How Can One Strengthen a Tiered Healthcare System through Health System Reform? Lessons Learnt from Beijing, China
Abstract
:1. Introduction
2. Methods
2.1. Data Sources
2.2. Measurement
2.3. Data Analysis
2.4. Patient and Public Involvement
3. Results
3.1. Impacts of the Beijing Reform on the Healthcare-Seeking Behavior of Outpatients
3.2. Changes of Outpatient Flow between PHC Providers, Secondary Hospitals, and Tertiary Hospitals
3.3. Changes of Inpatient Flow between PHC Providers, Secondary Hospitals, and Tertiary Hospitals
3.4. Explanations for Changes of the PHC Utilization from Interviewees
3.5. The Main Reasons for Increase in Ambulatory Care Visits for PHC Institutions
As for a secondary or tertiary hospital, now you have to pay at least 20 yuan, 40 yuan, and 60 yuan for the deputy chief physicians or experts. Then if he is a minor patient, he won’t go. If he is over 60 years old, he doesn’t need to spend money on medical service fee in PHC. The change is very obvious and many people have turned around to the community health centers. (Director of a community health service center, July 2017).
Additionally, we have docking 105 catalogues and prescriptions for four chronic diseases (hypertension, diabetic stroke, coronary heart disease) between community health centers and big hospitals which is very important. The long prescription policy is also very helpful. First you need to sign a contract, if the diagnosis is clear and the condition is relatively stable, and it is suitable for long prescriptions at home. (Community Health Management Center of Beijing Municipal Health Commission, June 2016).
We have done a few things to improve. For example, to save the time and improve convenience, the community healthcare centers explore a convenient way for patients to pay, that is, after you see doctor, the payment will be completed once. You pay the drug inspection fee and medical service fee once. (Community Health Management Center Beijing Municipal Health Commission, June 2016).
In fact, it means that we still want to increase the sense of experience or gain of the patients. We increased the green plants, then purchased the waiting chairs in our lobby, and the pharmacy added this automatic medicine dispenser. (Director of a community health service center, July 2017).
3.6. The Main Reasons for the Decrease in Ambulatory Care Visits for Tertiary Hospitals
I think for the decline in the number of outpatients, and the most important reason is the impact of the medical service fee. (Doctor of Oncology, a third-level hospital, July 2017)
Outpatients are definitely much less than before, especially those in our department, because our department has some chronic diseases, and they come regularly to get medicines. Actually for this ten yuan for medical service, the old man cares very much, so obviously less than before. (Doctor of Cardiology, a tertiary hospital, June 2018)
3.7. The Implementation Process of the Beijing Reform
Before the policy appeared, the government departments learned and mastered in advance and then training the medical institutions, training the chief dean, the deputy dean, the main leadership team. The next step was the gradual training at the hospital level, and everyone has been trained. (The Beijing Municipal Health Commission, July 2017)
The first was to organize special training in the hospital to give training to each department, and then the department and the head nurse gave us training for doctors. The reform policy was not only for patients to understand, we also needed to understand before we could explain to the patients. We had been trained for a long time. (Physician at a tertiary Hospital, July 2017)
