Effects of the Integrated Healthcare Delivery System on 270 pilot cities in 2016: a mixed methods study

Abstract

BackgroundIn the end of 2015, a new round health reform—the Integrated Healthcare Delivery System—was issued by the National Health and Family Planning Commission. The policy emphasises capability building of primary care providers by recruiting more qualified family doctors, improving infrastructure, and building coordination between tertiary hospitals and community health centres. This reform will contribute to transformation of the current health-care delivery system, shifting more health resources and transferring patients to the community level to improve accessibility and affordability of health care, facilitate the achievement of the 13th Five Year Plan (the most important national development plan), and emphasise the development of an integrated health-care delivery system. The aim of this study was to evaluate the progress of the Integrated Healthcare Delivery System during the past 2 years in pilot cities. MethodsIn a mixed-methods study, we integrated cross-sectional research from 270 pilot cities, to get an overall understanding of the current status of the Integrated Healthcare Delivery System, with 15 pioneered field research centres including Shanghai, Luohu District in Shenzhen, Tianchang in Anhui province, Qingyang in Gansu province, and Haidong in Qinghai province, to highlight advanced experiences for system design optimisation. We used a combination of institutional data, face-to-face interviews, institutional surveys, and expert consultation. FindingsThe relationship between primary care providers and patients was improved by the Family Doctor Strategy, in which health facilities provide training and recruitment and contract qualified family doctors to build up a stable relationship with residents; more patients were willing to having a contracted family doctor, and regarded general practitioners (family doctors) as a first point of contact for seeking treatment in the health system. Additionally, the infrastructure improvement of community-based clinics, general practitioner competency, and promotion of Chinese traditional medicine were strengthened. Finally, vertical coordination among primary, secondary, and tertiary health facilities has been established, which is a key strategy to optimise resource allocation, and provide technical support and shifting of resources to primary care health providers. InterpretationThe preliminary results of Integrated Healthcare Delivery System include a great improvement in gatekeeper capability, effective resource allocation, patient satisfaction, and access to primary care. FundingWorld Health Organization China.