Sample characteristics
Table 1 presents the characteristics of the 1,837 respondents. Among them, 1,088 participants who came from county hospitals and 749 physicians that from provincial hospitals. The proportion of males (42.2%) was lower than that of females (57.8%). More than half of the participants were 30–39 years (53.8%). Nearly half of the participants employed more than ten years (45.0%), had a middle professional title (49.7%) and had a bachelor’s degree (49.6%). In this survey, the major specialties of physicians were surgical medicine (35.8%) and internal medicine (33.4%), followed by medical technology (22.9%), and traditional Chinese medicine (7.9%). The majority of the participants had more than 5000 RMB income in every month (61.9%) and had a high level of altruism (70.2%).
Table 1
Socio-demographic, collaborative contents and incentive of physicians
Variables
|
All participants (%)
|
Participants from county hospitals (%)
|
Participants from provincial hospitals (%)
|
Total participants
|
n = 1,837(100)
|
n = 1,088 (100)
|
n = 749 (100)
|
Demographic characteristics
|
Gender
|
|
|
|
Male
|
775 (42.2)
|
381 (35.0)
|
394 (52.6)
|
Female
|
1062 (57.8)
|
707 (65.0)
|
355 (47.4)
|
Age
|
|
|
|
18–29
|
296 (16.1)
|
270 (24.8)
|
26 (3.5)
|
30–39
|
988 (53.8)
|
469 (43.1)
|
519 (69.3)
|
40–49
|
415 (22.6)
|
227 (20.9)
|
188 (25.1)
|
≥ 50
|
138 (7.5)
|
122 (11.2)
|
16 (2.1)
|
Work year
|
|
|
|
≤ 5
|
463 (25.2)
|
300 (27.6)
|
163 (21.8)
|
6–10
|
547 (29.8)
|
253 (23.3)
|
294 (39.3)
|
10–15
|
382 (20.8)
|
186 (17.1)
|
196 (26.2)
|
≥ 16
|
445 (24.2)
|
349 (32.1)
|
96 (12.8)
|
Title
|
|
|
|
Primary title
|
636 (34.6)
|
536 (49.3)
|
100 (13.4)
|
Middle title
|
913 (49.7)
|
372 (34.2)
|
541 (72.2)
|
High title
|
288 (15.7)
|
180 (16.5)
|
108 (14.4)
|
Education status
|
|
|
|
Bachelor
|
911 (49.6)
|
825 (75.8)
|
86 (11.5)
|
Master
|
815 (44.4)
|
263 (24.2)
|
552 (73.7)
|
PhD
|
111 (6.0)
|
0 (0)
|
111 (14.8)
|
Occupation category
|
Surgical medicine
|
658 (35.8)
|
318 (29.2)
|
340 (45.4)
|
Internal medicine
|
614 (33.4)
|
424 (39.0)
|
190 (25.4)
|
Medical technology
|
420 (22.9)
|
238 (21.9)
|
182 (24.3)
|
Traditional Chinese medicine
|
145 (7.9)
|
108 (9.9)
|
37 (4.9)
|
Monthly income (RMB)
|
≤ 5000
|
699 (38.1)
|
699 (64.2)
|
0 (0)
|
5001-1,0000
|
414 (22.5)
|
323 (29.7)
|
91 (12.1)
|
1,0001–2,0000
|
337 (18.3)
|
42 (3.9)
|
295 (39.4)
|
≥ 2,0001
|
387 (21.1)
|
24 (2.2)
|
363 (48.5)
|
Altruism
|
|
|
|
Low level
|
117 (6.4)
|
108 (9.9)
|
9 (1.2)
|
Middle level
|
430 (23.4)
|
323 (29.7)
|
107 (14.3)
|
High level
|
1290 (70.2)
|
657 (60.4)
|
633 (84.5)
|
Collaborative contents
|
|
|
|
Case discussions
|
|
|
|
No participation
|
492 (26.8)
|
329 (30.2)
|
163 (21.8)
|
Participated
|
1345 (73.2)
|
759 (69.8)
|
586 (78.2)
|
Surgical guidance
|
|
|
|
No participation
|
1223 (66.6)
|
685 (63.0)
|
538 (71.8)
|
Participated
|
614 (33.4)
|
403 (37.0)
|
211 (28.2)
|
Academic lectures
|
|
|
|
No participation
|
755 (41.1)
|
434 (39.9)
|
321 (42.9)
|
Participated
|
1082 (58.9)
|
654 (60.1)
|
428 (57.1)
|
Continuing education
|
No participation
|
595 (32.4)
|
406 (37.3)
|
189 (25.2)
|
Participated
|
1242 (67.6)
|
682 (62.7)
|
560 (74.8)
|
Remote consultation
|
No participation
|
1129 (61.5)
|
506 (46.5)
|
623 (83.2)
|
Participated
|
708 (38.5)
|
582 (53.5)
|
126 (16.8)
|
Regular outpatient service
|
No participation
|
894 (48.7)
|
696 (64.0)
|
198 (26.4)
|
Participated
|
943 (51.3)
|
392 (36.0)
|
551 (73.6)
|
Two-way referral
|
No participation
|
1025 (55.8)
|
656 (60.3)
|
369 (49.3)
|
Participated
|
812 (44.2)
|
432 (39.7)
|
380 (50.7)
|
Scientific research cooperation
|
No participation
|
1609 (87.6)
|
1009 (92.7)
|
600 (80.1)
|
Participated
|
228 (12.4)
|
79 (7.3)
|
149 (19.9)
|
Medical management
|
No participation
|
1307 (71.1)
|
826 (75.9)
|
481 (64.2)
|
Participated
|
530 (28.9)
|
262 (24.1)
|
268 (35.8)
|
Incentive types
|
|
|
|
Economic returns
|
|
|
|
Low level
|
636 (34.6)
|
531 (48.8)
|
105 (14.0)
|
Middle level
|
375 (20.4)
|
235 (21.6)
|
140 (18.7)
|
High level
|
826 (45.0)
|
322 (29.6)
|
504 (67.3)
|
Rewards
|
|
|
|
Low level
|
390 (21.2)
|
241 (22.2)
|
149 (19.9)
|
Middle level
|
692 (37.7)
|
485 (44.6)
|
207 (27.6)
|
High level
|
755 (41.1)
|
362 (33.3)
|
393 (52.5)
|
Position promotion
|
Low level
|
453 (24.7)
|
349 (32.1)
|
104 (13.9)
|
Middle level
|
510 (27.8)
|
305 (28.0)
|
205 (27.4)
|
High level
|
874 (47.6)
|
434 (39.9)
|
440 (58.7)
|
Professional title promotion
|
Low level
|
464 (25.3)
|
411 (37.8)
|
53 (7.1)
|
Middle level
|
338 (18.4)
|
291 (26.7)
|
47 (6.3)
|
High level
|
1035 (56.3)
|
386 (35.5)
|
649 (86.6)
|
Expanding fame
|
Low level
|
374 (20.4)
|
298 (27.4)
|
76 (10.1)
|
Middle level
|
774 (42.1)
|
481 (44.2)
|
293 (39.1)
|
High level
|
689 (37.5)
|
309 (28.4)
|
380 (50.7)
|
Obtaining respect
|
|
|
|
Low level
|
249 (13.6)
|
214 (19.7)
|
35 (4.7)
|
Middle level
|
816 (44.4)
|
511 (47.0)
|
305 (40.7)
|
High level
|
772 (42.0)
|
363 (33.4)
|
409 (54.6)
|
Enhancing professional status
|
Low level
|
293 (15.9)
|
248 (22.8)
|
45 (6.0)
|
Middle level
|
801 (43.6)
|
501 (46.0)
|
300 (40.1)
|
High level
|
743 (40.4)
|
339 (31.2)
|
404 (53.9)
|
Improving professional skills
|
Low level
|
123 (6.7)
|
104 (9.6)
|
19 (2.5)
|
Middle level
|
484 (26.3)
|
318 (29.2)
|
166 (22.2)
|
High level
|
1230 (67.0)
|
666 (61.2)
|
564 (75.3)
|
The characteristics of the respondents who came from county and provincial hospitals are provided in Table 1. Among the participants of county hospitals, the majority of the participants were female (65.0%) and had a bachelor’s degree (75.8%). Nearly half of the participants were 30–39 years (43.1%), had work experience more than ten years (49.2%), and had a primary professional title (49.3%). The major specialties of physicians were internal medicine (39.0%), followed by surgical medicine (29.2%), and medical technology (21.9%). More than half of the participants had less than 5000 RMB income in every month (64.2%) and had a high level of altruism (60.4%). Among the participants of provincial hospitals, there were more male (52.6%) than female (47.4%). More than half of the participants were 30–39 years (69.3%), had a middle professional title (72.2%), and had a master’s degree (73.7%). The major specialty of physicians was surgical medicine (45.4%). The majority of participants in provincial hospitals had more than 1,0000 RMB income per month (87.9%) and had a high level of altruism (84.5%).
