Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China.
Medical Device Regulatory Research and Evaluation Center, West China Hospital, Sichuan University, Chengdu, China.
Front Public Health. 2023 Apr 27;11:1148847. doi: 10.3389/fpubh.2023.1148847. eCollection 2023.
The COVID-19 pandemic has challenged the health system worldwide. This study aimed to assess how China's hierarchical medical system (HMS) coped with COVID-19 in the short-and medium-term. We mainly measured the number and distribution of hospital visits and healthcare expenditure between primary and high-level hospitals during Beijing's 2020-2021 pandemic relative to the 2017-2019 pre-COVID-19 benchmark period.
Hospital operational data were extracted from Municipal Health Statistics Information Platform. The COVID-19 period in Beijing was divided into five phases, corresponding to different characteristics, from January 2020 to October 2021. The main outcome measures in this study include the percentage change in inpatient and outpatient emergency visits, and surgeries, and changing distribution of patients between different hospital levels across Beijing's HMS. In addition, the corresponding health expenditure in each of the 5 phases of COVID-19 was also included.
In the outbreak phase of the pandemic, the total visits of Beijing hospitals declined dramatically, where outpatient visits fell 44.6%, inpatients visits fell 47.9%; emergency visits fell 35.6%, and surgery inpatients fell 44.5%. Correspondingly, health expenditures declined 30.5% for outpatients and 43.0% for inpatients. The primary hospitals absorbed a 9.51% higher proportion of outpatients than the pre-COVID-19 level in phase 1. In phase 4, the number of patients, including non-local outpatients reached pre-pandemic 2017-2019 benchmark levels. The proportion of outpatients in primary hospitals was only 1.74% above pre-COVID-19 levels in phases 4 and 5. Health expenditure for both outpatients and inpatients reached the baseline level in phase 3 and increased nearly 10% above pre-COVID-19 levels in phases 4 and 5.
The HMS in Beijing coped with the COVID-19 pandemic in a relatively short time, the early stage of the pandemic reflected an enhanced role for primary hospitals in the HMS, but did not permanently change patient preferences for high-level hospitals. Relative to the pre-COVID-19 benchmark, the elevated hospital expenditure in phase 4 and phase 5 pointed to hospital over-treatment or patient excess treatment demand. We suggest improving the service capacity of primary hospitals and changing the preferences of patients through health education in the post-COVID-19 world.
新冠疫情对全球卫生系统构成挑战。本研究旨在评估中国分级医疗体系（HMS）在短期内应对新冠疫情的情况。我们主要测量了 2020-2021 年北京疫情期间与 2017-2019 年新冠前基准期相比，基层和高级医院的门诊和医疗支出数量和分布情况。
从市级卫生统计信息平台提取医院运营数据。将北京疫情期间分为五个阶段，对应不同的特征，从 2020 年 1 月到 2021 年 10 月。本研究的主要观察指标包括住院和门诊急诊就诊、手术的百分比变化，以及北京 HMS 中不同医院级别之间患者分布的变化。此外，还包括新冠疫情五个阶段的相应卫生支出。
疫情爆发阶段，北京市医院总就诊量大幅下降，其中门诊下降 44.6%，住院下降 47.9%；急诊下降 35.6%，手术住院下降 44.5%。相应地，门诊支出下降 30.5%，住院支出下降 43.0%。第 1 阶段，基层医院吸收的门诊患者比例比新冠前水平高 9.51%。第 4 阶段，包括非本地门诊在内的患者数量达到了新冠前 2017-2019 年的基准水平。第 4 和第 5 阶段，基层医院的门诊患者比例仅比新冠前水平高 1.74%。第 3 阶段门诊和住院支出达到基线水平，第 4 和第 5 阶段支出增长近 10%，超过新冠前水平。
北京的 HMS 相对较快地应对了新冠疫情，疫情早期反映了基层医院在 HMS 中的作用增强，但并没有永久性地改变患者对高级医院的偏好。与新冠前基准相比，第 4 和第 5 阶段升高的医院支出表明医院过度治疗或患者过度治疗需求。我们建议在新冠疫情后，通过健康教育提高基层医院的服务能力，并改变患者的偏好。
