Exploring Patients' Intentions to Switch from Hospitals to Primary Care Institutions for Primary Care: A Push-Pull-Mooring Framework

Jingrong Zhu; Maoxing Liu; Muyang Zhang; Yi Cui

Just Accepted

This article has been peer reviewed and accepted for publication. It is in production and has not been edited, so may differ from the final published form.

Exploring Patients' Intentions to Switch from Hospitals to Primary Care Institutions for Primary Care: A Push-Pull-Mooring Framework

Jingrong Zhu , Maoxing Liu, Muyang Zhang, Yi Cui

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). Objectives: This study apply the push-pull-mooring (PPM) framework to analyze patients' switching intentions from higher-level healthcare institutions to the 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/distrust of GPs (mooring factors). Methods: 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 of 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 of primary care.

PY24181 Accepted 03 June 2025