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Coping with COVID: Performance of China’s hierarchical medical system during the COVID-19 pandemic

OBJECTIVE: The COVID-19 pandemic has challenged the health system worldwide. This study aimed to assess how China’s hierarchical medical system (HMS) coped with COVID-19 in the short-and medium-term. We mainly measured the number and distribution of hospital visits and healthcare expenditure between...

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Autores principales: Yang, Yong, Huang, Lieyu, Yan, Hao, Nicholas, Stephen, Maitland, Elizabeth, Bai, Qian, Shi, Xuefeng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10173579/
https://www.ncbi.nlm.nih.gov/pubmed/37181683
http://dx.doi.org/10.3389/fpubh.2023.1148847
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author Yang, Yong
Huang, Lieyu
Yan, Hao
Nicholas, Stephen
Maitland, Elizabeth
Bai, Qian
Shi, Xuefeng
author_facet Yang, Yong
Huang, Lieyu
Yan, Hao
Nicholas, Stephen
Maitland, Elizabeth
Bai, Qian
Shi, Xuefeng
author_sort Yang, Yong
collection PubMed
description OBJECTIVE: The COVID-19 pandemic has challenged the health system worldwide. This study aimed to assess how China’s hierarchical medical system (HMS) coped with COVID-19 in the short-and medium-term. We mainly measured the number and distribution of hospital visits and healthcare expenditure between primary and high-level hospitals during Beijing’s 2020–2021 pandemic relative to the 2017–2019 pre-COVID-19 benchmark period. METHODS: Hospital operational data were extracted from Municipal Health Statistics Information Platform. The COVID-19 period in Beijing was divided into five phases, corresponding to different characteristics, from January 2020 to October 2021. The main outcome measures in this study include the percentage change in inpatient and outpatient emergency visits, and surgeries, and changing distribution of patients between different hospital levels across Beijing’s HMS. In addition, the corresponding health expenditure in each of the 5 phases of COVID-19 was also included. RESULTS: In the outbreak phase of the pandemic, the total visits of Beijing hospitals declined dramatically, where outpatient visits fell 44.6%, inpatients visits fell 47.9%; emergency visits fell 35.6%, and surgery inpatients fell 44.5%. Correspondingly, health expenditures declined 30.5% for outpatients and 43.0% for inpatients. The primary hospitals absorbed a 9.51% higher proportion of outpatients than the pre-COVID-19 level in phase 1. In phase 4, the number of patients, including non-local outpatients reached pre-pandemic 2017–2019 benchmark levels. The proportion of outpatients in primary hospitals was only 1.74% above pre-COVID-19 levels in phases 4 and 5. Health expenditure for both outpatients and inpatients reached the baseline level in phase 3 and increased nearly 10% above pre-COVID-19 levels in phases 4 and 5. CONCLUSION: The HMS in Beijing coped with the COVID-19 pandemic in a relatively short time, the early stage of the pandemic reflected an enhanced role for primary hospitals in the HMS, but did not permanently change patient preferences for high-level hospitals. Relative to the pre-COVID-19 benchmark, the elevated hospital expenditure in phase 4 and phase 5 pointed to hospital over-treatment or patient excess treatment demand. We suggest improving the service capacity of primary hospitals and changing the preferences of patients through health education in the post-COVID-19 world.
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spelling pubmed-101735792023-05-12 Coping with COVID: Performance of China’s hierarchical medical system during the COVID-19 pandemic Yang, Yong Huang, Lieyu Yan, Hao Nicholas, Stephen Maitland, Elizabeth Bai, Qian Shi, Xuefeng Front Public Health Public Health OBJECTIVE: The COVID-19 pandemic has challenged the health system worldwide. This study aimed to assess how China’s hierarchical medical system (HMS) coped with COVID-19 in the short-and medium-term. We mainly measured the number and distribution of hospital visits and healthcare expenditure between primary and high-level hospitals during Beijing’s 2020–2021 pandemic relative to the 2017–2019 pre-COVID-19 benchmark period. METHODS: Hospital operational data were extracted from Municipal Health Statistics Information Platform. The COVID-19 period in Beijing was divided into five phases, corresponding to different characteristics, from January 2020 to October 2021. The main outcome measures in this study include the percentage change in inpatient and outpatient emergency visits, and surgeries, and changing distribution of patients between different hospital levels across Beijing’s HMS. In addition, the corresponding health expenditure in each of the 5 phases of COVID-19 was also included. RESULTS: In the outbreak phase of the pandemic, the total visits of Beijing hospitals declined dramatically, where outpatient visits fell 44.6%, inpatients visits fell 47.9%; emergency visits fell 35.6%, and surgery inpatients fell 44.5%. Correspondingly, health expenditures declined 30.5% for outpatients and 43.0% for inpatients. The primary hospitals absorbed a 9.51% higher proportion of outpatients than the pre-COVID-19 level in phase 1. In phase 4, the number of patients, including non-local outpatients reached pre-pandemic 2017–2019 benchmark levels. The proportion of outpatients in primary hospitals was only 1.74% above pre-COVID-19 levels in phases 4 and 5. Health expenditure for both outpatients and inpatients reached the baseline level in phase 3 and increased nearly 10% above pre-COVID-19 levels in phases 4 and 5. CONCLUSION: The HMS in Beijing coped with the COVID-19 pandemic in a relatively short time, the early stage of the pandemic reflected an enhanced role for primary hospitals in the HMS, but did not permanently change patient preferences for high-level hospitals. Relative to the pre-COVID-19 benchmark, the elevated hospital expenditure in phase 4 and phase 5 pointed to hospital over-treatment or patient excess treatment demand. We suggest improving the service capacity of primary hospitals and changing the preferences of patients through health education in the post-COVID-19 world. Frontiers Media S.A. 2023-04-27 /pmc/articles/PMC10173579/ /pubmed/37181683 http://dx.doi.org/10.3389/fpubh.2023.1148847 Text en Copyright © 2023 Yang, Huang, Yan, Nicholas, Maitland, Bai and Shi. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Public Health
Yang, Yong
Huang, Lieyu
Yan, Hao
Nicholas, Stephen
Maitland, Elizabeth
Bai, Qian
Shi, Xuefeng
Coping with COVID: Performance of China’s hierarchical medical system during the COVID-19 pandemic
title Coping with COVID: Performance of China’s hierarchical medical system during the COVID-19 pandemic
title_full Coping with COVID: Performance of China’s hierarchical medical system during the COVID-19 pandemic
title_fullStr Coping with COVID: Performance of China’s hierarchical medical system during the COVID-19 pandemic
title_full_unstemmed Coping with COVID: Performance of China’s hierarchical medical system during the COVID-19 pandemic
title_short Coping with COVID: Performance of China’s hierarchical medical system during the COVID-19 pandemic
title_sort coping with covid: performance of china’s hierarchical medical system during the covid-19 pandemic
topic Public Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10173579/
https://www.ncbi.nlm.nih.gov/pubmed/37181683
http://dx.doi.org/10.3389/fpubh.2023.1148847
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