China has made some achievements in the construction of hierarchical medical system, but the development of its primary healthcare settings is still relatively slow.

To analyze the changes in patient visits and associated determinants in primary healthcare settings in Guangdong during 2013 to 2020, providing a basis for deepening the construction of hierarchical medical system.

In December 2021, this study extracted patient visits in primary healthcare institutions of Guangdong from Guangdong Health Statistics Yearbook (2013—2015), Guangdong Health and Family Planning Statistical Yearbook (2016—2017), and Guangdong's Hygiene and Health Statistical Yearbook (2018—2020) as the reference sequence, and extracted the population data and per capita disposable income from Guangdong Statistical Yearbook 2021, and the financial subsidy for primary healthcare institutions and the number of medical insurance participants from China Health and Family Planning Statistical Yearbook (2015—2017) and China's Hygiene and Health Statistical Yearbook (2018—2021) as the comparative sequence. Grey relational analysis was used to evaluate the strength of correlation between the number of patient visits and its potential associated determinants involving demographic and socioeconomic status, health resource allocation and medical insurance participation.

The number of hospital visits in Guangdong increased from 334.592 million in 2013 to 401.317 million in 2019, with an average annual growth of 3.08%. The number of patient visits in primary healthcare settings in the province reached 437.317 million in 2019, and the average annual growth in these settings was 2.10% during 2013 to 2019. In 2020, the number of patient visits in hospitals and in primary healthcare settings both decreased significantly because of the COVID-19 pandemic. The number of patients visits in primary healthcare settings accounted for 50.7% of all patients visits in medical institutions in 2013, which declined to 48.1% in 2020. Grey relational analysis showed that both the number of residents (r=0.913) and the number of people aged over 65 years old (r=0.913) had the strongest correlation with the number of patient visits in primary healthcare settings, followed by the number of urban-rural resident basic medical insurance participants (r=0.899), the number of beds in primary healthcare settings (r=0.893), the number of primary healthcare settings (r=0.886) and the number of urban employee basic medical insurance participants (r=0.872) .

At present, many patients still choose to hospitals for medical services, which calls for actions to strengthen the first contact in primary care system. It is suggested to meet the needs of residents for nearby medical treatment by enriching the connotation of primary care services, widening the gap of healthcare expenses reimbursed by medical insurance among medical institutions and improving the service capacity of primary healthcare settings under the background of population aging.