This study surveyed among residents seeking medical care within the compact urban medical alliance in the North，Central，and South regions of Anhui Province to understand their initial healthcare - seeking intentions and influencing factors. Among the 513 participants in the analysis，16.8% of the residents were aware of dual referrals. 78.4% of the participant chose primary healthcare institutions for their initial visit， and 82.8% selected the hospital because it was close to their home or workplace. Further analysis revealed that educational level，age，monthly income，trust level in primary healthcare institutions，and perceptions of the necessity of dual referrals significantly influenced residents’healthcare - seeking behavior. It is necessary to optimize the referral process and guide residents to seek healthcare in an orderly manner. Furthermore，it is also essential to strengthen the policy favoring primary healthcare institutions，and improve the welfare of primary healthcare staff. We recommended implementing measures such as talent introduction and continuing education to enhance the service quality of primary healthcare institutions. Accelerating the development of urban healthcare networks and rationalizing the downward distribution of high - quality medical resources will help optimize the configuration of healthcare resources.