Table 2 lists the significant difference between the characteristics of the respondents who came from county and provincial hospitals. A higher proportion among participants of county hospitals who were female (χ2 = 46,245, p < 0.001), were 18–29 years (χ2 = 234.166, p < 0.001), employed less than five years (χ2 = 129.566, p < 0.001), had primary professional title (χ2 = 295.686, p < 0.001), majored in internal medicine (χ2 = 72.041, p < 0.001) and had low and middle level of altruism (χ2 = 134.748, p < 0.001) than participants of provincial hospitals. Contrary, a higher proportion among participants of provincial hospitals who had master’s and PhD’s degree (χ2 = 776.851, p < 0.001), also had higher level of monthly income (χ2 = 1297.529, p < 0.001) than physicians of county hospitals.
Table 2 Differences between county and provincial level physicians
Variables
|
Hospital level
|
X2 |
P-Value
|
|
County hospital (%)
|
Provincial hospital (%)
|
Total participants
|
n=1,088 (100)
|
n=749 (100)
|
|
|
Demographic characteristics
|
|
|
Gender
|
|
|
56.245
|
<0.001
|
Male
|
381 (49.2)
|
394 (50.8)
|
|
|
Female
|
707 (66.6)
|
355 (33.4)
|
|
|
Age
|
|
|
234.166
|
<0.001
|
18-29
|
270 (91.2)
|
26 (8.8)
|
|
|
30-39
|
469 (47.5)
|
519 (52.5)
|
|
|
40-49
|
227 (54.7)
|
188 (45.3)
|
|
|
≥50
|
122 (88.4)
|
16 (11.6)
|
|
|
Work year
|
|
|
129.566
|
<0.001
|
≤5
|
300 (64.8)
|
163 (35.2)
|
|
|
6-10
|
253 (46.3)
|
294 (53.7)
|
|
|
10-15
|
186 (48.7)
|
196 (51.3)
|
|
|
≥16
|
349 (78.4)
|
96 (21.6)
|
|
|
Title
|
|
|
295.686
|
<0.001
|
Primary title
|
536 (84.3)
|
100 (15.7)
|
|
|
Middle title
|
372 (40.7)
|
541 (59.3)
|
|
|
High title
|
180 (62.5)
|
108 (37.5)
|
|
|
Education status
|
|
|
776.851
|
<0.001
|
Bachelor
|
825 (90.6)
|
86 (9.4)
|
|
|
Master
|
263 (32.3)
|
552 (67.7)
|
|
|
PhD
|
0 (0.0)
|
111 (100.0)
|
|
|
Occupation category
|
72.041
|
<0.001
|
Surgical medicine
|
318 (48.3)
|
340 (51.7)
|
|
|
Internal medicine
|
424 (69.1)
|
190 (30.9)
|
|
|
Medical technology
|
238 (56.7)
|
182 (43.3)
|
|
|
Traditional Chinese medicine
|
108 (74.5)
|
37 (25.5)
|
|
|
Monthly income (RMB)
|
1297.529
|
<0.001
|
≤5000
|
699 (100.0)
|
0 (0.0)
|
|
|
5001-1,0000
|
323 (78.0)
|
91 (22.0)
|
|
|
1,0001-2,0000
|
42 (12.5)
|
295 (87.5)
|
|
|
≥2,0001
|
24 (6.2)
|
363 (93.8)
|
|
|
Altruism
|
|
|
134.748
|
<0.001
|
Low level
|
108 (92.3)
|
9 (7.7)
|
|
|
Middle level
|
323 (75.1)
|
107 (24.9)
|
|
|
High level
|
657 (50.9)
|
633 (49.1)
|
|
|
Collaborative contents
|
Case discussions
|
|
|
16.255
|
<0.001
|
No participation
|
329 (66.9)
|
163 (33.1)
|
|
|
Participated
|
759 (56.4)
|
586 (43.6)
|
|
|
Surgical guidance
|
|
|
15.683
|
<0.001
|
No participation
|
685 (56.0)
|
538 (44.0)
|
|
|
Participated
|
403 (65.6)
|
211 (34.4)
|
|
|
Academic lectures
|
|
|
1.614
|
0.204
|
No participation
|
434 (57.5)
|
321 (42.5)
|
|
|
Participated
|
654 (60.4)
|
428 (39.6)
|
|
|
Continuing education
|
29.573
|
<0.001
|
No participation
|
406 (68.2)
|
189 (31.8)
|
|
|
Participated
|
682 (54.9)
|
560 (45.1)
|
|
|
Remote consultation
|
251.837
|
<0.001
|
No participation
|
506 (44.8)
|
623 (55.2)
|
|
|
Participated
|
582 (82.2)
|
126 (17.8)
|
|
|
Regular outpatient service
|
250.179
|
<0.001
|
No participation
|
696 (77.9)
|
198 (22.1)
|
|
|
Participated
|
392 (41.6)
|
551 (58.4)
|
|
|
Two-way referral
|
21.876
|
<0.001
|
No participation
|
656 (64.0)
|
369 (36.0)
|
|
|
Participated
|
432 (53.2)
|
380 (46.8)
|
|
|
Scientific research cooperation
|
65.115
|
<0.001
|
No participation
|
1009 (62.7)
|
600 (37.3)
|
|
|
Participated
|
79 (34.6)
|
149 (65.4)
|
|
|
Medical management
|
29.584
|
<0.001
|
No participation
|
826 (63.2)
|
481 (36.8)
|
|
|
Participated
|
262 (49.4)
|
268 (50.6)
|
|
|
Incentive types
|
Economic returns
|
|
|
297.065
|
<0.001
|
Low level
|
531 (83.5)
|
105 (16.5)
|
|
|
Middle level
|
235 (62.7)
|
140 (37.3)
|
|
|
High level
|
322 (39.0)
|
504 (61.0)
|
|
|
Rewards
|
74.640
|
<0.001
|
Low level
|
241 (60.6)
|
149 (38.2)
|
|
|
Middle level
|
485 (70.8)
|
207 (29.9)
|
|
|
High level
|
362 (48.0)
|
393 (52.1)
|
|
|
Position promotion
|
92.754
|
<0.001
|
Low level
|
349 (77.0)
|
104 (23.0)
|
|
|
Middle level
|
305 (59.8)
|
205 (40.2)
|
|
|
High level
|
434 (49.7)
|
440 (50.3)
|
|
|
Professional title promotion
|
472.727
|
<0.001
|
Low level
|
411 (88.6)
|
53 (11.4)
|
|
|
Middle level
|
291 (86.1)
|
47 (13.9)
|
|
|
High level
|
386 (37.3)
|
649 (62.7)
|
|
|
Expanding fame
|
126.505
|
<0.001
|
Low level
|
298 (79.7)
|
76 (20.3)
|
|
|
Middle level
|
481 (62.1)
|
293 (37.9)
|
|
|
High level
|
309 (44.8)
|
380 (55.2)
|
|
|
Obtaining respect
|
|
|
125.127
|
<0.001
|
Low level
|
214 (85.9)
|
35 (14.1)
|
|
|
Middle level
|
511 (62.6)
|
305 (37.4)
|
|
|
High level
|
363 (47.0)
|
409 (53.0)
|
|
|
Enhancing professional status
|
138.942
|
<0.001
|
Low level
|
248 (84.6)
|
45 (15.4)
|
|
|
Middle level
|
501 (62.5)
|
300 (37.5)
|
|
|
High level
|
339 (45.6)
|
404 (54.4)
|
|
|
Improving professional skills
|
54.221
|
<0.001
|
Low level
|
104 (84.6)
|
19 (15.4)
|
|
|
Middle level
|
318 (65.7)
|
166 (34.3)
|
|
|
High level
|
666 (54.1)
|
564 (45.9)
|
|
|
Incentive of urban-rural medical consortia
Table 1 lists the level distribution of the eight incentive types of the urban-rural medical consortium. More than half of the participants had a high level of professional title promotion (56.3%) and improved professional skills (67.0%) by participating in an urban-rural medical consortium. Nearly half of the participants had a high level of economic returns (45.0%) and position promotion (47.6%) through participation in urban-rural medical consortium projects. In addition, the majority of the participants expressed a low and middle level of reward (58.9%), expanded fame (62.5%), more respect (68.0%) and improved professional status (59.6%).
