Building the tiered system of disease diagnosis and treatment from 2015 to 2017 in Jiangsu: achievements and challenges

Abstract

BackgroundJiangsu, China, launched a comprehensive provincial medical reform in 2015, and the implementation of a tiered system of disease diagnosis and treatment is the core strategy. Focusing on improving the service capacity of primary care facilities and building the contract system of family doctors and medical alliance, which is an cooperative mode of medical institutions of different levels in the same region, aiming to promote medical resources integration, Jiangsu established a new tiered system of disease diagnosis and treatment. We aimed to explore the achievements and challenges in the construction of the system. MethodsIn January, 2019, a compilation of health statistics of all cities in Jiangsu Province during 2013–17 were drawn from the Health Statistics Information System provided by the Statistical Information Centre of Jiangsu Health Commission. An autoregressive integrated moving average (ARIMA) model and descriptive analysis was done to assess the trends in patient visits and referrals in Jiangsu province. FindingsResults from the ARIMA model showed that the primary health facilities were predicted to contribute 52·38% of total outpatient visits in the province, which was lower than the actual proportion of 52·73%. In 11 cities, the consultation rate in counties was over 90%, which reaches the national standard (82·5%). More than 60% of key groups have signed up to the family doctors. Also, the proportion of referrals from hospitals to primary care facilities barely changed, from 0·02% in 2013, to 0·03% in 2017, and the proportion of referrals from primary care facilities to hospitals increased from 0·22 to 0·38, by 0·16 percentage points. InterpretationThe construction of the medical alliance has effectively contributed to the sinking of medical resources from tertiary hospitals to primary care facilities, the establishment of the contract system of family doctors, and the improvement of the capacity of primary care facilities. However, grassroots services were still far from meeting residents' needs of basic medical services. Family doctor services primarily serviced key groups, and the first diagnosis provided by family doctors was not mandatory. Because of the insufficient coordination between hospitals and communities, the referral system within the medical alliance has not been effectively implemented. Because Jiangsu is one of the first pilot provinces in China undergoing a comprehensive health-care reform, our findings are informative to national policy rollout. FundingNational Natural Science Foundation of China.