The effect of patient perceived involvement on patient loyalty in primary care: The mediating role of patient satisfaction and the moderating role of the family doctor contract service

The Chinese government has taken many incentives to promote the implementation of the family doctor (FD) contract service; however, whether primary health care providers establishing a strong relationship with patients that shapes their loyalty is still unknown. Under this circumstance, drawing the public attention to patient loyalty in primary care and clarifying the underlying mechanism of loyalty is imperative to the development of primary care.To analyse the effect of patient perceived involvement on patient loyalty in primary care, investigate the mediating role of patient satisfaction, and explore the moderating role of the FD contract service on the relationship between patient perceived involvement and patient loyalty.A cross-sectional questionnaire survey of patients in primary health facilities was conducted in Jilin province of China. Participants comprised 1334 patients selected via a multi-stage sampling method.Patient perceived involvement not only had a direct positive impact on patient loyalty but also had an indirect effect on patient loyalty via patient satisfaction. Furthermore, for patients who contracted with FDs, patient perceived involvement had a higher direct effect and indirect effect on patient loyalty when compared with patients who did not contract with FDs.Our findings suggest that health managers should encourage patients to participate in medical visits to improve patient satisfaction. Additionally, customised and tailored health services that meet individuals' specific needs and preferences should be designed and implemented to attract more patients to contract the FD contract service.