To investigate the signing status of combination contract( "1+1+1" contract) for primary care among elderly residents in Shanghai communities and its influencing factors.

The policy of combination contract for primary care has been implemented in Shanghai since 2015, the residents signed a service contract with general practitioners in community health service center as well as with one of the secondary or tertiary hospitals ( "1+1+1" ). The questionnaire survey on the signing status of "1+1+1" contract was conducted among residents over 60 years in 6 communities in Shanghai which were selected by stratified and convenience sampling method from September 2017 to November 2017. The questionnaire was designed based on the previous research results of the qualitative interviews. The contents of the questionnaire included the basic characteristics, health status, understanding of the "1+1+1" signing policy, the status and reasons for contract signing, and so on. The date were analyzed by descriptive method, chi-square test, and binary logistic regression.

Total 574 questionnaires were distributed and 564 valid questionnaires were retrieved with a recovery rate of 98.25%. Among all participants, 300 (53.2%) had signed and 264 (46.8%) had not signed. Univariate analysis showed that age, self-evaluated health status, chronic disease, medication, visits to the community health service center, the purpose of this visit,satisfaction with the community health service center, medical examination, concerning health knowledge, the willingness of community doctor as gatekeeper, the willingness of community referral, whether or not know the "1+1+1" contract policy, influence the rate of signing were associated with the signing of the contract (all P<0.05). Multivariate analysis showed that whether or not know the "1+1+1" contract policy, the willingness of community referral, and self-evaluation health status were independent factors affecting "1+1+1" contract signing (all P<0.05). The reason for signing the contract were convenience to visit doctor (69.00%, 207/300), and having a good relationship with family doctor (29.33%, 88/300). The reasons for not signing the contract were not understanding the policy (65.15%, 172/264), lack of help for signing (25.38%, 67/264), and restricted choice of seeking medical services (7.58%, 20/264).

Whether or not know the "1+1+1" contract policy, the willingness of community referral, and self-evaluation health status are the main influencing factors of signing "1+1+1" contract for primary care among elderly residents in Shanghai communities.

Hierarchical medical; Family doctor; Influencing factors