Nearly half of the participants in county hospitals expressed a low level of economic returns (48.8%). The majority of the participants had a low and middle level of position promotion (60.1%) and professional title promotion (64.5%). Nearly half of the participants expressed a moderate level of reward (44.6%), expanded fame (44.2%), more respect (47.0%), and improved professional status (46.0%). More than half of the participants had a high level of improved professional skills (61.2) from participating in urban-rural medical consortium projects. Provincial hospital participants commonly expressed a high level of economic returns (67.3%), position promotion (58.7%), professional title promotion (86.6%), reward (52.5%), expanded fame (50.7%), more respect (54.6%), improved professional status (53.9%), and skills (75.3%).
Table 2 lists the significant difference between the incentive levels of the respondents who came from county and provincial hospitals. Compared with incentive levels of participants among county hospitals, the participants who came from provincial hospitals seemed to have a higher level of economic returns (χ2 = 297.065, p < 0.001), position promotion (χ2 = 92.754, p < 0.001), professional title promotion (χ2 = 472.727, p < 0.001), reward (χ2 = 74.640, p < 0.001), expanded fame (χ2 = 126.505, p < 0.001), more respect (χ2 = 125.127, p < 0.001), improved professional status (χ2 = 138.942, p < 0.001) and skills (χ2 = 54.221, p < 0.001) by participating in urban-rural medical consortium.
Willingness to participate in urban-rural medical consortia
In terms of collaborative projects in the urban-rural medical consortium, the majority of the respondents participated in case discussions (73.2%) and continuing education (67.6%). Half of the physicians participated in academic lectures (58.9%) and in regular outpatient service (51.3%). A low proportions of physicians participated in surgical guidance (33.4%), remote consultation (38.5%), scientific research cooperation (12.4%) and medical management (28.9%) (Table 1).
Among the 1,837 respondents, 945 expressed a high level of willingness to participate in the urban-rural medical consortium (51.4%), whereas 196 (10.7%) and 696 (37.9%) expressed low and middle levels of willingness to participate, respectively (Fig. 2). As shown in Table 3, a significant difference was found between the levels of willingness to participate on the various variables. Among the characteristics of the participants, the physicians who came from county hospitals (χ2 = 207.067, p < 0.001), were older (χ2 = 60.352, p < 0.001), had longer work years (χ2 = 28.663, p < 0.001), had a primary professional title (χ2 = 60.088, p < 0.001), had a lower education degree (χ2 = 72.557, p < 0.001), majored in traditional Chinese medicine (χ2 = 21.344, p = 0.002), had lower income (χ2 = 175.068, p < 0.001), had a high level of altruism (χ2 = 598.949, p < 0.001) seemed to have a high level of willingness to participant in the urban-rural medical consortium. Among the collaborative projects, physicians who participated in surgical guidance (χ2 = 23.718, p < 0.001), academic lectures (χ2 = 9.076, p = 0.011), remote consultation (χ2 = 66.561, p < 0.001), scientific research cooperation (χ2 = 8.114, p = 0.017), and medical management (χ2 = 11.992, p = 0.002) had a high level of willingness to participant in the urban-rural medical consortium. However, respondents who participated in regular outpatient services had a low level of willingness to participant in the future (χ2 = 12.091, p = 0.002). Among the incentive types, the participates who expressed a high level of economic returns (χ2 = 2424.701, p < 0.001), position promotion (χ2 = 387.118, p < 0.001), reward (χ2 = 187.965, p < 0.001), expanded fame (χ2 = 114.661, p < 0.001), more respect (χ2 = 160.380, p < 0.001) and improved professional skills (χ2 = 642.864, p < 0.001) by participating in urban-rural medical consortia seemed to have a high level of willingness to participate in the future. However, the participates who expressed a low level of title promotion (χ2 = 232.721, p < 0.001) and professional status (χ2 = 137.415, p < 0.001) seemed to have a high level of willingness to participate in urban-rural medical consortia.
Table 3
Correlation between all physicians’ willingness to participate, and demographic, collaborative contents, incentive types.