4. Discussions
5. Conclusions
Author Contributions
Data Sharing Statement
Funding
Ethics Approval
Acknowledgments
Conflicts of Interest
References
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Reform Measures | Descriptions of Reform Measures |
---|---|
Zero mark-up of drug sales and hierarchical medical service fee |
|
Changes of drug catalogues in PHC |
|
Prices adjustment of 435 medical service items |
|
Levels | Classifications | Numbers |
---|---|---|
Tertiary hospitals | 89 | |
Traditional Chinese Medicine Hospitals | 23 | |
Specialist Hospitals | 20 | |
General Hospitals | 46 | |
Secondary hospitals | 78 | |
Maternal and Child Health Hospitals | 13 | |
Traditional Chinese Medicine Hospitals | 12 | |
Specialist Hospitals | 11 | |
General Hospitals | 42 | |
Primary health institutions | 206 | |
In total | 373 |
Medical Institutions | Year | Second Quarter | Third Quarter | Fourth Quarter | First Quarter * | Total |
---|---|---|---|---|---|---|
Tertiary hospitals | 2016 | 309.2 | 313.4 | 331.5 | 288.5 | 1242.6 |
2017 | 272.1 | 278.0 | 287.7 | 256.9 | 1094.7 | |
Percent increase | −12.01% | −11.29% | −13.23% | −10.94% | 11.90% | |
Secondary hospitals | 2016 | 97.8 | 97.9 | 107.6 | 87.0 | 390.2 |
2017 | 94.5 | 97.1 | 110.5 | 90.3 | 392.4 | |
Percent increase | −3.35% | −0.79% | 2.72% | 3.79% | 0.55% | |
Primary health centers | 2016 | 24.6 | 25.7 | 29.7 | 22.2 | 102.2 |
2017 | 26.9 | 29.0 | 33.7 | 27.9 | 117.6 | |
Percent increase | 9.40% | 13.11% | 13.35% | 25.60% | 15.01% |
Medical Institutions | Year | Second Quarter | Third Quarter | Fourth Quarter | First Quarter * | Total |
---|---|---|---|---|---|---|
Tertiary hospitals | 2016 | 7787.46 | 7827.49 | 7922.44 | 7486.42 | 31,023.81 |
2017 | 7951.04 | 8207.90 | 7986.67 | 7706.35 | 31,851.97 | |
Percent increase | 2.10% | 4.86% | 0.81% | 2.94% | 2.67% | |
Secondary hospitals | 2016 | 1718.15 | 1748.47 | 1846.82 | 1670.46 | 6983.90 |
2017 | 1718.69 | 1738.51 | 1771.39 | 1710.48 | 6939.07 | |
Percent increase | 0.03% | −0.57% | −4.08% | 2.40% | −0.64% |
Level/Trend | PHC | Secondary | Tertiary |
---|---|---|---|
Baseline trend | 0.135 (0.149) | 0.367 (0.534) | 1.294 (1.300) |
Level change | −0.939 (1.656) | −5.453 (5.729) | −27.423 (14.358) * |
Trend change | 0.108 (0.084) | 0.223 (0.322) | −0.078 (0.775) |
Post-reform trend | 0.244 (0.139) * | 0.590 (0.458) | 1.216 (1.201) |
Level/Trend | Secondary | Tertiary |
---|---|---|
Baseline trend | 0.005 (0.007) | 0.034 (0.037) |
Level change | −0.052 (0.076) | −0.334 (0.410) |
Trend change | −0.003 (0.004) | −0.001 (0.019) |
Post-reform trend | 0.002 (0.006) | 0.033 (0.032) |
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Zhou, S.; Xu, J.; Ma, X.; Yuan, B.; Liu, X.; Fang, H.; Meng, Q. How Can One Strengthen a Tiered Healthcare System through Health System Reform? Lessons Learnt from Beijing, China. Int. J. Environ. Res. Public Health 2020, 17, 8040. https://doi.org/10.3390/ijerph17218040
Zhou S, Xu J, Ma X, Yuan B, Liu X, Fang H, Meng Q. How Can One Strengthen a Tiered Healthcare System through Health System Reform? Lessons Learnt from Beijing, China. International Journal of Environmental Research and Public Health. 2020; 17(21):8040. https://doi.org/10.3390/ijerph17218040
Chicago/Turabian StyleZhou, Shuduo, Jin Xu, Xiaochen Ma, Beibei Yuan, Xiaoyun Liu, Hai Fang, and Qingyue Meng. 2020. "How Can One Strengthen a Tiered Healthcare System through Health System Reform? Lessons Learnt from Beijing, China" International Journal of Environmental Research and Public Health 17, no. 21: 8040. https://doi.org/10.3390/ijerph17218040