Abstract: The family doctor signing system is an important foundation for the supply of integrated medical and preventive services. This study uses the data from the China Health and Elderly Care Tracking Survey 2018 to investigate the mechanism of paid family doctor signing services on public medical behavior and choice. The findings of this paper show that from the perspective of medical service utilization, paid family doctor contract services can effectively promote their medical service utilization behaviors, and the improvement effect on outpatient behavior is stronger than that on hospitalization. From the perspective of medical expenses, participating in paid contracts can significantly reduce residents’ self payment expenses for medical. From the perspective of grassroots first visit behavior, paid family doctor contract services can effectively regulate resident hospitalization behaviors in grassroots first visits, but have no significant improvement effect on outpatient services. From the perspective of the impact mechanism, medical service satisfaction plays a mediating role in the mechanism of paid contract signing on hospitalization behavior, but does not affect outpatient behavior. From the perspective of accessibility to medical resources, both outpatient and inpatient medical distances can positively moderate the impact of paid contracts on medical out-of-pocket expenses, while only a negative moderating effect of inpatient medical distance is found in the impact on grassroots first visit behavior. Based on the above findings, this article suggests relying on paid contract services to improve the utilization level of medical services, strengthen the capacity of grassroots medical and health services, include paid contracts in medical insurance to further reduce patient self payment costs, and improve the accessibility and public satisfaction of grassroots medical and health services.

Key words: medical-prevention integration services, signed contracts with family doctors, medical treatment behavior, medical service satisfaction