China’s hierarchical medical system seeks to route first-contact care for mild, nonurgent conditions to primary healthcare (PHC), yet hospital-centrism persists. Evidence is needed on how financing and visible access/quality signals jointly shape initial provider choice, and which groups respond most. This study quantifies those trade-offs and simulates policy impacts in Shanghai. A discrete choice experiment (12 tasks; two labeled provider alternatives plus opt-out) was administered to adult residents and long-term migrants in Shanghai (N = 441). Attributes included reimbursement rate, deductible, travel time, provider title (ref. General physician), hospital tier (ref. PHC), and online booking. A respondent-panel mixed logit with random coefficients for reimbursement, deductible, and travel time captured unobserved heterogeneity; effects were summarized as marginal rates of substitution (MRS) in reimbursement percentage points. Higher reimbursement pulled patients toward PHC. Beyond price, visible access and quality signals exerted strong influence on first-contact choice. Price responsiveness varied meaningfully across people, with those who better understand insurance reacting more strongly to reimbursement. Policy simulations raised PHC’s first-contact share from 23.4% (UEBMI baseline) to 29.7% with a PHC-tilted reimbursement schedule, and to 33.3% when pairing the same schedule with assured booking and senior staffing at PHC. Price gradients are necessary but insufficient; coupling PHC-tilted financing with visible access/quality signals delivers the largest shift of mild first-contact care away from tertiary hospitals.
Yi Gong (Wed,) studied this question.