Abstract
BackgroundInitiatives on integrated care between hospitals and community health centers (CHCs) have been introduced to transform the current fragmented health care delivery system into an integrated system in China. Up to date no research has analyzed in-depth the experiences of these initiatives based on perspectives from various stakeholders. This study analyzed the integrated care pilot in Hangzhou City by investigating stakeholders’ perspectives on its design features and supporting environment, their acceptability of this pilot, and further identifying the enabling and constraining factors that may influence the implementation of the integrated care reform.MethodsThe qualitative study was carried out based on in-depth interviews and focus group discussions with 50 key informants who were involved in the policy-making process and implementation. Relevant policy documents were also collected for analysis.ResultsThe pilot in Hangzhou was established as a CHC-led delivery system based on cooperation agreement between CHCs and hospitals to deliver primary and specialty care together for patients with chronic diseases. An innovative learning-from-practice mentorship system between specialists and general practitioners was also introduced to solve the poor capacity of general practitioners. The design of the pilot, its governance and organizational structure and human resources were enabling factors, which facilitated the integrated care reform. However, the main constraining factors were a lack of an integrated payment mechanism from health insurance and a lack of tailored information system to ensure its sustainability.ConclusionsThe integrated care pilot in Hangzhou enabled CHCs to play as gate-keeper and care coordinator for the full continuum of services across the health care providers. The government put integrated care a priority, and constructed an efficient design, governance and organizational structure to enable its implementation. Health insurance should play a proactive role, and adopt a shared financial incentive system to support integrated care across providers in the future.
Highlights
Initiatives on integrated care between hospitals and community health centers (CHCs) have been introduced to transform the current fragmented health care delivery system into an integrated system in China
The design feature of an integrated care model can be analyzed from the following aspects: target groups, integrated care providers, scope of services, and integration mechanisms; and the supporting environment can be structured into five aspects: governance, organizational structure and human resources (HR) conditions, financing and payment mechanism, information environment, and performance management
Design features described in policy documents The Joint Health Center (JHC) for chronic care was initiated by the Hangzhou municipal government as a pilot project of integrated care in 2013
Summary
Initiatives on integrated care between hospitals and community health centers (CHCs) have been introduced to transform the current fragmented health care delivery system into an integrated system in China. The considerable resources invested by the government in health care reform have been disproportionately flowed into hospitals instead of PHC facilities [1, 2, 4]. Nudging and incentivizing patients to seek health care at PHC facilities continued to be a priority in the new round of China’s health care reform [11]. The current hospital-centered and fragmented delivery system is incapable to meet the health needs of the rapidly increased aging population, weakens continuity of care, and leads to cost escalation [11]. A more effective and efficient health care model is necessary to improve health for NCD patients
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