Background Since the 1970s, the WHO has recognized primary health care as essential for universal health coverage. Following China's 2009 healthcare reform, the functional features theory (4Cs) for primary care was introduced. Researchers have conducted extensive studies, employing both international and localized instruments to evaluate the process quality of primary care service across diverse regions and populations in China.
Objective This review synthesizes qualitative and quantitative evidence on the concepts, intensity, and health service outcome impacts of functional features in China's primary care services, offering evidence for quality assessment and improvement in China and comparable low- and middle-income countries.
Methods Using the JBI mixed-methods systematic review framework, the researchers searched PubMed, Embase, Web of Science, Google Scholar, CNKI, and Wanfang for studies from January 2009 to March 2025. Two researchers screened literature using Rayyan, evaluated methodological quality with JBI tools, and synthesized qualitative and quantitative data via the convergent segregated approach to explore outcome mechanisms.
Results This review included 60 studies (52 quantitative studies, 4 qualitative studies, 3 mixed-method studies). The functional features of China's primary care services can be broadly categorized into six dimensions: first contact, accessibility, comprehensiveness, continuity, coordination, and patient empowerment. Accessibility and patient empowerment are strong, while comprehensiveness is weaker. Overall, stronger functional features correlate with improved health outcomes, patient experiences, lower healthcare costs, utilization preference for primary care, and reduced hospital utilization, supported by qualitative data.
Conclusion Future efforts should develop a China-specific functional features framework for primary care services, create tailored measurement tools, and generate rigorous evidence to advance practice and research.
