Abstract
BackgroundThere is, globally, an often observed inequality in the health services available in urban and rural areas. One strategy to overcome the inequality is to require urban doctors to spend time in rural hospitals. This approach was adopted by the Beijing Municipality (population of 20.19 million) to improve rural health services, but the approach has never been systematically evaluated.MethodsDrawing upon 1.6 million cases from 24 participating hospitals in Beijing (13 urban and 11 rural hospitals) from before and after the implementation of the policy, changes in the rural–urban hospital performance gap were examined. Hospital performance was assessed using changes in six indices over-time: Diagnosis Related Groups quantity, case-mix index (CMI), cost expenditure index (CEI), time expenditure index (TEI), and mortality rates of low- and high-risk diseases.ResultsSignificant reductions in rural–urban gaps were observed in DRGs quantity and mortality rates for both high- and low-risk diseases. These results signify improvements of rural hospitals in terms of medical safety, and capacity to treat emergency cases and more diverse illnesses. No changes in the rural–urban gap in CMI were observed. Post-implementation, cost and time efficiencies worsened for the rural hospitals but improved for urban hospitals, leading to a widening rural–urban gap in hospital efficiency.ConclusionsThe strategy for reducing urban–rural gaps in health services adopted, by the Beijing Municipality shows some promise. Gains were not consistent, however, across all performance indicators, and further improvements will need to be tried and evaluated.
Highlights
There is, globally, an often observed inequality in the health services available in urban and rural areas
Sizable changes in the average case severity were observed only for hospital A which happened to be the hospital with the lowest Diagnosis Related Groups (DRG) both just before and 2 years after the introduction of the policy
Overall, our current analysis shows that, in the two-years following the introduction of the counterpart technical support policy, there have been promising improvements in rural hospital services, in terms of the expansion in the scope of services provided by participating rural hospitals and their capacity to treat emergency cases
Summary
There is, globally, an often observed inequality in the health services available in urban and rural areas. One strategy to overcome the inequality is to require urban doctors to spend time in rural hospitals This approach was adopted by the Beijing Municipality (population of 20.19 million) to improve rural health services, but the approach has never been systematically evaluated. Counterpart technical support policies aimed at mobilizing the greater capacity of top urban hospitals to improve rural hospital capacity have been in development since 2005. It commenced when the Ministry of Health, Ministry and Finance and the Bureau of Traditional Chinese Medicine jointly established the “Mobilization of 10,000 Doctors for Rural Health Project” in Western and Central China, and began as a pilot in 2009 [10]. More recent policy developments have focused on the establishment of longer-term partnerships between rural and urban hospitals to strengthen rural hospital capacity [12]
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