Factors Influencing Primary Care Utilization among Patients with Chronic Diseases under Integrated Health System Reforms: A Cross-Sectional Study in Fujian Province, China

Background China faces an escalating chronic disease burdens, yet primary care utilization remains low due to inadequate service capacity and a fragmented healthcare systems. Recent integrated health reforms aim to enhance care coordination and resource allocation to promote tiered healthcare adoption. Aim This study investigates the factors of primary care utilization among patients with chronic diseases in the context of the integrated health system reform. Methods A cross-sectional survey was conducted on 527 diabetes or hypertension patients in Fujian Province, China, from February to March 2023. The influencing factors of patients' preference for primary care were investigated by a self-administered questionnaire, with statistical analysis implemented through the ordered logit model. Results The research reveals that service convenience, service effectiveness, and integrated care coordination significantly promote primary care utilization; however, financial subsidies show diminishing returns among patients with referral experiences, where systemic coordination outweighs economic incentives. Conclusion Improving primary care capabilities and integrated service quality proves more effective than subsidy escalation in promoting primary care triage. The findings propose a patient-centered transition mechanism: as integrated services offset the opportunity costs of bypassing higher-tier hospitals, intrinsic preferences for primary care emerge, reducing reliance on subsidies.