Abstract
BACKGROUND: Primary healthcare plays a pivotal role in optimizing healthcare resource allocation and ensuring equitable access to services. In China, first-contact care within the tiered medical care system is essential for alleviating pressure on large hospitals and enhancing healthcare equity. However, challenges such as uneven resource distribution and low patient trust in primary institutions limit the effectiveness of first-contact care. This study aims to explore the dynamic interactions of key factors influencing first-contact effectiveness and provide evidence-based policy recommendations. METHODS: A systematic approach was employed, integrating a literature review, qualitative interviews, and MICMAC structural analysis. Using Causal Loop Diagram (CLD) methodology, this study mapped the causal pathways and feedback mechanisms among factors such as health insurance awareness, medical consortium development, and tiered healthcare policy guidance. MICMAC analysis quantified the influence and dependence of these variables to identify key drivers within the system. RESULTS: The study revealed that primary healthcare service quality, patient trust, and healthcare-seeking behaviors are are vital determinants for improving first-contact effectiveness. Key driving factors include health insurance awareness, medical consortium construction, and tiered healthcare policy guidance, which form reinforcing feedback loops to enhance system efficiency. The findings highlight the importance of resource sharing, trust-building, and policy support in optimizing the tiered medical care system. CONCLUSIONS: This study provides a comprehensive framework for understanding the complexities of first-contact care within China's healthcare system. The insights gained emphasize the need for targeted interventions, including promoting health insurance awareness, strengthening medical consortiums, and improving policy incentives. These recommendations can inform policy reforms aimed at achieving equitable and efficient healthcare systems globally. TRIAL REGISTRATION: Not applicable, as this study does not involve a healthcare intervention on human participants.