Variables
|
Willingness to participate
|
χ2
|
P-Value
|
|
Low (%)
|
Middle (%)
|
High (%)
|
|
|
Demographic characteristics
|
Hospital level
|
207.067
|
< 0.001
|
County hospital
|
87 (8.0)
|
290 (26.7)
|
711 (65.3)
|
|
|
Provincial hospital
|
109 (14.6)
|
406 (54.2)
|
234 (31.2)
|
|
|
Gender
|
|
|
|
5.882
|
0.053
|
Male
|
96 (12.4)
|
301 (38.8)
|
378 (48.8)
|
|
|
Female
|
100 (9.4)
|
395 (37.2)
|
567 (53.4)
|
|
|
Age
|
|
|
|
60.352
|
< 0.001
|
18–29
|
22 (7.4)
|
76 (25.7)
|
198 (66.9)
|
|
|
30–39
|
119 (12.0)
|
432 (43.7)
|
437 (44.2)
|
|
|
40–49
|
42 (10.1)
|
153 (36.9)
|
220 (53.0)
|
|
|
≥ 50
|
13 (9.4)
|
35 (25.4)
|
90 (65.2)
|
|
|
Work year
|
|
|
|
28.663
|
< 0.001
|
≤ 5
|
48 (10.4)
|
164 (35.4)
|
251 (54.2)
|
|
|
6–10
|
70 (12.8)
|
241 (44.1)
|
236 (43.1)
|
|
|
10–15
|
39 (10.2)
|
150 (39.3)
|
193 (50.5)
|
|
|
≥ 16
|
39 (8.8)
|
141 (31.7)
|
265 (59.6)
|
|
|
Title
|
|
|
|
60.088
|
< 0.001
|
Primary title
|
60 (9.4)
|
177 (27.8)
|
399 (62.7)
|
|
|
Middle title
|
111 (12.2)
|
408 (44.7)
|
394 (43.2)
|
|
|
High title
|
25 (8.7)
|
111 (38.5)
|
152 (52.8)
|
|
|
Education status
|
|
|
|
72.557
|
< 0.001
|
Bachelor
|
81 (8.9)
|
276 (30.3)
|
554 (60.8)
|
|
|
Master
|
101 (12.4)
|
356 (43.7)
|
358 (43.9)
|
|
|
PhD
|
14 (12.6)
|
64 (57.7)
|
33 (29.7)
|
|
|
Occupation category
|
|
|
|
21.344
|
0.002
|
Surgical medicine
|
84 (12.8)
|
261 (39.7)
|
313 (47.6)
|
|
|
Internal medicine
|
55 (9.0)
|
233 (37.9)
|
326 (53.1)
|
|
|
Medical technology
|
43 (10.2)
|
167 (39.8)
|
210 (50.0)
|
|
|
Traditional Chinese medicine
|
14 (9.7)
|
35 (24.1)
|
96 (66.2)
|
|
|
Monthly income (RMB)
|
|
|
|
175.068
|
< 0.001
|
≤ 5000
|
51 (7.3)
|
167 (23.9)
|
481 (68.8)
|
|
|
5001-1,0000
|
43 (10.4)
|
152 (36.7)
|
219 (52.9)
|
|
|
1,0001–2,0000
|
49 (14.5)
|
175 (51.9)
|
113 (33.5)
|
|
|
≥ 2,0001
|
53 (13.7)
|
202 (52.2)
|
132 (34.1
|
|
|
Altruism
|
|
|
|
598.949
|
< 0.001
|
Low level
|
68 (58.1)
|
33 (28.2)
|
16 (13.7)
|
|
|
Middle level
|
53 (12.3)
|
298 (69.3)
|
79 (18.4)
|
|
|
High level
|
75 (5.8)
|
365 (28.3)
|
850 (65.9)
|
|
|
Collaborative contents
|
|
|
|
|
|
Case discussions
|
|
|
|
3.883
|
0.143
|
No participation
|
64 (13.0)
|
183 (37.2)
|
245 (49.8)
|
|
|
Participated
|
132 (9.8)
|
513 (38.1)
|
700 (52.0)
|
|
|
Surgical guidance
|
|
|
|
23.718
|
< 0.001
|
No participation
|
149 (12.2)
|
492 (40.2)
|
582 (47.6)
|
|
|
Participated
|
47 (7.7)
|
204 (33.2)
|
363 (59.1)
|
|
|
Academic lectures
|
|
|
|
9.076
|
0.011
|
No participation
|
95 (12.6)
|
300 (39.7)
|
360 (47.7)
|
|
|
Participated
|
101 (9.3)
|
396 (36.6)
|
585 (54.1)
|
|
|
Continuing education
|
|
|
|
3.764
|
0.152
|
No participation
|
72 (12.1)
|
209 (35.1)
|
314 (52.8)
|
|
|
Participated
|
124 (10.0)
|
487 (39.2)
|
631 (50.8)
|
|
|
Remote consultation
|
|
|
|
66.561
|
< 0.001
|
No participation
|
143 (12.7)
|
490 (43.4)
|
496 (43.9)
|
|
|
Participated
|
53 (7.5)
|
206 (29.1)
|
449 (63.4)
|
|
|
Regular outpatient service
|
|
|
|
12.091
|
0.002
|
No participation
|
89 (10.0)
|
308 (34.5)
|
497 (55.6)
|
|
|
Participated
|
107 (11.3)
|
388 (41.1)
|
448 (47.5)
|
|
|
Two-way referral
|
|
|
|
3.019
|
0.221
|
No participation
|
119 (11.6)
|
375 (36.6)
|
531 (51.8)
|
|
|
Participated
|
77 (9.5)
|
321 (39.5)
|
414 (51.0)
|
|
|
Scientific research cooperation
|
|
|
|
8.114
|
0.017
|
No participation
|
184 (11.4)
|
602 (37.4)
|
823 (51.1)
|
|
|
Participated
|
12 (5.3)
|
94 (41.2)
|
122 (53.5)
|
|
|
Medical management
|
|
|
|
11.992
|
0.002
|
No participation
|
160 (12.2)
|
482 (36.9)
|
665 (50.9)
|
|
|
Participated
|
36 (6.8)
|
214 (40.4)
|
280 (52.8)
|
|
|
Incentive types
|
|
|
|
|
|
Economic returns
|
|
|
|
242.701
|
< 0.001
|
Low level
|
117 (18.4)
|
152 (23.9)
|
367 (57.7
|
|
|
Middle level
|
26 (6.9)
|
255 (68.0)
|
94 (25.1)
|
|
|
High level
|
53 (6.4)
|
289 (35.0)
|
484 (58.6)
|
|
|
Rewards
|
187.965
|
< 0.001
|
Low level
|
99 (25.4)
|
166 (42.6)
|
125 (32.1)
|
|
|
Middle level
|
49 (7.1)
|
314 (45.4)
|
329 (47.5)
|
|
|
High level
|
48 (6.4)
|
216 (28.6)
|
491 (65.0)
|
|
|
Position promotion
|
|
|
|
387.118
|
< 0.001
|
Low level
|
79 (17.4)
|
85 (18.8)
|
289 (63.8)
|
|
|
Middle level
|
47 (9.2)
|
365 (71.6)
|
98 (19.2)
|
|
|
High level
|
70 (8.0)
|
246 (28.1)
|
558 (63.8)
|
|
|
Professional title promotion
|
|
|
|
232.721
|
< 0.001
|
Low level
|
73 (15.7)
|
86 (18.5)
|
305 (65.7)
|
|
|
Middle level
|
13 (3.8)
|
239 (70.7)
|
86 (25.4)
|
|
|
High level
|
110 (10.6)
|
371 (35.8)
|
554 (53.5)
|
|
|
Expanding fame
|
|
|
|
114.661
|
< 0.001
|
Low level
|
86 (23.0)
|
149 (39.8)
|
139 (37.2)
|
|
|
Middle level
|
56 (7.2)
|
338 (43.7)
|
380 (49.1)
|
|
|
High level
|
54 (7.8)
|
209 (30.3)
|
426 (61.8)
|
|
|
Obtaining respect
|
|
|
|
160.380
|
< 0.001
|
Low level
|
74 (29.7)
|
101 (40.6)
|
74 (29.7)
|
|
|
Middle level
|
63 (7.7)
|
361 (44.2)
|
392 (48.0)
|
|
|
High level
|
59 (7.6)
|
234 (30.3)
|
479 (62.0)
|
|
|
Enhancing professional status
|
|
|
|
137.415
|
< 0.001
|
Low level
|
79 (27.0)
|
115 (39.2)
|
99 (33.8)
|
|
|
Middle level
|
61 (7.6)
|
351 (43.8)
|
389 (48.6)
|
|
|
High level
|
56 (7.5)
|
230 (31.0)
|
457 (61.5)
|
|
|
Improving professional skills
|
|
|
|
642.864
|
< 0.001
|
Low level
|
70 (56.9)
|
34 (27.6)
|
19 (15.4)
|
|
|
Middle level
|
59 (12.2)
|
334 (69.0)
|
91 (18.8)
|
|
|
High level
|
67 (5.4)
|
328 (26.7)
|
835 (67.9)
|
|
|
For participants among county hospitals, the majority of participants had a high level of willingness to participate in the urban-rural medical consortium (65.3%), while 87 (8.0%) and 290 (26.7%) expressed low and middle levels of willingness to participate, respectively (Fig. 2). As shown in Table 4, a significant difference was found between the levels of willingness to participate on various variables, including title (χ2 = 16.980, p = 0.002), monthly income (χ2 = 8.255, p = 0.004), altruism (χ2 = 1038.825, p < 0.001), economic returns (χ2 = 353.575, p < 0.001), position promotion (χ2 = 742.936, p < 0.001), professional title promotion (χ2 = 539.951, p < 0.001), rewards (χ2 = 362.502, p < 0.001), fame (χ2 = 268.147, p < 0.001), respect (χ2 = 391.761, p < 0.001), professional status (χ2 = 375.647, p < 0.001) and skills (χ2 = 113.064, p < 0.001).
