Why do they sign but not consult? A study on the effectiveness of China's family doctor contract services from the perspective of patient-doctor interaction

The study examined family doctor services in China, where despite their implementation, many patients sign contracts but do not use the services. The research included 4,578 residents from 16 districts in Tianjin and examined service accessibility and the quality of patient-doctor relationships. Using analysis, three patient groups were identified: those with low, moderate, and high perceived service quality. Traditional factors such as geographic and financial accessibility had no direct impact on service utilization. Instead, the patient's subjective perception of the quality of the doctor-patient relationship was crucial, particularly the sense of continuity of care. The study concludes that patient decisions depend more on trust in the medical relationship than on structural service accessibility.