To understand the initial healthcare-seeking intentions and influencing factors among residents in the compact urban medical alliance in Anhui Province, a survey was conducted among residents seeking medical care within the compact urban medical alliance in the North, Central, and South regions of Anhui Province. Among the 513 participants included in the analysis, 16.8% of residents were aware of bidirectional referrals, 78.4% chose primary healthcare institutions for their initial visit, and 82.8% selected the hospital due to its proximity to their home or workplace. Further analysis revealed that factors such as educational level, age, monthly income, trust in primary healthcare institutions, and perceptions of the necessity of bidirectional referrals significantly influenced residents" healthcare-seeking behavior. It is recommended to optimize the referral process and guide residents to seek healthcare in an orderly manner. Furthermore, policy support should be strengthened for primary healthcare institutions, and the welfare of primary healthcare personnel should be improved. Measures such as talent introduction and continuing education should be implemented 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.