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

被引:4
|
作者
Zeng, Zhi [1 ]
Tao, Wenjuan [1 ]
Ding, Shanlong [2 ]
Fang, Jianlong [3 ]
Wen, Jin [1 ]
Yao, Jianhong [4 ]
Zhang, Wei [1 ]
机构
[1] Sichuan Univ, West China Hosp, Inst Hosp Management, Chengdu 610041, Peoples R China
[2] WHO, CH-1207 Geneva, Switzerland
[3] Natl Inst Environm Hlth, Chinese Ctr Dis Control & Prevent, Beijing 100021, Peoples R China
[4] Chinese Acad Med Sci & Peking Union Med Coll, Beijing 100730, Peoples R China
关键词
integrated care; primary care; rural area; health care reform; PRIMARY-HEALTH-CARE; MIDDLE-INCOME COUNTRIES; PERFORMANCE IMPROVEMENT; ALMA-ATA; COVERAGE; PROGRESS; SYSTEMS;
D O I
10.3390/ijerph19148356
中图分类号
X [环境科学、安全科学];
学科分类号
08 ; 0830 ;
摘要
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.
引用
收藏
页数:12
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