Hangzhou's Family Doctor Program Reaches 30% Population Coverage, Driving Surge in General Practitioner Demand

Recently, Tonglu County in Hangzhou issued implementation guidelines for general practitioner contracted services, officially launching integrated medical, nursing, and elderly care contracting services. This marks the citywide coverage of Hangzhou’s integrated medical, nursing, and elderly care contracting services, which have been implemented since 2014.

In October 2014, the "Implementation Plan for Integrated Medical, Nursing, and Elderly Care Contracted Services in Hangzhou" was officially launched, allowing residents of Hangzhou to choose their own contracted family physicians. In addition to providing health management services, the contracted services offered by general practitioners include community medical care and two-way referral services, home hospital bed services, remote health monitoring and management services, and health assessment services. By the end of December 2016, the number of individuals under such contracts in Hangzhou’s main urban districts had reached 785,000, achieving the target of covering 30% of the registered household population.

What Are the Services Included in the Integrated Medical, Nursing, and Care Model?After signing up, community general practitioners will conduct regular home visits to monitor enrolled residents’ health through blood pressure measurements, blood glucose testing, and other assessments. They will adjust medications as needed, provide education on disease prevention and healthy eating, and develop personalized comprehensive treatment plans. If residents have questions about medication or experience physical discomfort, they can consult their community general practitioner by phone. The physician will provide detailed guidance and, depending on the patient’s condition, either arrange a follow-up home visit or decide to refer the patient to municipal or provincial hospitals for further treatment, assisting with appointment scheduling for specialist consultations or securing hospital bed admissions.

In accordance with Hangzhou Municipal Government Office Letter [2014] No. 122 and Hangzhou Health and Family Planning Commission Document [2015] No. 77, the monthly fee for integrated medical, nursing, and elderly care contracted services is RMB 10, totaling RMB 120 per year. Contracted individuals are required to pay only RMB 12 annually, which can be covered using the accumulated funds in their personal medical insurance accounts or paid directly in cash. Preferential policies waiving the individual’s share of the contracted service fee apply to residents aged 60 and above, disadvantaged groups, persons holding disability certificates, and individuals entitled to special care and preferential treatment.

After enrolling in the contracted service, employees covered by the Employee Basic Medical Insurance will have their outpatient deductible reduced by RMB 300 if they receive medical treatment at the contracted medical institution or are referred by their contracted physician to other designated medical institutions within the main urban area due to medical necessity. The individual’s cost-sharing ratio shall be determined based on the tier of the designated medical institution where treatment is received. However, except in cases of emergency, the outpatient deductible will not be waived for visits to other designated medical institutions without a referral.For residents covered by Tier 1 and Tier 2 of the Urban and Rural Resident Basic Medical Insurance who enroll in the contracted service, the annual outpatient deductible is waived. If referred by their contracted physician to other designated medical institutions within the main urban area due to medical necessity, their individual cost-sharing ratio shall be determined according to the standards applicable to community health service institutions.

Hangzhou is the first city in China to explore the community-based medical care model, and its integrated medical, nursing, and elderly care contracted services have been implemented for two years. Over the past two years, the government has provided substantial subsidies to support this integrated approach. The service fees for these contracts are jointly covered by municipal and district governments and insured individuals, while the sole obligation for enrolled residents is to ensure that their initial consultation (except in emergencies) takes place within the community, thereby facilitating the gradual implementation of a tiered diagnosis and treatment system.

Following the implementation of contract-based services, the doctor-patient relationship has been significantly strengthened, enabling comprehensive, whole-person health management throughout the entire care continuum. Consequently, there has been a marked increase in the number of residents seeking medical care within their communities. In 2015, the total number of outpatient and emergency visits at community health service institutions in Hangzhou’s main urban districts reached 9.377 million, representing a 13.35% year-on-year increase. The rate at which contracted patients sought care at community health service centers stood at 61.09%. From January to October 2016, this rate among contracted residents rose to 64.29%, demonstrating initial success in implementing the tiered diagnosis and treatment system.

Based on current data, the number of signed-up residents in Hangzhou’s main urban districts has reached 785,000, significantly increasing the demand for community general practitioners (GPs). There are currently 1,200 registered GPs in these areas, meaning each doctor serves an average of more than 600 patients. In addition to physicians, over 1,000 specialists, rehabilitation therapists, pharmacists, and community nurses have joined the contracted service teams. The government’s integrated medical-care-nursing model not only provides preferential policies for the public but also employs supporting measures to motivate healthcare workers. Specifically, 70% of the funding for contracted services is allocated to GPs and their teams, 20% is reserved for the overall coordination of community health service centers, and 10% is designated for management personnel involved in contracted service operations. Notably, fees from contracted services are excluded from the total performance-based salary cap, thereby encouraging doctors to proactively provide more services. For instance, core GP teams with more than 1,000 signed-up residents can expect an annual income increase of approximately RMB 50,000 if they achieve full scores in performance assessments.