Promoting equality in utilization of basic public health services in China: the role of the family doctor contract service

Background: The Family Doctor Contract Service (FDCS) system is a service model for primary care reform launched in 2016 to offer families and individuals active and continuous health care by a team of family doctors within primary care institutions in China. Objectives: This study aimed to estimate socioeconomic-related inequalities in the utilization of basic public health services, and to identify the contribution of FDCS to promoting equality. Methods: Data for the study were collected from a 2023 cross-sectional household health survey in western China, involving 39,456 participants. The concentration index (C) was employed for analyzing the extent of socioeconomic-related inequalities in the utilization of basic public health services and the coarsened exact matching technique was employed for sensitivity analysis in order to reduce selection bias. Results: Our results indicated pro-poor inequalities in the utilization of health records (C = −0.046), free health check-ups (C = −0.009), and follow-ups for hypertension (C = −0.051). Additionally, a more equitable distribution across the economic spectrum was observed within the FDCS group (people who voluntarily contracted for services) compared to the non-FDCS group. The FDCS demonstrated more favorable positive impacts among individuals with higher (quintiles 60–80%) and the highest (top 20%) socioeconomic status. The FDCS contributed 83.94%, 59.24%, and 36.92% to pro-poor inequalities in the utilization of three basic public health services. These contributions reflected the positive impact of the FDCS on utilization. Conclusions: Government policy and service delivery models require a paradigm shift to promote a stronger primary healthcare approach to practice, as evidenced by the effectiveness of the FDCS in promoting equality.