How Can One Strengthen a Tiered Healthcare System through Health System Reform? Lessons Learnt from Beijing, China

Shuduo Zhou, Jin Xu, Xiaochen Ma, Beibei Yuan, Xiaoyun Liu, Hai Fang and Qingyue Meng
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Shuduo Zhou: School of Public Health, Peking University, Beijing 100191, China
Jin Xu: China Center for Health Development Studies, Peking University, Beijing 100191, China
Xiaochen Ma: China Center for Health Development Studies, Peking University, Beijing 100191, China
Beibei Yuan: China Center for Health Development Studies, Peking University, Beijing 100191, China
Xiaoyun Liu: China Center for Health Development Studies, Peking University, Beijing 100191, China
Hai Fang: China Center for Health Development Studies, Peking University, Beijing 100191, China
Qingyue Meng: School of Public Health, Peking University, Beijing 100191, China

IJERPH, 2020, vol. 17, issue 21, 1-14

Abstract: How one can reshape the current healthcare sector into a tiered healthcare system with clarified division of functions between primary care facilities and hospitals, and improve the utilization of primary care, is a worldwide problem, especially for the low and middle-income countries (LMICs). This paper aimed to evaluate the impact of the Beijing Reform on healthcare-seeking behavior and tried to explain the mechanism of the change of patient flow. In this before and after study, we evaluated the changes of outpatient visits and inpatient visits among different levels of health facilities. Using the monitored and statistical data of 373 healthcare institutions 1-year before and 1-year after the Beijing Reform, interrupted time series analysis was applied to evaluate the impact of the reform on healthcare-seeking behavior. Semi-structured interviews were used to further explore the mechanisms of the changes. One year after the reform, the flow of outpatients changed from tertiary hospitals to community health centers with an 11.90% decrease of outpatients in tertiary hospitals compared to a 15.01% increase in primary healthcare facilities. The number of ambulatory care visits in primary healthcare (PHC) showed a significant upward trend ( P < 0.10), and the reform had a significant impact on the average number of ambulatory care visits per institution in Beijing’s tertiary hospitals ( p < 0.10). We concluded that the Beijing Reform has attracted a substantial number of ambulatory care visits from hospitals to primary healthcare facilities in the short-term. Comprehensive reform policies were necessary to align incentives among relative stakeholders, which was a critical lesson for other provinces in China and other LMICs.

Keywords: health system reform; tiered healthcare system; China (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (2)

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