Table 4
Correlation between county and provincial level physicians’ willingness to participate, and demographic, collaborative contents, incentive types.
Variables
|
County physicians’ willingness to participate(n = 1,088)
|
Provincial physicians’ willingness to participate(n = 749)
|
|
Low (%)
|
Middle (%)
|
High (%)
|
χ2
|
P-Value
|
Low (%)
|
Middle (%)
|
High (%)
|
χ2
|
P-Value
|
Demographic characteristics
|
Gender
|
1.130
|
0.568
|
|
3.415
|
0.181
|
Male
|
35 (9.2)
|
100 (26.2)
|
246 (64.6)
|
|
|
61 (15.5)
|
201 (51.0)
|
132 (33.5)
|
|
|
Female
|
52 (7.4)
|
190 (26.9)
|
465 (65.8)
|
|
|
48 (13.5)
|
205 (57.7)
|
102 (28.7)
|
|
|
Age
|
12.254
|
0.057
|
|
5.474
|
0.485
|
18–29
|
18 (6.7)
|
61 (22.6)
|
191 (70.7)
|
|
|
4 (15.4)
|
15 (57.7)
|
7 (26.9)
|
|
|
30–39
|
45 (9.6)
|
144 (30.7)
|
280 (59.7)
|
|
|
74 (14.3)
|
288 (55.5)
|
157 (30.3)
|
|
|
40–49
|
16 (7.0)
|
57 (25.1)
|
154 (67.8)
|
|
|
26 (13.8)
|
96 (51.1)
|
66 (35.1)
|
|
|
≥ 50
|
8 (87)
|
28 (23.0)
|
86 (70.5)
|
|
|
5 (31.3)
|
7 (43.8)
|
4 (25.0)
|
|
|
Work year
|
8.144
|
0.228
|
|
9.803
|
0.133
|
≤ 5
|
23 (7.7)
|
69 (23.0)
|
208 (69.3)
|
|
|
25 (15.3)
|
95 (58.3)
|
43 (26.4)
|
|
|
6–10
|
23 (9.1)
|
79 (31.2)
|
151 (59.7)
|
|
|
47 (16.0)
|
162 (55.1)
|
85 (28.9)
|
|
|
10–15
|
18 (9.7)
|
52 (28.0)
|
116 (62.4)
|
|
|
21 (10.7)
|
98 (50.0)
|
77 (39.3)
|
|
|
≥ 16
|
23 (6.6)
|
90 (25.8)
|
236 (67.6)
|
|
|
16 (16.7)
|
51 (53.1)
|
29 (30.2)
|
|
|
Title
|
|
|
|
16.980
|
0.002
|
|
|
|
5.311
|
0.257
|
Primary title
|
45 (8.4)
|
114 (21.3)
|
377 (70.3)
|
|
|
15 (15.0)
|
63 (63.0)
|
22 (22.0)
|
|
|
Middle title
|
31 (8.3)
|
121 (32.5)
|
220 (59.1)
|
|
|
80 (14.8)
|
287 (53.0)
|
174 (32.2)
|
|
|
High title
|
11 (6.1)
|
55 (30.6)
|
114 (63.3)
|
|
|
14 (13.0)
|
56 (51.9)
|
38 (35.2)
|
|
|
Education status
|
|
|
|
3.884
|
0.143
|
|
|
|
1.273
|
0.866
|
Bachelor
|
66 (8.0)
|
232 (28.1)
|
527 (63.9)
|
|
|
15 (17.4)
|
44 (51.2)
|
27 (31.4)
|
|
|
Master
|
21 (8.0)
|
58 (22.1)
|
184 (70.0)
|
|
|
80 (14.5)
|
298 (54.0)
|
174 (31.5)
|
|
|
PhD
|
0 (0.0)
|
0 (0.0)
|
0 (0.0)
|
|
|
14 (12.6)
|
64 (57.7)
|
33 (29.7)
|
|
|
Occupation category
|
6.288
|
0.392
|
|
|
|
9.977
|
0.126
|
Surgical medicine
|
26 (8.2)
|
89 (28.0)
|
203 (63.8)
|
|
|
58 (17.1)
|
172 (50.6)
|
110 (32.4)
|
|
|
Internal medicine
|
35 (8.3)
|
119 (28.1)
|
270 (63.7)
|
|
|
20 (10.5)
|
114 (60.0)
|
56 (29.5)
|
|
|
Medical technology
|
20 (8.4)
|
62 (26.1)
|
156 (65.5)
|
|
|
23 (12.6)
|
105 (57.7)
|
54 (29.7)
|
|
|
Traditional Chinese medicine
|
6 (5.6)
|
20 (18.5)
|
82 (75.9)
|
|
|
8 (21.6)
|
15 (40.5)
|
14 (37.8)
|
|
|
Monthly income (RMB)
|
8.255
|
0.004
|
|
|
|
1.014
|
0.908
|
≤ 5000
|
51 (7.3)
|
167 (23.9)
|
481 (68.8)
|
|
|
0 (0.0)
|
0 (0.0)
|
0 (0.0)
|
|
|
5001-1,0000
|
28 (8.7)
|
101 (31.3)
|
194 (60.1)
|
|
|
15 (16.5)
|
51 (56.0)
|
25 (27.5)
|
|
|
1,0001–2,0000
|
6 (14.3)
|
14 (33.3)
|
22 (52.4)
|
|
|
43 (14.6)
|
161 (54.6)
|
91 (30.8)
|
|
|
≥ 2,0001
|
2 (8.3)
|
8 (33.3)
|
14 (58.3)
|
|
|
51 (14.0)
|
194 (53.4)
|
118 (32.5)
|
|
|
Altruism
|
|
|
|
1038.285
|
< 0.001
|
|
|
|
52.842
|
< 0.001
|
Low level
|
63 (58.3)
|
31 (28.7)
|
14 (13.0)
|
|
|
5 (55.6)
|
2 (22.2)
|
2 (22.2)
|
|
|
Middle level
|
19 (5.9)
|
239 (74.0)
|
65 (20.1)
|
|
|
34 (31.8)
|
59 (55.1)
|
14 (13.1)
|
|
|
High level
|
5 (0.8)
|
20 (3.0)
|
632 (96.2)
|
|
|
70 (11.1)
|
345 (54.5)
|
218 (34.4)
|
|
|
Collaborative contents
|
Case discussions
|
|
|
|
0.699
|
0.705
|
|
|
|
13.816
|
0.001
|
No participation
|
28 (8.5)
|
92 (28.0)
|
209 (63.5)
|
|
|
36 (22.1)
|
91 (55.8)
|
36 (22.1)
|
|
|
Participated
|
59 (7.8)
|
198 (26.1)
|
502 (66.1)
|
|
|
73 (12.5)
|
315 (53.8)
|
198 (33.8)
|
|
|
Surgical guidance
|
|
|
|
1.030
|
0.597
|
|
|
|
24.746
|
< 0.001
|
No participation
|
57 (8.3)
|
188 (27.4)
|
440 (64.2)
|
|
|
92 (17.1)
|
304 (56.5)
|
142 (26.4)
|
|
|
Participated
|
30 (7.4)
|
102 (25.3)
|
271 (67.2)
|
|
|
17 (8.1)
|
102 (48.3)
|
92 (43.6)
|
|
|
Academic lectures
|
|
|
|
0.995
|
0.608
|
|
|
|
10.444
|
0.005
|
No participation
|
36 (8.3)
|
122 (28.1)
|
276 (63.6)
|
|
|
59 (18.4)
|
178 (55.5)
|
84 (26.2)
|
|
|
Participated
|
51 (7.8)
|
168 (25.7)
|
435 (66.5)
|
|
|
50 (11.7)
|
228 (53.3)
|
150 (35.0)
|
|
|
Continuing education
|
0.475
|
0.789
|
|
|
|
5.368
|
0.068
|
No participation
|
35 (8.6)
|
110 (27.1)
|
261 (64.3)
|
|
|
37 (19.6)
|
99 (52.4)
|
53 (28.0)
|
|
|
Participated
|
52 (7.6)
|
180 (26.4)
|
450 (66.0)
|
|
|
72 (12.9)
|
307 (54.8)
|
181 (32.3)
|
|
|
Remote consultation
|
0.785
|
0.675
|
|
|
|
26.322
|
< 0.001
|
No participation
|
41 (8.1)
|
141 (27.9)
|
324 (64.0)
|
|
|
102 (16.4)
|
349 (56.0)
|
172 (27.6)
|
|
|
Participated
|
46 (7.9)
|
149 (25.6)
|
387 (66.5)
|
|
|
7 (5.6)
|
57 (45.2)
|
62 (49.2)
|
|
|
Regular outpatient service
