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Purpose: Based on the diagnosis-related groups payment, China developed an innovative episode-based payment scheme, called "payment method by disease types with point counting ", to control health expenditures inflation. This study aimed to investigate the impacts of this new payment method on volume, expenditures, and efficiency in Chinese public hospitals. Methods: The study sample consisted of 7 tertiary hospitals and 14 secondary hospitals in Jinhua (intervention group) and 4 tertiary hospitals and 14 secondary hospitals in Taizhou (control group). Monthly data points were collected for each sampled hospital from June 2016 to June 2019 using a self-administered questionnaire with impact evaluation indicators. Controlled interrupted time-series analysis was employed to estimate the effect of the new payment method. Results: The significant slowing trends in inpatient expenditures per visit (tertiary hospitals: beta(7)=-123.16, p=0.042; secondary hospitals: beta(7)=-89.24, p=0.021) and out-of-pocket payments (tertiary hospitals: beta(7)=-4.18, p=0.027; secondary hospitals: beta(7)=-4.87, p=0.019) were observed after policy intervention. However, outpatient expenditures per visit in tertiary (beta(7)=1.67, p=0.018) and secondary hospitals (beta(7)=1.24, p=0.003) rose faster with the new payment method. Additionally, payment reform also caused an increase in the number of inpatient visits (beta(7)=100.01, p=0.038) and reduced the length of stay (beta(7)=-0.10, p=0.036) in tertiary hospitals. Conclusion: The introduction of payment method by disease types with point counting causes the cost containment for inpatient care, whereas the increase in outpatient expenditures. The findings suggest this new payment scheme has the potential for rollout in other areas, but the cost-shifting from the inpatient to outpatient setting should be prevented.

Background Web-based medical services have become an effective supplement to traditional services in hospitals and an essential part of medical services. Studies have shown that web-based medical services are useful for shortening the delayed admission time and for enhancing the treatment effect from the service continuity perspective. However, the specific measures that patients and physicians should take to improve service continuity remain unknown. Objective Based on the information richness theory and continuity of care, this study investigates the dynamic effects of information continuity and interpersonal continuity on physician services online. Methods Data of 7200 patients with 360 physicians covering complete interaction records were collected from a professional web-based platform in China. Content analysis was performed to recognize matching patients and physicians, and least square regression analysis was performed to obtain all empirical results. Results Empirical results showed that in the short term, information continuity (including offline experience, medical records, and detailed information) influences physicians’ web-based services, and their influences show heterogeneity. Moreover, if a patient’s online physician is the same physician who he/she has visited offline, we find that interpersonal continuity is important for service. In the long term, information continuity and interpersonal continuity positively improve service continuity by facilitating repeat purchases. Conclusions Overall, our findings not only shed new light on patient behavior online and cross-channel behavior but also provide practical insights into improving the continuity of care in online health communities.

China introduced the county medical community (CMC) reform, aimed to provide high-quality medical resources to rural citizens, in 2017. This study examines the impact of the reform on the medical service efficiency of county-level public general hospitals in Shanxi Province, China. In total, 92 county-level public general hospitals from Shanxi Province were taken as the research objective, and the super-efficiency SBM-DEA model was applied to measure medical service efficiency. Further, a two-way fixed-effect model was used to evaluate the impact of CMC reform on the medical service efficiency of county-level public general hospitals by using health statistics data from 2014 to 2018. The study reveals that the CMC reform improved the medical service efficiency of county-level public general hospitals by 15.6%. Moreover, the CMC reform had regional heterogeneity in its impact on the medical service efficiency of county-level public general hospitals. The CMC reform improved the medical service efficiency of hospitals in the southern region more than in the northern region of the province. The medical service efficiency of hospitals in the central region was also improved by CMC reform, but the causal relationship was not found significant. Further, hospital-level factors (e.g., fixed assets, hospital stay, and regional health center) and environmental factors (e.g., GDP, population, urbanization rate, and government subsidies) affected the medical service efficiency of county-level public hospitals during the process of promoting the CMC reform.

