Does Contracting With a Family Doctor Affect the Medical Expenditures of Residents in China?

The Chinese government implemented a nationwide family doctor policy in 2016 as a component of the Healthy China 2030 plan. Previous studies on the role of family doctors in reducing medical expenditures in China have produced inconsistent results. This study employed large-sample microsurvey data from across China to analyze the effects of family doctor contracts on actual medical and hospitalization expenditures. Utilizing both ordinary least squares (OLS) regression and instrumental variable (IV) regression, we analyzed data from 11,221 participants in the 2021 National China Livelihood Survey. The OLS and IV regression results suggested that engaging with a family doctor enhanced actual medical and hospitalization costs. This study conducted two additional analyses to delve deeper into this finding. The mechanistic analysis indicated that the association between contracting with a family doctor and increased medical spending was mediated by improved medical accessibility, prompt medication adherence, and regular hospital visits. Furthermore, a heterogeneity analysis showed that this increase in medical expenditures was particularly pronounced among residents with an educational level of high school and below, those suffering from chronic diseases, and individuals residing in regions with superior infrastructure and health resource availability. Consequently, our study indicates that contracting with a family doctor, although it raises medical costs for Chinese residents, is also associated with enhancements in health status.