|
2.700
|
0.259
|
|
|
|
4.112
|
0.128
|
No participation
|
54 (7.8)
|
197 (28.3)
|
445 (63.9)
|
|
|
35 (17.7)
|
111 (56.1)
|
52 (26.3)
|
|
|
Participated
|
33 (8.4)
|
93 (23.7)
|
266 (67.9)
|
|
|
74 (13.4)
|
295 (53.3)
|
182 (33.0)
|
|
|
Two-way referral
|
|
|
|
5.454
|
0.065
|
|
|
|
6.498
|
0.039
|
No participation
|
55 (8.4)
|
190 (29.0)
|
411 (62.7)
|
|
|
64 (17.3)
|
185 (50.1)
|
120 (32.5)
|
|
|
Participated
|
32 (7.4)
|
100 (23.1)
|
300 (69.4)
|
|
|
45 (11.8)
|
221 (58.2)
|
114 (30.0)
|
|
|
Scientific research cooperation
|
1.088
|
0.580
|
|
|
|
36.507
|
< 0.001
|
No participation
|
81 (8.0)
|
265 (26.3)
|
663 (65.7)
|
|
|
103 (17.2)
|
337 (56.2)
|
160 (26.7)
|
|
|
Participated
|
6 (7.6)
|
25 (31.6)
|
48 (60.8)
|
|
|
6 (4.0)
|
69 (46.3)
|
74 (49.7)
|
|
|
Medical management
|
0.328
|
0.849
|
|
|
|
31.320
|
< 0.001
|
No participation
|
68 (8.2)
|
218 (26.4)
|
540 (65.4)
|
|
|
92 (19.1)
|
264 (54.9)
|
125 (26.0)
|
|
|
Participated
|
19 (7.3)
|
72 (27.5)
|
171 (65.3)
|
|
|
17 (6.3)
|
142 (53.0)
|
109 (40.7)
|
|
|
Incentive types
|
Economic returns
|
353.575
|
< 0.001
|
|
|
|
87.551
|
< 0.001
|
Low level
|
73 (13.7)
|
110 (20.7)
|
348 (65.5)
|
|
|
44 (41.9)
|
42 (40.0)
|
19 (18.1)
|
|
|
Middle level
|
7 (3.0)
|
163 (69.4)
|
65 (27.7)
|
|
|
19 (13.6)
|
92 (65.7)
|
29 (20.7)
|
|
|
High level
|
7 (2.2)
|
17 (5.3)
|
298 (92.5)
|
|
|
46 (9.1)
|
272 (53.0)
|
186 (36.9)
|
|
|
Rewards
|
|
|
|
365.502
|
< 0.001
|
|
|
|
27.477
|
< 0.001
|
Low level
|
72 (29.2)
|
85 (35.3)
|
84 (34.9)
|
|
|
27 (18.1)
|
81 (54.4)
|
41 (27.5)
|
|
|
Middle level
|
9 (1.9)
|
188 (38.8)
|
288 (59.4)
|
|
|
40 (19.3)
|
126 (60.9)
|
41 (19.8)
|
|
|
High level
|
6 (1.7)
|
17 (4.7)
|
339 (93.6)
|
|
|
42 (10.7)
|
199 (50.6)
|
152 (38.7)
|
|
|
Position promotion
|
742.936
|
< 0.001
|
|
|
|
3.954
|
0.412
|
Low level
|
67 (19.2)
|
29 (8.3)
|
253 (72.5)
|
|
|
12 (11.5)
|
56 (53.8)
|
36 (34.6)
|
|
|
Middle level
|
13 (4.3)
|
248 (81.3)
|
44 (14.4)
|
|
|
34 (16.6)
|
117 (57.1)
|
54 (26.3)
|
|
|
High level
|
7 (1.6)
|
13 (3.0)
|
414 (95.4)
|
|
|
63 (14.3)
|
233 (53.0)
|
144 (32.7)
|
|
|
Professional title promotion
|
539.951
|
< 0.001
|
|
|
|
8.738
|
0.068
|
Low level
|
69 (16.8)
|
61 (14.8)
|
281 (68.4)
|
|
|
4 (7.5)
|
25 (47.2)
|
24 (45.3)
|
|
|
Middle level
|
8 (2.7)
|
216 (74.2)
|
67 (23.0)
|
|
|
5 (10.6)
|
23 (48.9)
|
19 (40.4)
|
|
|
High level
|
10 (2.6)
|
13 (3.4)
|
363 (94.0)
|
|
|
100 (15.4)
|
358 (55.2)
|
191 (29.4)
|
|
|
Expanding fame
|
|
|
|
268.147
|
< 0.001
|
|
|
|
3.937
|
0.415
|
Low level
|
77 (25.8)
|
109 (36.6)
|
112 (37.6)
|
|
|
9 (11.8)
|
40 (52.6)
|
27 (35.5)
|
|
|
Middle level
|
9 (1.9)
|
172 (35.8)
|
300 (62.4)
|
|
|
47 (16.0)
|
166 (56.7)
|
80 (27.3)
|
|
|
High level
|
1 (0.3)
|
9 (2.9)
|
299 (96.8)
|
|
|
53 (13.9)
|
200 (52.6)
|
127 (33.4)
|
|
|
Obtaining respect
|
|
|
|
391.761
|
< 0.001
|
|
|
|
3.316
|
0.506
|
Low level
|
69 (32.2)
|
84 (39.3)
|
61 (28.5)
|
|
|
5 (14.3)
|
17 (48.6)
|
13 (37.1)
|
|
|
Middle level
|
14 (2.7)
|
190 (37.2)
|
307 (60.1)
|
|
|
49 (16.1)
|
171 (56.1)
|
85 (27.9)
|
|
|
High level
|
4 (1.1)
|
16 (4.4)
|
343 (94.5)
|
|
|
55 (13.4)
|
218 (53.3)
|
136 (33.3)
|
|
|
Enhancing professional status
|
375.647
|
< 0.001
|
|
|
|
5.293
|
0.259
|
Low level
|
73 (29.4)
|
95 (38.3)
|
80 (32.3)
|
|
|
6 (13.3)
|
20 (44.4)
|
19 (42.2)
|
|
|
Middle level
|
12 (2.4)
|
183 (36.5)
|
306 (61.1)
|
|
|
49 (16.3)
|
168 (56.0)
|
83 (27.7)
|
|
|
High level
|
2 (0.6)
|
12 (3.5)
|
325 (95.9)
|
|
|
54 (13.4)
|
218 (54.0)
|
132 (32.7)
|
|
|
Improving professional skills
|
113.064
|
< 0.001
|
|
|
|
28.614
|
< 0.001
|
Low level
|
64 (61.5)
|
27 (26.0)
|
13 (12.5)
|
|
|
6 (31.6)
|
7 (36.8)
|
6 (31.6)
|
|
|
Middle level
|
18 (5.7)
|
244 (76.7)
|
56 (17.6)
|
|
|
41 (24.7)
|
90 (54.2)
|
35 (21.1)
|
|
|
High level
|
5 (0.8)
|
19 (2.9)
|
642 (96.4)
|
|
|
62 (11.0)
|
309 (54.8)
|
193 (34.2)
|
|
|
For participants of provincial hospitals, half of participants were a middle level of willingness to participate in an urban-rural medical consortium (54.2%), while 109 (14.6%) and 234 (31.2%) expressed low and high levels of willingness to participate, respectively (Fig. 2). As shown in Table 4, a significant difference was found between the levels of willingness to participate on the various variables, including altruism (χ2 = 52.842, p < 0.001), case discussion (χ2 = 13.816, p = 0.001), surgical guidance (χ2 = 24.746, p < 0.001), academic lectures (χ2 = 10.444, p = 0.005), remote consultation (χ2 = 26.322, p < 0.001), two-way referral (χ2 = 6.498, p = 0.039), scientific research cooperation (χ2 = 36.507, p < 0.001), medical management (χ2 = 31.320, p < 0.001), economic returns (χ2 = 87.551, p < 0.001), and rewards (χ2 = 27.477, p < 0.001).
