Horizontal Integration and Financing Reform of Rural Primary Care in China: A Model for Low-Resource and Remote Settings

Abstract

Primary health care (PHC) systems are compromised by under-resourcing and inadequate governance, and fail to provide high-quality health care services in most low- and middle-income countries (LMICs). As a response to solve the problems of underfunding and understaffing, Pengshui County, an impoverished area in rural Chongqing, China, implemented a profound reform of its PHC delivery system in 2009, focusing on horizontal integration and financing mechanisms. This paper aims to present new evidence from the Pengshui model, and to assess the relevant changes over the past 10 years (2009–2018). An inductive approach was adopted, based on analysis of national and local policy documents and administrative data. From 2009 to 2018, the proportion of outpatients who sought first-contact care in rural community or township health centers increased from 29% (522,700 of 1,817,600) in 2009, to 40% (849,900 of 2,147,800) in 2018 (the national average in 2018 was 23%). Our findings suggest that many positive results have been achieved through the reform, and that innovations in financial governance and incentive mechanisms are the main driving forces behind the improvement. Pengshui County’s experience has proven to be a successful experiment, particularly in rural and low-income areas.

Efficiency evaluation and promoter identification of primary health care system in China: an enhanced DEA-Tobit approach

“…To elucidate this finding, a comprehensive literature review was conducted. Previous studies indicating that County P enhanced its PHC capacity and output via horizontal integration and innovative financing reforms were found to corroborate our results [ 46 ]. County P implemented gradual integration reform via localised pilots in 2009, with initial effects emerging around 2012 (Fig.…”

“…In most Chinese counties, dominant county hospitals spearhead hierarchical or vertical integration with PHC providers [ 8 , 57 ]. While predominantly vertical integration among PHC institutions showed some utility in China [ 55 , 58 ], our study corroborates past research [ 46 , 59 ] that reported the effectiveness of horizontal integration reforms in underprivileged County P, potentially complementing mainstream vertical integration efforts.…”

Resource Allocation Efficiency of Urban Medical and Health Financial Expenditure Under the Background of Employees’ Health

“…Model (3) indicates that comprehensive medical reform can improve comprehensive technical efficiency, with a positive and significant coefficient under the fixed effect model. Finally, with a positive and statistically significant difference-in-differences variable at the 5% level, model (4) demonstrates that the execution of comprehensive reform has greatly improved the scale efficiency of urban employees' medical and health financial expenditures. Overall, the results suggest that after the implementation of comprehensive reform, the comprehensive technical efficiency and scale efficiency of urban medical…”

“… 3 Therefore, it is very necessary to reasonably allocate medical and health financial expenditure resources. Zeng Zhi et al 4 proposed a method of horizontal integration and financing reform for healthcare. By utilizing the inductive approach to analyze national and local policy documents along with administrative data, researchers concluded that implementing financial governance and incentive mechanisms could facilitate healthcare reform and foster the equitable allocation of financial resources for medical and healthcare expenditures.…”

Japanese Perception of Organ Donation and Implications for New Medical Technologies: Quantitative and Qualitative Social Media Analyses

“…Thus, we detected a need to include information on the donation process and costs more constantly and openly to the public. Moreover, tools to foster a more equitable distribution of organs should be available to allocate more organs to places with high populations of people with target diseases and increase the accessibility of organ donation services in rural areas [51], as well as economic aid for mid and low-income patients and a gender perspective [52]. Having more transparent reporting of organ transplantation donors and recipients across gender, income and geographical regions could help develop such programmes.…”