Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China.
Int J Health Policy Manag. 2022 Sep 1;11(9):1835-1843. doi: 10.34172/ijhpm.2021.93. Epub 2021 Aug 21.
Integrated care is a global trend in international healthcare reform, particularly for piloting vertical integration involving hospitals and primary healthcare institutions (PHIs). However, evidence regarding the impact of vertical integration on primary healthcare has been mixed and limited. Our study aims to evaluate the empirical effects of vertical integration reform on PHIs in China, and examines variations across integration intensity (tight integration vs. loose collaboration).
This study used a longitudinal design. The time-varying difference-in-difference (DID) method with a fixed-effect model for panel data was adopted. A total of 370 PHIs in the eastern, central, and western areas of China from 2009 to 2018 were covered. Outcome measures included the indicators at three dimensions regarding inpatient and outpatient service volume, patient flow between PHIs and hospitals and quality of chronic disease care (hypertension and diabetes).
Significant increases in absolute (the number) and relative (the ratio between PHIs and hospitals) volume of inpatient admissions have been found after reform under tight integration, peaking at 183% and 15.0% respectively, in the third reform year. The quality of hypertension and diabetes care (by indicators of control rate of blood pressure and blood glucose) showed significant improvements under both types of vertical integration after reform. It was much more distinct for the PHIs under tight integration, which had the most significant increase of 34.0% and 22.8% under tight integration for the control rate of hypertension and diabetes compared to the peak of 21.2% and 22.1% respectively under loose collaboration.
Our findings suggest that vertical integration (especially tight integration) in China significantly contributed to strengthening primary healthcare in terms of inpatient services and quality of hypertension and diabetes care, providing empirical evidence to other countries on integrating primary healthcare-based health systems.
综合医疗是国际医疗改革的全球趋势，尤其是在试点涉及医院和基层医疗保健机构（PHI）的垂直整合方面。然而，关于垂直整合对基层医疗保健影响的证据一直存在分歧且有限。我们的研究旨在评估中国垂直整合改革对 PHI 的实证影响，并检验整合强度（紧密整合与松散合作）的差异。
本研究采用纵向设计。采用面板数据的时变差异（DID）方法和固定效应模型。涵盖了来自中国东部、中部和西部地区的 370 家 PHI，时间跨度为 2009 年至 2018 年。结果衡量指标包括住院和门诊服务量、PHI 和医院之间的患者流量以及慢性病护理质量（高血压和糖尿病）的三个维度的指标。
在紧密整合下，改革后绝对（数量）和相对（PHI 与医院之比）住院人数均显著增加，在第三年改革高峰期分别达到 183%和 15.0%。高血压和糖尿病的护理质量（通过血压和血糖控制率指标）在两种类型的垂直整合下改革后均有显著改善。紧密整合下的 PHI 改善更为明显，其高血压和糖尿病控制率分别比松散合作下的峰值增加了 34.0%和 22.8%，分别增加了 34.0%和 22.8%。
我们的研究结果表明，中国的垂直整合（特别是紧密整合）在加强基层医疗的住院服务和高血压、糖尿病护理质量方面发挥了重要作用，为其他国家整合基于基层医疗保健的卫生系统提供了经验证据。
