Horizontal Integration and Financing Reform of Rural Primary Care in China: A Model for Low-Resource and Remote Settings

Zhi Zeng, Wenjuan Tao, Shanlong Ding, Jianlong Fang, Jin Wen, Jianhong Yao and Wei Zhang
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Zhi Zeng: Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu 610041, China
Wenjuan Tao: Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu 610041, China
Shanlong Ding: World Health Organization, 1207 Geneva, Switzerland
Jianlong Fang: Chinese Center for Disease Control and Prevention, National Institute of Environmental Health, Beijing 100021, China
Jin Wen: Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu 610041, China
Jianhong Yao: Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
Wei Zhang: Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu 610041, China

IJERPH, 2022, vol. 19, issue 14, 1-12

Abstract: Primary health care (PHC) systems are compromised by under-resourcing and inadequate governance, and fail to provide high-quality health care services in most low- and middle-income countries (LMICs). As a response to solve the problems of underfunding and understaffing, Pengshui County, an impoverished area in rural Chongqing, China, implemented a profound reform of its PHC delivery system in 2009, focusing on horizontal integration and financing mechanisms. This paper aims to present new evidence from the Pengshui model, and to assess the relevant changes over the past 10 years (2009–2018). An inductive approach was adopted, based on analysis of national and local policy documents and administrative data. From 2009 to 2018, the proportion of outpatients who sought first-contact care in rural community or township health centers increased from 29% (522,700 of 1,817,600) in 2009, to 40% (849,900 of 2,147,800) in 2018 (the national average in 2018 was 23%). Our findings suggest that many positive results have been achieved through the reform, and that innovations in financial governance and incentive mechanisms are the main driving forces behind the improvement. Pengshui County’s experience has proven to be a successful experiment, particularly in rural and low-income areas.

Keywords: integrated care; primary care; rural area; health care reform (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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