Fishbone diagram for analyzing factors influencing first contact care of community in China

The construction of community health service in China have achieved great development,but the first contact care of community system has not built up nationwide. The first contact care of community is influenced by many factors.This paper systematically carded the influencing factors by using fishbone diagram that influence policy factors,organization factors,supplier factor,demander factors and technology factors. The policy factors include policy documents,essential drug system,medical insurance system and performance-based pay system. The organization factors include two-way referral mechanism and the-risk binding mechanism. The supplier factors include equipment and facilities,GP team and multisited license. The demander factors include health concept,hospitalization habit,trust degree,character of the patients and migrants. The technology factors include regional health information platform and remote medical technology. The construction of first contact care of community should be carried out according to local conditions by steps. Publicity measures should be adopted to make residents understand the first contact care of community,the reimbursement proportion for different levels of medical institutions and different pool areas should be further widened,the cultivating and training of GP should be reinforced to make more high-level GP work in basic medical and health institutions,and take responsibility of Gatekeeper authentically. Some provinces and cities formulated operational instructions on classification of diagnosis and treatment in 2014,such as Gansu province and Heilongjiang province,both set restriction on inpatient-disease category in appointed medical institution at township and county level those who referral bypassing will not allowed to reimburse,which makes a beneficial exploration and practice for the construction of the first contact care of community in our country.