Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Office of Policy Research, Chinese Center for Disease Control and Prevention & Chinese Academy of Preventive Medicine, Beijing, China.
BMC Prim Care. 2024 Jun 1;25(1):195. doi: 10.1186/s12875-024-02450-0.
Inadequate financing constrains primary healthcare (PHC) capacity in many low- and middle-income countries, particularly in rural areas. This study evaluates an innovative PHC financing reform in rural China that aimed to improve access to healthcare services through supply-side integration and the establishment of a designated PHC fund.
We employed a quasi-experimental synthetic difference-in-differences (SDID) approach to analyze county-level panel data from Chongqing Province, China, spanning from 2009 to 2018. The study compared the impact of the reform on PHC access and per capita health expenditures in Pengshui County with 37 other control counties (districts). We assessed the reform's impact on two key outcomes: the share of outpatient visits at PHC facilities and per capita total PHC expenditure.
The reform led to a significant increase in the share of outpatient visits at PHC facilities (14.92% points; 95% CI: 6.59-23.24) and an increase in per capita total PHC expenditure (87.30 CNY; 95% CI: 3.71-170.88) in Pengshui County compared to the synthetic control. These effects were robust across alternative model specifications and increased in magnitude over time, highlighting the effectiveness of the integrated financing model in enhancing PHC capacity and access in rural China.
This research presents compelling evidence demonstrating that horizontal integration in PHC financing significantly improved utilization and resource allocation in rural primary care settings in China. This reform serves as a pivotal model for resource-limited environments, demonstrating how supply-side financing integration can bolster PHC and facilitate progress toward universal health coverage. The findings underscore the importance of sustainable financing mechanisms and the need for policy commitment to achieve equitable healthcare access.
在许多低收入和中等收入国家，尤其是农村地区，初级卫生保健（PHC）的资金不足限制了其能力。本研究评估了中国农村一项创新的 PHC 融资改革，该改革旨在通过供方整合和设立指定的 PHC 基金来改善医疗服务的可及性。
我们采用准实验合成差异中的差异（SDID）方法，分析了中国重庆市的县级面板数据，时间跨度为 2009 年至 2018 年。该研究比较了改革对彭水县级 PHC 服务可及性和人均卫生支出的影响，与 37 个对照县（区）进行比较。我们评估了改革对两个关键结果的影响：PHC 机构门诊就诊比例和人均 PHC 总支出。
与合成对照组相比，改革使 PHC 机构门诊就诊比例显著增加（14.92%；95%CI：6.59-23.24），人均 PHC 总支出增加 87.30 元（95%CI：3.71-170.88）。这些影响在替代模型规范中是稳健的，并且随着时间的推移而增加，这突显了综合融资模式在提高中国农村 PHC 能力和可及性方面的有效性。
本研究提供了令人信服的证据，表明 PHC 融资的横向整合显著提高了中国农村初级保健服务的利用率和资源配置。这项改革为资源有限的环境提供了一个关键模式，展示了供方融资整合如何增强 PHC 并促进实现全民健康覆盖的进展。研究结果强调了可持续融资机制的重要性以及实现公平医疗保健可及性的政策承诺的必要性。
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