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How Can One Strengthen a Tiered Healthcare System through Health System Reform? Lessons Learnt from Beijing, China

How one can reshape the current healthcare sector into a tiered healthcare system with clarified division of functions between primary care facilities and hospitals, and improve the utilization of primary care, is a worldwide problem, especially for the low and middle-income countries (LMICs). This...

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Autores principales: Zhou, Shuduo, Xu, Jin, Ma, Xiaochen, Yuan, Beibei, Liu, Xiaoyun, Fang, Hai, Meng, Qingyue
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7663312/
https://www.ncbi.nlm.nih.gov/pubmed/33142790
http://dx.doi.org/10.3390/ijerph17218040
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author Zhou, Shuduo
Xu, Jin
Ma, Xiaochen
Yuan, Beibei
Liu, Xiaoyun
Fang, Hai
Meng, Qingyue
author_facet Zhou, Shuduo
Xu, Jin
Ma, Xiaochen
Yuan, Beibei
Liu, Xiaoyun
Fang, Hai
Meng, Qingyue
author_sort Zhou, Shuduo
collection PubMed
description How one can reshape the current healthcare sector into a tiered healthcare system with clarified division of functions between primary care facilities and hospitals, and improve the utilization of primary care, is a worldwide problem, especially for the low and middle-income countries (LMICs). This paper aimed to evaluate the impact of the Beijing Reform on healthcare-seeking behavior and tried to explain the mechanism of the change of patient flow. In this before and after study, we evaluated the changes of outpatient visits and inpatient visits among different levels of health facilities. Using the monitored and statistical data of 373 healthcare institutions 1-year before and 1-year after the Beijing Reform, interrupted time series analysis was applied to evaluate the impact of the reform on healthcare-seeking behavior. Semi-structured interviews were used to further explore the mechanisms of the changes. One year after the reform, the flow of outpatients changed from tertiary hospitals to community health centers with an 11.90% decrease of outpatients in tertiary hospitals compared to a 15.01% increase in primary healthcare facilities. The number of ambulatory care visits in primary healthcare (PHC) showed a significant upward trend (P < 0.10), and the reform had a significant impact on the average number of ambulatory care visits per institution in Beijing’s tertiary hospitals (p < 0.10). We concluded that the Beijing Reform has attracted a substantial number of ambulatory care visits from hospitals to primary healthcare facilities in the short-term. Comprehensive reform policies were necessary to align incentives among relative stakeholders, which was a critical lesson for other provinces in China and other LMICs.
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spelling pubmed-76633122020-11-14 How Can One Strengthen a Tiered Healthcare System through Health System Reform? Lessons Learnt from Beijing, China Zhou, Shuduo Xu, Jin Ma, Xiaochen Yuan, Beibei Liu, Xiaoyun Fang, Hai Meng, Qingyue Int J Environ Res Public Health Article How one can reshape the current healthcare sector into a tiered healthcare system with clarified division of functions between primary care facilities and hospitals, and improve the utilization of primary care, is a worldwide problem, especially for the low and middle-income countries (LMICs). This paper aimed to evaluate the impact of the Beijing Reform on healthcare-seeking behavior and tried to explain the mechanism of the change of patient flow. In this before and after study, we evaluated the changes of outpatient visits and inpatient visits among different levels of health facilities. Using the monitored and statistical data of 373 healthcare institutions 1-year before and 1-year after the Beijing Reform, interrupted time series analysis was applied to evaluate the impact of the reform on healthcare-seeking behavior. Semi-structured interviews were used to further explore the mechanisms of the changes. One year after the reform, the flow of outpatients changed from tertiary hospitals to community health centers with an 11.90% decrease of outpatients in tertiary hospitals compared to a 15.01% increase in primary healthcare facilities. The number of ambulatory care visits in primary healthcare (PHC) showed a significant upward trend (P < 0.10), and the reform had a significant impact on the average number of ambulatory care visits per institution in Beijing’s tertiary hospitals (p < 0.10). We concluded that the Beijing Reform has attracted a substantial number of ambulatory care visits from hospitals to primary healthcare facilities in the short-term. Comprehensive reform policies were necessary to align incentives among relative stakeholders, which was a critical lesson for other provinces in China and other LMICs. MDPI 2020-10-31 2020-11 /pmc/articles/PMC7663312/ /pubmed/33142790 http://dx.doi.org/10.3390/ijerph17218040 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Zhou, Shuduo
Xu, Jin
Ma, Xiaochen
Yuan, Beibei
Liu, Xiaoyun
Fang, Hai
Meng, Qingyue
How Can One Strengthen a Tiered Healthcare System through Health System Reform? Lessons Learnt from Beijing, China
title How Can One Strengthen a Tiered Healthcare System through Health System Reform? Lessons Learnt from Beijing, China
title_full How Can One Strengthen a Tiered Healthcare System through Health System Reform? Lessons Learnt from Beijing, China
title_fullStr How Can One Strengthen a Tiered Healthcare System through Health System Reform? Lessons Learnt from Beijing, China
title_full_unstemmed How Can One Strengthen a Tiered Healthcare System through Health System Reform? Lessons Learnt from Beijing, China
title_short How Can One Strengthen a Tiered Healthcare System through Health System Reform? Lessons Learnt from Beijing, China
title_sort how can one strengthen a tiered healthcare system through health system reform? lessons learnt from beijing, china
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7663312/
https://www.ncbi.nlm.nih.gov/pubmed/33142790
http://dx.doi.org/10.3390/ijerph17218040
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