Hierarchical medical system and local medical performance: A quasi-natural experiment evaluation in Shanghai, China

Abstract

BackgroundIn order to maintain high standards of healthcare, it is necessary for medical departments to provide high-quality and affordable medical services to local residents. This has been widely accepted in developed countries, while the medical treatment systems in developing countries remain to be improved. This research is based on a pilot of a hierarchical medical system in Shanghai, China, to evaluate the effects on policy of medical reform in developing countries.Methods and resultsBy means of the difference-in-differences (DID) method, the causal relationship between medical care services' improvement and hierarchical medical systems' implementation could be identified. This project also explores the differential effects of policy intervention and confirms that the pilot showed a significant improvement in medical performance in central districts while the result remains uncertain in terms of suburban districts. Furthermore, the dynamic effect of a hierarchical medical system has also been identified with the event study method, while the policy pilot only had short-term effects on local medical resources' improvement. In order to ascertain the function mechanisms of hierarchical medical systems and explain why the policy pilot only had short-term effects, this project also conducts influencing mechanism analysis with the triple-differences method (also known as difference-in-difference-in-differences or DDD method). According to the empirical results, there is no direct evidence indicating the hierarchical medical system could bring obvious benefits from the perspectives of patients and medical institutions.ConclusionsFor better implementation of hierarchical medical systems in the future, long-term supervision mechanisms should be given more attention in the enforcement process of hierarchical medical systems. At the same time, more safeguarding measures should be implemented, such as supervising the payment systems of the medical institution and conducting performance evaluation.

Effectiveness of hierarchical medical system and economic growth: based on China’s urban vs. rural health perspectives

“…In Shanghai, for example, the average length of hospitalization is as high as 160.9 days in 2021, which is significantly higher than the national average. On the other hand, the utilization rate of hospital beds in Beijing and Shanghai, as well as in developed coastal provinces, is higher than that in underdeveloped areas (3,23). However, the implementation of the goal of "linking primary care institutions and hospitals" is not effective in these areas.…”

Quality and Dependability of ChatGPT and DingXiangYuan Forums for Remote Orthopedic Consultations: Comparative Analysis

“…In addition, China is unable to guarantee the effectiveness of medical resource allocation, as other high-income countries can, due to ineffective rules and legislation and a lack of rigorously educated general practitioners [23]. To address this issue, the hierarchical medical system was created, and it has steadily replaced other medical systems to provide basic health care in the majority of high-income countries [24].…”

“…The hierarchical medical system has not had the desired impact in China as a consequence of its deployment. Some medical facilities are suffering from severe work pressure overload due to a lack of medical resources and patients' unrealistic treatment preferences [23]. To enhance patients' medical behavior and help them choose the best medical facilities, high-quality guiding services are thus necessary to assist patients in understanding their disease-related information before treatment [28].…”