The effect of the integrated delivery system on managing hypertension in rural areas of China.

Abstract

Since the implementation of the new medical reform in 2009, China has established and improved a series of medical security systems, established medical confederations based on four categories, and promoted the operation of the hierarchical diagnosis and treatment model. The purpose of this study is to analyze the effects of the matrix chronic diseases management platform developed from the integrated delivery system. To evaluate the effects of the matrix chronic diseases management platform developed from the integrated delivery system in China on expenses, medical seeking behaviors, compensation, and degree of satisfaction in hypertensive patients. A longitudinal and retrospective study was performed to investigate medical expenses, actual compensation ratios, medical behaviors, and the degree of satisfaction across different levels of medical institutions in hypertensive patients. A total of 7,037 patients with hypertension aged 36-99 from Zhili Town Health Center were selected based on the diagnostic criteria of the Guidelines for Prevention and Treatment of Hypertension in China. Data was collected from the hospital's database and systems, and questionnaires were distributed to patients who attended the Department of Cardiology. Outcomes included inspection and drug expenses in the outpatient and inpatient departments, actual reimbursement ratios, number of visits across different levels of hospitals, expenditure per visit, medical behaviors, complications of patients, and the degree of satisfaction of both patients and doctors in primary hospitals. The average cost for hypertensive patients was shown to be increasing year by year in the outpatient and inpatient departments. The number of patients in tertiary hospitals decreased significantly, while the number of patients in community hospitals (primary hospitals) increased, and the number of patients in secondary hospitals has remained almost unchanged. Furthermore, expenses per visit in hospitals across all levels also decreased during the study period. The primary complications of hypertension were cerebrovascular disease and coronary heart disease, which showed a slightly increasing trend. The degree of satisfaction of patients and doctors in primary hospitals was relatively high, and rose from 2014 to 2019. The matrix chronic diseases management platform developed from the integrated delivery system built in Huzhou No.1 Hospital had a positive effect on improving the reimbursement and satisfaction of patients with hypertension.