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Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
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RESEARCH ARTICLE
Contents Vol 31(4)

Exploring patients’ intentions to switch from hospitals to primary care institutions for primary care: a push-pull-mooring framework

Jingrong Zhu https://orcid.org/0000-0002-5607-0329 A # , Maoxing Liu B # , Muyang Zhang A Yi Cui A *
+ Author Affiliations
- Author Affiliations

A School of Economics and Management, Communication University of China, Beijing 100024, China.

B Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital and Institute, Beijing 100142, China.

* Correspondence to: yicui@cuc.edu.cn

# These authors contributed equally to this paper

Australian Journal of Primary Health 31, PY24181 https://doi.org/10.1071/PY24181
Submitted: 29 October 2024  Accepted: 3 June 2025  Published: 23 June 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University

Abstract

Background

China’s tiered healthcare delivery system encourages patients to choose primary care institutions (PCIs) as their first point of contact, but no mandatory gatekeeping role has been imposed. Despite this policy encouragement, patients often prefer higher-level institutions. Existing research has largely focused on factors influencing patient preferences for higher-level care, but there is a gap in understanding the factors that drive patients to switch to primary care provided by general practitioners (GPs).

Methods

This study applied the push–pull–mooring (PPM) framework to analyze patients’ switching intentions from higher-level healthcare institutions to a GP in PCIs for primary care, focusing on dissatisfaction with hospital services (push factors), attractiveness of the GP system (pull factors), and entrenched hospital habits and distrust in GPs (mooring factors). Data from 612 respondents in China were collected to test the proposed hypotheses using partial least squares-structural equation modeling.

Results

Our results suggest that both push factors, such as dissatisfaction with hospital services, and pull factors, such as the attractiveness of the GP system, positively influence switching intentions. Conversely, mooring factors, including entrenched hospital care habits and distrust in GPs, exert a negative influence on switching behavior. Furthermore, mooring factors moderate the relationship between push–pull factors and switching intentions.

Conclusions

The findings highlight the importance of addressing push and pull factors while mitigating the impact of mooring factors to promote efficient healthcare utilization. Policy interventions should focus on improving GP system attractiveness and reducing patient distrust in primary care.

Keywords: general practitioners, health services, health services policy, hospital care, patient’s behavior, primary care, push-pull-mooring model, switching intention.

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