Evaluation of the Effectiveness of Initial Consultation at Primary Level for Rural Residents under the Context of Hierarchical Medical System – An Empirical Study Based on Five Mountainous Counties in Wenzhou City

Abstract

Objective: This study aims to evaluate the effectiveness of first consultation at the primary care level for rural residents under the hierarchical medical system, explore key factors influencing primary care first visits, and provide a scientific basis for further improving the hierarchical medical system and enhancing the accessibility of rural primary healthcare services. Methods: A stratified random sampling method was adopted to select rural residents from five mountainous counties in Wenzhou City (Cangnan, Pingyang, Taishun, Wencheng, Yongjia) as research subjects. A self-designed questionnaire, the "Evaluation of the Effectiveness of First Consultation at Primary Care Level for Rural Residents under the Hierarchical Medical System," was used for the survey, yielding 369 valid responses. Data analysis was performed using SPSS25.0 statistical software, employing descriptive statistics, chi-square tests, and one-way ANOVA. Results: The willingness of rural residents to choose primary care for their first visit was 42.0%; Significant regional differences existed in the geographical accessibility of medical services, with 39.6% of residents living≤1 km from the nearest healthcare facility, but the standard deviation was large; 70.5% of residents had not experienced insufficient medical resources, but 23.8% had encountered service shortages 1-2 times; Overall satisfaction with medical services was relatively high, but about 30% of residents held neutral or negative evaluations; 18.4% of residents had delayed or forgone treatment due to cost issues. Conclusion: The overall effectiveness of first consultation at the primary care level for rural residents in the five mountainous counties of Wenzhou City is generally good. However, issues such as uneven service radii, imbalanced resource distribution, variable service quality, and economic burden persist. It is recommended to comprehensively improve the effectiveness of primary care first visits by optimizing service radii, improving resource chains, enhancing service capacity, and strengthening the safety net.