Fig. 1

A Conceptual Framework for Assessing Patients’ Self-referral Behaviors within China’s two-tiered health system in rural region. We integrated the Anderson and Adey model with the health belief model to understand patients’ self-referral behavior. Both models have been widely used to analyze health services utilization. As shown in Fig. 1, individual belief is a mediator in the pathway between individual predisposing factors (i.e. age, gender, census registration status, and marital status), enabling factors (i.e. household income, and whether having a usual primary care provider), need factors (i.e. whether the same disease existed in the last month and whether the patient is in an acute condition) and patients’ health care seeking behavior