Objectives Public hospital reform is a key area in the Chinese healthcare system reform with the aim of controlling excessive growth of medical expenditures. This study aims to evaluate the impacts of two rounds of urban public hospital reforms respectively starting in 2018 and 2019. Method A mixed-method method was conducted in Hangzhou. In the quantitative phase, monthly data covering 7 provincial, 12 municipal, and 35 district hospitals from March 2017 to June 2020 was analyzed using a panel-interrupted time-series. Thematic content analysis was conducted using qualitative data collected from 32 in-depth interviews. Results Quantitative data showed a considerable reduction in the proportion of drug revenue (provincial hospitals: −4.937%; municipal hospitals: −2.765%; district hospitals: −2.189%) and an increase in the proportion of consumable (provincial hospitals: β2 = 2.025; municipal hospitals: β3 = 0.206) and examinations (provincial hospitals: β2 = 1.354, β3=0.159; municipal hospitals: β2 = 1.179) revenue after the first reform. In post-reform 2, The respective instant decrease and increase in the proportion of consumable (provincial hospitals: −2.395%; municipal hospitals: −0.898%) and medical services (provincial hospitals: 2.115%; municipal hospitals: −2.604%) revenue were observed. Additionally, quantitative and qualitative data indicated inpatient expenditures dropped considerably after the reform. However, insufficient compensation for medical services and increased financial pressure on hospitals were repeatedly mentioned as unintended consequences in qualitative interviews. Conclusions Overall, the urban public hospital reforms in China created positive effects in adjusting hospital revenue structure and constraining soaring medical expenditures. Unintended consequences remind policymakers to establish rational and dynamic compensation mechanisms for public hospitals.

Background: Rural medical health centers (RMHCs) are the foundation of the three-level primary medical and health service system in China. The efficiency of RMHCs is related to the rationality of the health care resource allocation for China’s 560 million rural population. Methods: This study analyzed the dynamic changes in the efficiency of RMHCs and its convergence using the non-guided SBM–DEA window model and convergence model, in Shanxi Province, China. Results: The results showed that the medical service efficiency is low. The average scores of the comprehensive technical efficiency and pure technical efficiency of the RMHCs in China from 2016 to 2018 were only 0.1541 and 0.1670, respectively, with nearly 63% of the values being lower than their average scores. The comprehensive technical efficiency and pure technical efficiency of the RMHCs in 2016–2018 exhibited a downtrend year on year. The convergence analysis results also showed that the current rural health clinic medical service efficiency had absolute convergence and conditional convergence. If appropriate policies are followed, the medical service efficiency of the RMHCs can be improved to reach its steady-state level.Conclusions: The medical service efficiency of RMHCs remains low and may gradually decline. The government should promote the efficiency of medical service in RMHCs to reach their own optimal level by formulating corresponding medical and health resource allocation policies.

Providing universal quality health services is one of the Sustainable Development Goals (SDG) to achieve by 2030. We evaluated the sustainable and coordinated development of urban and rural medical care from 2008–2017 in Dalian, China, by developing an evaluation system based on population and health services. We used a comprehensive development index model and a coupling coordination model to evaluate the status and sustainable development of population and medical services in Dalian. The overall level of population development index in urban areas was significantly lower than in rural areas in the past decade. Comparing the data for 2008 and 2017, Zhongshan District (−31.51%), Ganjingzi District (−25.67%), Lyshunkou District (−35.45%), and Pulandian District (−19.59%) posted significant declines in the population development index. The overall medical service development index for both urban and rural areas registered a steady upward trend. In terms of the relationship between population and medical services, a more pronounced coupling running-in stage was observed among urban areas than among rural areas. Among urban areas, the coupling running-in stage in Zhongshan District (2013–2016) and Shahekou District (2011–2014) was most pronounced, while among rural areas, Jinzhou District (2012–2016, 0.684~0.756) had the most distinct coupling running-in stage. In terms of coordination development, we found that both urban and rural areas experienced a long period of moderate coordination stage. Among urban areas, except for some middle and mountainous districts with unstable changes in the coordination degree, the overall development trend in the region showed a stable transition from moderate coordination stage towards high coordination stage. From 2008 to 2017, only the coordination degree in Jinzhou District (−9.17%) showed negative growth. Although considerable efforts have been initiated to improve the coordinated development of Dalian’s urban and rural populations and its medical services, the medical and healthcare systems still face numerous challenges.

