Progress analysis of family doctor contract service capacity of county-level medical community units of Beilun District, 2019 to 2023

In February 2020, Beilun District's medical community units were officially established. This study analyzed the family doctor contract service coverage for permanent residents and key populations in Beilun District's medical community units under county-level medical community construction to provide references and suggestions for advancing family doctor contract services. Using annual family doctor report data from 2019 to 2023 in Beilun District's medical community units before and after the establishment of the medical community, this study analyzed family doctor team conditions and contract rates among permanent residents and key populations. Over the past 5 years, the average number of contracts per family doctor team showed an overall upward trend, with a 5-year average annual growth rate of 37.40%. Contract rates for various key populations showed an upward trend, with all groups except the elderly exceeding 85%. Among key populations, tuberculosis patients showed the highest average annual growth rate in contract rates at 94.63%, while pregnant women and disabled persons showed the lowest at <2.0%. The amount of general medical fee exemptions in Beilun District's medical community units showed a slight overall decline from 2019 to 2023. The number of appointment visits by contracted residents in 2023 increased 16.63-fold compared to 2019. The number of visits to family doctors by contracted residents showed a declining trend, with an average annual decrease of 1.16%. From 2019 to 2023, the number of physical examinations, diagnostic reports, and health management plans for contracted residents showed increasing trends, with 5-year average annual growth rates of 11.37%, 17.52%, and 12.84% respectively. Through medical community construction, the specialized medical service capacity and family doctor contract service capability of primary healthcare institutions have been effectively enhanced. However, the declining trend in visits to family doctors by contracted residents from 2019 to 2023 and the increasing trend in referrals to other hospital outpatient departments suggest a possible "siphon effect" under the medical community model. The medical community units should establish a 2-way referral assessment mechanism to fully leverage the dual effects of specialists from the main hospital and family doctors in contract services.