Predictors affecting the influence of incentive on willingness to participate
For all participants, after discovering that hospital levels, age, work year, title, education degree, occupation category, monthly income, altruism, surgical guidance, academic lectures, remote consultation, regular outpatient, scientific research cooperation, and medical management were significantly associated with willingness to participate, which were controlled using cumulative logistic regression analysis to examine the incentive factors of willingness to participate in the urban-rural medical consortium. Physicians who had a high level of economic returns by participating in urban-rural medical consortia apparently had a higher level of willingness to participate than those with low (β=−1.103, 95% CI = − 1.495 to − 0.711, P < 0.001) and middle (β=−0.773, 95% CI = − 1.134 to − 0.411, P < 0.001) levels of economic returns. Compared with those who had a high level of professional title (β = 0.466, 95% CI = 0.001 to 0.930, P = 0.049) and status (β = 0.879, 95% CI = 0.021 to 1.738, P = 0.045) promotion, respondents who had a low level of title and status promotion were more willing to participate in urban-rural medical consortia. Meanwhile, physicians who had a high level of reward had a higher willingness to participate in urban-rural medical consortia than those who had a low level of rewards (β=−0.498, 95% CI = − 0.922 to − 0.074, P = 0.021). Physicians who had a high level of professional skills improved by participating in urban-rural medical consortia apparently had a higher level of willingness to participate than those who had a low (β=−2.201, 95% CI = − 2.893 to − 1.509, P < 0.001) and middle (β=−1.224, 95% CI = − 1.573 to − 0.876, P < 0.001) improved level of skills. The detailed results are presented in Table 5.
Table 5
Outcome of a cumulative logistic model examining control variables, all physicians’ willingness to participate.
Control variables
|
Variables
|
B
|
P-Value
|
OR
|
95%CI
|
Lower
|
Upper
|
Hospital level
|
County hospital
|
2.641
|
< 0.001
|
14.027
|
2.082
|
3.199
|
Provincial hospital
|
Ref.
|
Age
|
18–29
|
0.181
|
0.644
|
1.198
|
-0.586
|
0.949
|
30–39
|
-0.147
|
0.655
|
0.863
|
-0.792
|
0.498
|
40–49
|
0.027
|
0.923
|
1.027
|
-0.513
|
0.566
|
≥ 50
|
Ref.
|
Work year
|
≤ 5
|
-0.348
|
0.228
|
0.706
|
-0.914
|
0.218
|
6–10
|
-0.239
|
0.346
|
0.787
|
-0.735
|
0.258
|
10–15
|
0.249
|
0.269
|
1.282
|
-0.193
|
0.690
|
≥ 16
|
Ref.
|
Title
|
Primary title
|
-0.437
|
0.075
|
0.646
|
-0.918
|
0.044
|
Middle title
|
-0.496
|
0.009
|
0.609
|
-0.866
|
-0.126
|
High title
|
Ref.
|
Education status
|
Bachelor
|
0.142
|
0.585
|
1.153
|
-0.367
|
0.651
|
Master
|
-0.040
|
0.853
|
0.961
|
-0.468
|
0.388
|
PhD
|
Ref.
|
Occupation category
|
Surgery medicine
|
-0.578
|
0.017
|
0.561
|
-1.055
|
-0.101
|
Internal medicine
|
-0.546
|
0.025
|
0.579
|
-1.024
|
-0.067
|
Medical technology
|
-0.821
|
0.001
|
0.440
|
-1.317
|
-0.324
|
Traditional Chinese medicine
|
Ref.
|
Monthly income (RMB)
|
≤ 5000
|
0.128
|
0.616
|
1.137
|
-0.373
|
0.629
|
5001-1,0000
|
-0.180
|
0.390
|
0.835
|
-0.591
|
0.231
|
1,0001–2,0000
|
0.086
|
0.584
|
1.090
|
-0.222
|
0.394
|
≥ 2,0001
|
Ref.
|
Altruism
|
Low level
|
-3.569
|
< 0.001
|
0.028
|
-4.328
|
-2.810
|
Middle level
|
-1.858
|
< 0.001
|
0.156
|
-2.249
|
-1.466
|
High level
|
Ref.
|
Surgical guidance
|
No participation
|
-0.254
|
0.093
|
0.776
|
-0.550
|
0.042
|
Participated
|
Ref.
|
Academic lectures
|
No participation
|
-0.086
|
0.500
|
0.918
|
-0.335
|
0.164
|
Participated
|
Ref.
|
Remote consultation
|
No participation
|
-0.272
|
0.087
|
0.762
|
-0.584
|
0.040
|
Participated
|
Ref.
|
Regular outpatient service
|
No participation
|
0.509
|
< 0.001
|
1.664
|
0.233
|
0.786
|
Participated
|
Ref.
|
Scientific research cooperation
|
No participation
|
-0.324
|
0.092
|
0.723
|
-0.700
|
0.052
|
Participated
|
Ref.
|
Medical management
|
No participation
|
-0.059
|
0.655
|
0.943
|
-0.318
|
0.200
|
Participated
|
Ref.
|
Independent variables
|
|
Economic returns
|
Low level
|
-1.103
|
< 0.001
|
0.332
|
-1.495
|
-0.711
|
Middle level
|
-0.773
|
< 0.001
|
0.462
|
-1.134
|
-0.411
|
High level
|
Ref.
|
Rewards
|
Low level
|
-0.498
|
0.021
|
0.608
|
-0.922
|
-0.074
|
Middle level
|
-0.358
|
0.054
|
0.699
|
-0.721
|
0.006
|
High level
|
Ref.
|
Position promotion
|
Low level
|
0.148
|
0.502
|
1.160
|
-0.285
|
0.581
|
Middle level
|
-0.359
|
0.049
|
0.698
|
-0.716
|
-0.002
|
High level
|
Ref.
|
Professional title promotion
|
Low level
|
0.466
|
0.049
|
1.594
|
0.001
|
0.930
|
Middle level
|
0.128
|
0.562
|
1.137
|
-0.304
|
0.559
|
High level
|
Ref.
|
Expanding fame
|
Low level
|
-0.147
|
0.677
|
0.863
|
-0.837
|
0.543
|
Middle level
|
-0.241
|
0.431
|
0.786
|
-0.841
|
0.359
|
High level
|
Ref.
