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Research Article

Evaluation of Willingness to Accept the Referral Policy: Mediation of System Related Sensibility on Power of Interest-Related Groups

Qian Yang1, Fei Teng2, Xudong Zhou3, Lin Gao4, Yuhang Zeng4, Hengjin Dong5*

1Center of Health Policy Studies, School of Public Health, Zhejiang University, P.R.China

2enter for Studies of Psychological Application, School of Psychology, The Base of Psychological Services and Counseling for "Happiness" in Guangzhou, South China Normal University, P.R.China

3Associatie Professor, Institute of Social Medicine, School of Public Health, Zhejiang University, P.R.China

4Graduate student, Institute of Social Medicine, School of Public Health, Zhejiang University, P.R.China

5Director, Center for Health Policy Studies, Zhejiang University School of Medicine, P.R.China

*Corresponding Author:
E-mail: [email protected]


Background: Although the Chinese government has enacted many policies to reform its health system, the reaction of its citizens to these policies remains unknown. The existence of different health reform interest-related groups means that there may be group-related differences in the willingness to accept a health reform policy.

Objectives: The objective of the study is to determine Chinese citizens' willingness to accept a referral policy, based on their social group. A related objective is to explore the underlying mechanism of the influence of the social group and system-related sensibilities on the reform process.

Methods: We selected a county-level city in eastern China as our study site. Purposive sampling yielded four groups of respondents, including patients, governmental officials, hospital workers, and primary care institution staff. We surveyed 468 people using a self-administered questionnaire. The variables of interest were perception of power, system threat, system dependency, system inescapability, and perceived feelings of control as well as willingness to accept the policy.

Results: Willingness to accept the referral policy differed by interest group. Specifically, willingness is affected by group power and mediated by a psychological feeling of perceived control.

Conclusions: Of the participants, 70% were willing to accept the referral policy to varying degrees depending on the group and other social and psychological features. Recommended interventions included strengthening the power of the executive department and addressing patients' feelings as related to control. To guarantee an appropriate policy environment for health reform, we need to empower the county health bureau and rebuild healthy doctor-patient relationships.

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