Online medical services have become an effective supplement to traditional services in hospitals and an essential organization in medical service. Prior studies have revealed that it’s useful to shorten the delayed admission time and enhance the treatment effect from the service continuity perspective. However, what specific measures the patients and physicians should take to improve service continuity remains unknown. Based on the information richness theory and continuity of care, this study investigates the dynamic impacts of information continuity and interpersonal continuity on physician’ service online. Data of 7200 patients with 360 physicians covering complete interaction records is collected from a professional online platform in China. Content analysis is used to recognize matching patient and physician and least square regression analysis is used to get all empirical results. Empirical results show that in the short term, information continuity (including offline experience, medical records, and detailed information) influences physicians’ online service. And, their influences show heterogeneity. Moreover, by recognizing if a patient’s online physician is the same physician who he has visited offline, we find that interpersonal continuity is also important for service. In the long term, information and interpersonal continuity positively improve service continuity by facilitating repeat purchases. Overall, our findings not only shed new light on patient behavior online and cross-channel behavior, but also provide practical insights into improving continuity of care in OHCs.

BackgroundRural Medical Health Centers (RMHCs) are the foundation of the three-level primary medical and healthcare service in China. The efficiency of RMHCs is related to the rationale behind healthcare resource allocation for China’s 560 million rural population.MethodsThis study analyzed the dynamic changes in efficiency of RMHCs and its convergence using the non-oriented SBM–DEA window model and convergence model in Shanxi Province, China. Data was obtained from the Shanxi Rural Health Institute’s 2014–2018 Health Statistics Report, involving 12360 RMHCs.ResultsFindings show that the medical service efficiency delivered in RMHCs is low. The average scores for the comprehensive technical efficiency and pure technical efficiency of the RMHCs in China from 2014 to 2018 were only 0.0568 and 0.0615 respectively, with nearly 68% of the values being lower than their average scores. The comprehensive technical efficiency and pure technical efficiency of RMHCs from 2014–2018 exhibited a downward trend year on year. The convergence analysis results also showed that current rural health clinic medical service efficiency had \({\alpha }\) convergence, absolute convergence and conditional convergence. If appropriate policies are followed, the medical service efficiency of the RMHCs can be improved to reach a steady-state level.ConclusionsThe medical service efficiency of RMHCs remains low and may gradually decline. The government should promote the efficiency of the medical service in RMHCs by formulating corresponding medical and health resource allocation policies to reach an optimal level.

BACKGROUND:Noncommunicable diseases (NCDs) are a major threat to population health worldwide. In Shanghai, China, a new pattern of NCD management-self-management-has been developed in community health service centres (CHSCs).OBJECTIVE:To clarify how contracting with CHSC-based family doctors (FDs) influences the engagement in and effectiveness of self-management behaviour among NCD patients.METHOD:We conducted two waves of a questionnaire survey (in 2013 and 2016) to collect data on patients with NCDs. Separate logistic regression models and longitudinal analysis were performed to examine the effect of contracting with an FD on NCD self-management and the effectiveness of this self-management.RESULTS:Nearly all contracted patients (80.79%) had implemented NCD self-management, while only 55.57% of non-contracted patients did so. The self-management effectiveness rate was also higher among contracted patients than among non-contracted ones (86.66% vs. 54.79%). In the population-averaged models, contracted patients had 2.25 and 2.91 times greater odds of implementing self-management and reporting that the self-management was effective, respectively, after controlling for all related variables. Additionally, awareness of FD-contracted services, satisfaction with CHSCs, and experiencing first contact at CHSCs had positive impacts on the implementation and effectiveness of self-management.CONCLUSIONS:FDs were important for ensuring that NCD patients engaged in self-management behaviour, the most common form of which was focus group. Participation in NCD focus groups may be key for attaining the effects of self-management, including improved health knowledge, greater health awareness, more frequent engagement in health behaviour, and, most importantly, greater practice of self-monitoring. Self-management might help to achieve greater NCD control.