|
Obtaining respect
|
Low level
|
-0.549
|
0.218
|
0.578
|
-1.423
|
0.324
|
Middle level
|
-0.019
|
0.958
|
0.981
|
-0.737
|
0.699
|
High level
|
Ref.
|
Enhancing professional status
|
Low level
|
0.879
|
0.045
|
2.408
|
0.021
|
1.738
|
Middle level
|
0.423
|
0.251
|
1.527
|
-0.299
|
1.146
|
High level
|
Ref.
|
Improving professional skills
|
Low level
|
-2.201
|
< 0.001
|
0.111
|
-2.893
|
-1.509
|
Middle level
|
-1.224
|
< 0.001
|
0.294
|
-1.573
|
-0.876
|
High level
|
Ref.
|
For county hospitals participants, after discovering that title, monthly income, and altruism were significantly associated with willingness to participate, these factors were controlled using cumulative logistic regression analysis to examine the incentive factors for willingness to participate in urban-rural medical consortia. Compared with those who had a high level of position promotion, respondents who had low (β=-2.767, 95% CI=-3.669 to -1.864, P < 0.001) and middle (β=-2.638, 95% CI=-3.429 to -1.848, P < 0.001) levels of position promotion were less willing to participate in urban-rural medical consortia. Physicians who had a high level of professional skills improved by participating in the urban-rural medical consortium apparently had a higher level of willingness to participate than those who had a low (β=−4.113, 95% CI = − 5.151 to − 3.074, P < 0.001) and middle (β=−2.817, 95% CI = − 3.602 to − 2.032, P < 0.001) improved level of skills. The detailed results are presented in Table 6.
Table 6
Outcome of a cumulative logistic model examining control variables, county physicians’ willingness to participate.
Control variables
|
Variables
|
B
|
P-Value
|
OR
|
95%CI
|
Lower
|
Upper
|
Title
|
Primary title
|
-0.202
|
0.485
|
0.817
|
-0.768
|
0.364
|
Middle title
|
-0.249
|
0.390
|
0.780
|
-0.817
|
0.319
|
High title
|
Ref.
|
Monthly income (RMB)
|
≤ 5000
|
0.654
|
0.304
|
1.923
|
-0.593
|
1.900
|
5001-1,0000
|
0.480
|
0.457
|
1.616
|
-0.784
|
1.743
|
1,0001–2,0000
|
0.886
|
0.248
|
2.425
|
-0.617
|
2.389
|
≥ 2,0001
|
Ref.
|
Altruism
|
Low level
|
-3.142
|
< 0.001
|
0.043
|
-4.211
|
-2.074
|
Middle level
|
-2.076
|
< 0.001
|
0.125
|
-2.829
|
-1.322
|
High level
|
Ref.
|
Independent variables
|
|
Economic returns
|
Low level
|
0.233
|
0.624
|
1.262
|
-0.698
|
1.163
|
Middle level
|
-0.217
|
0.642
|
0.805
|
-1.131
|
0.698
|
High level
|
Ref.
|
Rewards
|
Low level
|
-0.015
|
0.978
|
0.985
|
-1.080
|
1.049
|
Middle level
|
0.643
|
0.188
|
1.902
|
-0.315
|
1.600
|
High level
|
Ref.
|
|
|
|
|
Position promotion
|
Low level
|
-2.767
|
< 0.001
|
0.063
|
-3.669
|
-1.864
|
Middle level
|
-2.638
|
< 0.001
|
0.072
|
-3.429
|
-1.848
|
High level
|
Ref.
|
Professional title promotion
|
Low level
|
-0.226
|
0.652
|
0.798
|
-1.211
|
0.758
|
Middle level
|
0.109
|
0.813
|
1.115
|
-0.796
|
1.014
|
High level
|
Ref.
|
Expanding fame
|
Low level
|
-0.829
|
0.221
|
0.436
|
-2.157
|
0.498
|
Middle level
|
-0.764
|
0.271
|
0.466
|
-2.126
|
0.598
|
High level
|
Ref.
|
Obtaining respect
|
Low level
|
0.426
|
0.518
|
1.531
|
-0.864
|
1.715
|
Middle level
|
0.363
|
0.556
|
1.438
|
-0.844
|
1.569
|
High level
|
Ref.
|
Enhancing professional status
|
Low level
|
0.751
|
0.262
|
2.119
|
-0.562
|
2.063
|
Middle level
|
0.827
|
0.179
|
2.286
|
-0.378
|
2.032
|
High level
|
Ref.
|
Improving professional skills
|
Low level
|
-4.113
|
< 0.001
|
0.016
|
-5.151
|
-3.074
|
Middle level
|
-2.817
|
< 0.001
|
0.060
|
-3.602
|
-2.032
|
High level
|
Ref.
|
For participants of provincial hospitals, after discovering that altruism, case discussion, surgical guidance, academic lectures, remote consultation, two-way referral, scientific research cooperation, medical management were significantly associated with willing to participate, these factors were controlled using cumulative logistic regression analysis to examine the incentive factors of willing to participate in urban-rural medical consortium. Physicians who had a high level of economic returns by participating in urban-rural medical consortia apparently had a higher level of willingness to participate than those with low (β=−1.553, 95% CI = − 2.043 to − 1.063, P < 0.001) and middle (β=−0.503, 95% CI = − 0.912 to − 0.094, P = 0.016) levels of economic returns. Physicians who had a high level of reward had a higher level of willingness to participate in urban-rural medical consortia than those with a middle level of reward (β=−0.417, 95% CI = − 0.783 to − 0.051, P = 0.026). The detailed results are presented in Table 7.
Table 7
Outcome of a cumulative logistic model examining control variables, provincial physicians’ willingness to participate.
Control variables
|
Variables
|
B
|
P-Value
|
OR
|
95%CI
|
Lower
|
Upper
|
Altruism
|
Low level
|
-1.743
|
0.031
|
0.175
|
-3.323
|
-0.163
|
Middle level
|
-0.826
|
0.001
|
0.438
|
-1.313
|
-0.340
|
High level
|
Ref.
|
Case discussion
|
No participation
|
-0.286
|
0.125
|
0.751
|
-0.651
|
0.079
|
Participated
|
Ref.
|
Surgical guidance
|
No participation
|
-0.180
|
0.358
|
0.835
|
-0.565
|
0.205
|
Participated
|
Ref.
|
Academic lectures
|
No participation
|
-0.172
|
0.277
|
0.842
|
-0.483
|
0.138
|
Participated
|
Ref.
|
Remote consultation
|
No participation
|
-0.640
|
0.010
|
0.527
|
-1.127
|
-0.153
|
Participated
|
Ref.
|
Two-way referral
|
No participation
|
0.436
|
0.006
|
1.547
|
0.124
|
0.748
|
Participated
|
Ref.
|
Scientific research cooperation
|
No participation
|
-0.540
|
0.025
|
0.583
|
-1.012
|
-0.067
|
Participated
|
Ref.
|
Medical management
|
No participation
|
-0.182
|
0.299
|
0.834
|
-0.526
|
0.162
|
Participated
|
Ref.
|
Independent variables
|
Economic returns
|
Low level
|
-1.553
|
< 0.001
|
0.212
|
-2.043
|
-1.063
|
Middle level
|
-0.503
|
0.016
|
0.605
|
-0.912
|
-0.094
|
High level
|
Ref.
|
Reward
|
Low level
|
0.123
|
0.565
|
1.131
|
-0.297
|
0.544
|
Middle level
|
-0.417
|
0.026
|
0.659
|
-0.783
|
-0.051
|
High level
|
Ref.
|
Improve professional skills
|
Low level
|
0.550
|
0.334
|
1.733
|
-0.566
|
1.666
|
Middle level
|
-0.252
|
0.215
|
0.777
|
-0.651
|
0.147
|
High level
|
Ref.
|