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

Author

Listed:
  • Zhi Zeng

    (Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu 610041, China
    These authors contributed equally to this work.)

  • Wenjuan Tao

    (Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu 610041, China
    These authors contributed equally to this work.)

  • Shanlong Ding

    (World Health Organization, 1207 Geneva, Switzerland)

  • Jianlong Fang

    (Chinese Center for Disease Control and Prevention, National Institute of Environmental Health, Beijing 100021, China)

  • Jin Wen

    (Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu 610041, China)

  • Jianhong Yao

    (Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China)

  • Wei Zhang

    (Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu 610041, China)

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.

Suggested Citation

  • Zhi Zeng & Wenjuan Tao & Shanlong Ding & Jianlong Fang & Jin Wen & Jianhong Yao & Wei Zhang, 2022. "Horizontal Integration and Financing Reform of Rural Primary Care in China: A Model for Low-Resource and Remote Settings," IJERPH, MDPI, vol. 19(14), pages 1-12, July.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:14:p:8356-:d:858462
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    References listed on IDEAS

    as
    1. Manli Wang & Haiqing Fang & Ghose Bishwajit & Yuanxi Xiang & Hang Fu & Zhanchun Feng, 2015. "Evaluation of Rural Primary Health Care in Western China: A Cross-Sectional Study," IJERPH, MDPI, vol. 12(11), pages 1-18, October.
    2. Shuduo Zhou & Jin Xu & Xiaochen Ma & Beibei Yuan & Xiaoyun Liu & Hai Fang & Qingyue Meng, 2020. "How Can One Strengthen a Tiered Healthcare System through Health System Reform? Lessons Learnt from Beijing, China," IJERPH, MDPI, vol. 17(21), pages 1-14, October.
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