BackgroundChangning District of Shanghai pioneered in implementing Family Doctor and Medical Insurance Payment Coordination Reform. The survey aimed to assess the effect of the reform to provide a decision-making basis for ensuring the gatekeeper role of the family doctor.MethodsA cross-sectional survey was conducted using a self-designed questionnaire in Changning District of Shanghai during January and February in 2014. Multi-stage random cluster was applied and 3040 residents were selected. Comparisons were made with statistically test between the contracted and non-contracted residents in four policy targeted dimensions, doctor-visiting behavior, health management and status, medical cost control and satisfaction.ResultsCompared with the non-contracted residents, the contracted residents (72.9%) presented a higher prevalence rate of chronic diseases (32.6%), a higher proportion (51.9%) in first-contact in the community health service center and a higher proportion to refer to specialists as well (P<0.001).The result showed that the average annual medical expense were significantly higher than non-contracted residents (P<0.001), however, the difference disappeared after age, medical insurance and other socio-demographic variables were controlled. In terms of self-management of non-communicable diseases and complication prevention, the blood pressure control rate and blood glucose control rate for the contracted group were also higher than the counterparts, reaching up to 85.6 and 72.7% respectively.ConclusionThe preliminary analysis indicated that the contracted residents performed better in orderly doctor visiting behavior, health management behavior, health status and satisfaction. Follow up survey is necessary to further analyze the policy effect.

Background China adopted family doctor (FD) to help achieve "Healthy China 2030" through providing continuous, comprehensive, and life-cycle contract services. However, there is a disparity between actual and targeted FD use, as residents continue to visit specialists in large hospitals. The government implemented initiatives to improve residents' willingness to sign up with and visit their FDs. Factors that influence contract behavior are therefore significant for frontier policy research. Methods Two survey waves were conducted in Shanghai (2013 and 2016). The first wave included 2754 people and the second 1995 people. Exploratory factor analysis was used to synthesize "satisfaction" as a predictor of contract behavior. Pearson's chi-square, pooled and logistic regression models were used to estimate associations between influencing factors and contract behavior, and clarify variations in factors across the two waves. Results Four factors were extracted from 15 satisfaction items: "Treatment Environment," "Medical Technology," "Service Specification" and "Service Attitude". Consistent with descriptive analysis, longitudinal analysis showed sociodemographic characteristics (age, education, marital status, and hukou) were significant predictors of contract behavior. The odds ratio of non-communicable diseases (NCD) patients for contract behavior was 2.218 times that of residents without NCD. Contract behavior was positively correlated with awareness of FD services (OR = 21.674, 95% CI = 15.043-31.229), satisfaction with Service Attitude (OR = 1.210, 95% CI = 1.009-1.451), and visit compliance (OR = 1.959, 95% CI = 1.564-2.452). Over time, the odds ratios of the married, Shanghai hukou, NCD, and awareness of FD services declined from 0.456, 1.795, 2.492, 28.690 to 0.443, 1.678, 1.910 and 14.031 respectively, while those of age, and visit compliance increased from 1.027, 1.521 to 1.041 and 2.305 respectively. In 2016, an education-contract gradient had formed (the higher the education level, the higher probability of signing with a FD), whereas high school education had the highest odds ratio (OR = 1.163,95% CI = 0.740-1.827) in 2013. Service Attitude was the only significant satisfaction-related predictor (OR = 1.358, 95% CI = 1.001-1.842) in 2016, compared with "Treatment Environment" (OR = 1.224, 95% CI = 1.001-1.496) and " Service Specification" in 2013(OR = 1.270, 95% CI = 1.040-1.552). Conclusions Except for the socio-demographic variables, NCD, awareness of FD services, satisfaction and visit compliance were significant predictors of contract behavior with FDs. The effect of visit compliance had increased over time while NCD and awareness of FD services were losing impact over time. Significant satisfaction factors had also changed from "Treatment Environment" and "Service Specification" to "Service Attitude".