{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:25:03Z","timestamp":1787030703255,"version":"build-2736575974"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Expanding access to community-based primary care is central to addressing the health challenges posed by population aging in China. This study examines associations between Family Doctor Contract Service (FDCS) participation and multidimensional health outcomes among community-dwelling older adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Using nationally representative data from the 2023 China Longitudinal Aging Social Survey (\n                      <jats:italic>N<\/jats:italic>\n                      \u202f=\u202f11,455), we assessed three health dimensions: self-rated health, physical discomfort, and life satisfaction. OLS regression provided a transparent baseline of adjusted associations, ordered probit and logit models served as robustness checks for ordinal outcomes, and propensity score matching was used as a covariate-balance adjustment tool for observable selection into FDCS participation. Subgroup analyses examined heterogeneity by urban or rural residence and education level.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>FDCS participation was significantly associated with more favorable observed outcomes across all three health dimensions. Rural and less-educated older adults showed stronger associations with lower reported physical discomfort and higher life satisfaction, whereas urban and higher-educated older adults showed stronger associations with self-rated health appraisals. This pattern suggests heterogeneous associations between FDCS participation and health outcomes across population groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The findings suggest that reported FDCS participation is associated with multiple dimensions of older adults\u2019 health, with heterogeneous patterns across residence and education groups. Differentiated service design may help align community-based primary care with the observed needs of different older adult subpopulations. All findings reflect adjusted associations from a cross-sectional observational study and should not be interpreted as causal estimates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1875855","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:28:06Z","timestamp":1787027286000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Strengthening primary care gatekeeping for healthy aging in China: family doctor contract service and multidimensional health outcomes among older adults"],"prefix":"10.3389","volume":"14","author":[{"given":"Cangcang","family":"Jia","sequence":"first","affiliation":[{"name":"School of Health Policy & Management, Nanjing Medical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengyang","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Government, Nanjing University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Government, Nanjing University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Wang","sequence":"additional","affiliation":[{"name":"Nanjing Drum Tower Hospital, Nanjing University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1016\/j.arr.2015.08.003","article-title":"A research agenda for aging in China in the 21st century","volume":"24","author":"Fang","year":"2015","journal-title":"Ageing Res Rev"},{"key":"ref2","year":"2025"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1333","DOI":"10.1056\/NEJMoa1406656","article-title":"Demographic and epidemiologic drivers of global cardiovascular mortality","volume":"372","author":"Roth","year":"2015","journal-title":"N Engl J Med"},{"key":"ref4","year":"2024"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1016\/S0140-6736(14)61347-7","article-title":"The burden of disease in older people and implications for health policy and practice","volume":"385","author":"Prince","year":"2015","journal-title":"Lancet"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1930","DOI":"10.1016\/S0140-6736(16)31405-2","article-title":"The effects of China\u2019s universal two-child policy","volume":"388","author":"Zeng","year":"2016","journal-title":"Lancet"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s12939-020-01362-6","article-title":"Catastrophic health expenditure among single empty-nest elderly with multimorbidity in rural Shandong, China: the effect of co-occurrence of frailty","volume":"20","author":"Jing","year":"2021","journal-title":"Int J Equity Health"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"830","DOI":"10.1093\/pubmed\/fdy185","article-title":"Improvement of social support in empty-nest elderly: results from an intervention study based on the self-mutual-group model","volume":"41","author":"Zhang","year":"2019","journal-title":"J Public Health"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/09687599.2025.2498416","article-title":"Family doctor contract services for persons with disabilities in China","volume":"1","author":"Cong","year":"2025","journal-title":"Disability & Society"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"2675","DOI":"10.12114\/j.issn.1007-9572.2019.00.346","article-title":"Hotspots and emerging trends in contracted family doctor services research: a scientometric analysis in CiteSpace","volume":"22","author":"Minting","year":"2019","journal-title":"Chinese General Practice"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1186\/s12875-024-02383-8","article-title":"The impact of hypertension follow-up management on the choices of signing up family doctor contract services: does socioeconomic status matter?","volume":"25","author":"Wang","year":"2024","journal-title":"BMC Prim Care"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1186\/s12875-020-01353-0","article-title":"The developing family doctor system: evidence from the progress of the family doctor signing service from a longitudinal survey (2013\u20132016) in Pudong new area, Shanghai","volume":"22","author":"Liu","year":"2013","journal-title":"BMC Fam Pract"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1186\/s12877-021-02543-w","article-title":"Do older people with cardiovascular-metabolic multimorbidity prefer to sign contracts for family doctor services? 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