Patients' Visiting Preferences in Japan under Universal Coverage and Free Access

Background Patients’ orientation toward domain-specific specialists (SP) for treatment, a form of patient visiting preference, has not been confirmed in societies with universal coverage and free access.

Aim To investigate the visiting preferences of citizens for SPs and general practitioners (GPs) regarding symptoms, diseases, and procedures.

Design and Setting This cross-sectional study used a web survey in Japan, a society with universal coverage and free access, and without well-established general practitioners in the healthcare system.

Method Participants were asked about their visiting preferences for 19 symptoms, 15 diseases, and 16 procedures. Visiting preferences were measured using a 5-point Likert scale, where one meant favourable for SPs and five meant favourable for GPs. Descriptive statistics, including 95% confidence intervals (CIs), were calculated. If the mean score for an item was<3 and the CI did not exceed 3, the participants were considered to prefer SPs, and vice versa.

Results Some symptoms, procedures, and most diseases were oriented towards SPs. Especially, SPs were preferred for diseases, regardless of their invasiveness or speciality. Procedures oriented toward SPs are specialised and invasive. In contrast, GPs were preferred for some symptoms and procedures which are frequently encountered in primary care settings, such as basic outpatient procedures, follow-ups for health checkups, home-visiting care, and end-of-life care for older adults.

Conclusion Specialists were preferred for most diseases and advanced, invasive procedures. Additionally, a generalist orientation was found in procedures that frequently occurred in primary and home healthcare.