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Implementing system-wide health reform at district level: lessons from China

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Implementing system-wide health reform at district level: lessons from China

Future Health Systems

By the China Policy Influence and Research Uptake (PIRU) Team

It is increasingly important to understand the role of medical institutions in health care reform and the influences of payment system reform on the medical behaviors of clinicians. In order to do so, Deputy Director Yu Lihua, from the payment system and medical classification team of the China National Health Development Research Centre (CNHDRC), led seven junior researchers from the health security team and the payment system team to conduct the second round field survey in Yubei District, Chongqin City, from 25 to 26 September 2014.

The survey team visited five units, including Health Bureau of Yubei district, Yubei Renmin Hospital, Tongjing township central health centre and two village clinics. They conducted semi-structured interviews with 40 respondents, including:

  • the Director General, Directors and others from related departments of the Health Bureau;
  • the Director, Vice-Director, and other respondents from related executive and clinical departments of the hospital and township central health centre;
  • Doctors and nurses.

The survey team also conducted medical staff behavior questionnaires based on the theory of planned behavior with doctors from Renmin Hospital, Tongjing township central health centre, and two village clinics. They collected 80 questionnaires and over 30 copies of qualitative and quantitative information.

The survey revealed that since 2009, Yubei district has improved the basic medical security system reform, and continued to strengthen medical and health service system construction. The basic public health service reform had been steadily carried out, and the national essential drug system has been fully implemented. At the same time, Yubei district has actively explored public hospital reform, promoting the management of clinical pathways, and piloting case-based payment reform.

Currently, the prominent problem for Yubei district is that the piloting of the municipal global budget scheme brought strong negative influences to the medical institutions and medical staff, and the phenomenon of shuffling patients to higher level hospitals has become serious. The second problem for public hospitals is the income shortage as the essential drug mechanism cannot be compensated in time. The decrease in income means that some public hospitals experience running difficulties. The next step for the China team is to analyze the questionnaire data, explore the effect of policy change and provide suggestions for health bureau to encounter the problems.