 2023.

    WANG B. Study on problems and countermeasures of rural basic health service supply: based on a survey of D-town[D]. Baoding: Hebei University, 2023.
    [38]
    张超, 钟昌标. 我国区域基本公共卫生服务公平与效率测度[J]. 统计与决策, 2021, 37(22): 144-148.

    ZHANG C, ZHONG C B. Measurement of equity and efficiency in regional basic public health services in China[J]. Statistics and Decision, 2021, 37(22): 144-148.
    [39]
    国务院. 国务院关于《医疗卫生强基工程实施方案》的批复: 国函〔2025〕85号[A/OL]. (2025-09-07)[2025-10-04]. https://www.gov.cn/zhengce/zhengceku/202509/content_7039981.htm.

    State Council. State Council's approval on the "Implementation Plan for the Strengthening Foundation Project of Medical and Health Care": Guo Han[2025]No. 85[A/OL]. (2025-09-07)[2025-10-04]. https://www.gov.cn/zhengce/zhengceku/202509/content_7039981.htm.
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