Table 1
Differential strategies for integration in urban and rural areas.
| MEDICAL GROUPS | CIHOS | ADVANCED CIHOS | |
|---|---|---|---|
| Coverage | Urban | County regions (rural) | County regions (rural) |
| Model composition | 1) Hospital and community health centers within a specific geographical area; 2) community health centers that are affiliated | County hospital, township health centers, and village clinics within catchment area | Same as CIHOs |
| Model structure | 1) Vertical technical support; 2) horizontal integration of organizations | Vertical integration of organizations | Vertical integration of organizations |
| Accountable for population health | 1) No; 2) yes | No | Yes |
| Payment models | Fee-for-service | Fee-for-service | Shared savings |
Figure 1
Roadmap of the development strategies for integrated care models in China.
Figure 2
Map of Deqing county (B, bright area), within Zhejiang province (A, bright area).
Figure 3
The organization chart of CIHOs in Deqing to demonstrate the relationships among the medical institutions and resources centers.
Figure 4
Service utilizations among three levels of care providers.
Figure 5
Medical insurance compensation allocation in Deqing County (bars represent the compensations within the county, lines represent the proportion of primary care).
Table 2
Changes in capacity-building indicators of township health centers in Deqing County, 2016–2018.
| 2016 | 2017 | 2018 | AVERAGE ANNUAL GROWTH RATE | NATIONAL AVERAGE GROWTH RATE* | |
|---|---|---|---|---|---|
| Capacity indicators | |||||
| Number of GPs per 10,000 people | 1.04 | 1.41 | 1.63 | 25.2% | 21.3% |
| GPs/specialists ratio | 0.36 | 0.53 | 0.55 | 23.1% | – |
| Nurses/doctors ratio | 0.45 | 0.47 | 0.43 | –3.0% | – |
| Number of beds (per THC) | 86 | 158 | 155 | 34.3% | – |
| Average length of stay | 10.4 | 7.5 | 6.6 | –20.3% | 0 |
| Occupancy rate for curative care beds | 16.5% | 20.8% | 22.8% | 17.5% | –0.8% |
| Disease spectrum in ambulatory care | 62.2 | 70.67 | 74.3 | 9.3% | – |
| Disease spectrum in hospitalizations | 5.4 | 7.1 | 10.78 | 41.3% | – |
| Financial indicators | |||||
| Total revenue (per THC, in 1,000,000 CNY) | 17.40 | 19.85 | 24.25 | 18.1% | 9.9% |
| Proportion of consultation fee to total income | 17.8% | 18.0% | 21.5% | 9.9% | |
| Proportion of personnel cost to total cost | 35.6% | 38.9% | 37.4% | 2.5% | 1.5% |
| Professional income per physician (in 10,000 CNY) | 51.65 | 124.69 | 120.41 | 52.7% | 6.1% |
[i] * Source: National Healthcare Annual Statistics, 2017–2019.
Figure 6
Per capita costs in two levels of care (A for township health centers, and B for county hospitals) in Deqing CIHO.