Table 1
Policy Review of County-level Medical Community Development in China [13].
| STAGE | YEAR | POLICY TITLE | CORE CONTENT |
|---|---|---|---|
| Exploratory Preparation Stage | 2015 | Guiding Opinions on Promoting the Construction of Hierarchical Medical System | Emphasized the provision of healthcare services by different medical institutions through hierarchical classification, and integrated regional medical resources. |
| 2015 | Implementation Opinions on Comprehensively Promoting the Reform of County-Level Public Hospitals | Strengthened medical planning at the county level, explored the establishment of healthcare community models, and advanced the hierarchical medical system. | |
| 2016 | Guiding Opinions on Piloting the Construction of Medical Consortia | Clarified four organizational models of medical consortia: urban medical consortia, county-level medical communities, specialized medical alliances, and telemedicine collaboration networks. | |
| Pilot Development Stage | 2017 | Guiding Opinions on Promoting the Construction and Development of Medical Consortia | Launched multi-form pilot projects for medical consortia, promoted classified development according to local conditions, and further improved working mechanisms, resource support, and policy frameworks. |
| 2018 | Work Plan for Comprehensive Performance Evaluation of Medical Consortia | Formulated performance evaluation schemes for medical consortia, improved relevant systems, and emphasized the feedback and timely application of evaluation results. | |
| Construction and Improvement Stage | 2019 | Notice on Promoting the Construction of Compact County-level Medical Communities | The first policy document specifically targeting compact county-level medical communities, specifying pilot counties, detailed work requirements, and initial construction objectives. |
| 2020 | Opinions on Deepening the Reform of Medical Security Systems | Explored global budget payment for compact healthcare communities, strengthened supervision and evaluation, and proposed mechanisms such as retained surpluses and reasonable overspending sharing. | |
| 2020 | Notice on Issuing the Administrative Measures for Medical Consortia (Trial) | Stressed the standardization of construction and management for county-level medical communities and other medical consortia, and improved operational and management mechanisms for medical consortia. | |
| 2020 | Evaluation Criteria and Monitoring Index System for Compact County-level Medical Communities | The first evaluation index document for compact county-level medical communities, emphasizing the need to further enhance healthcare service capabilities at the county level and regularly monitor construction progress and effectiveness. | |
| Experience Promotion Stage | 2021 | Notice on Promoting the Experience of Sanming City in Hierarchical Medical System and Medical Consortium Construction | Summarized the main experiences of Sanming City in hierarchical medical system and medical consortium construction, and proposed key tasks for promoting hierarchical medical system and healthcare community construction nationwide. |
| 2021 | Notice on Implementing the Opinions on Deepening the Reform of Medical and Health Systems by Promoting the Experience of Sanming City, Fujian Province | Established a monitoring and evaluation mechanism for deepening the promotion of Sanming medical reform experience, and scheduled regular progress updates on policy implementation. | |
| 2023 | Opinions on Further Deepening Reform to Promote the Healthy Development of Rural Healthcare Systems | Highlighted the importance of rural healthcare work in rural revitalization, and advocated for improving high-quality and efficient rural healthcare systems adapted to rural characteristics, with a focus on primary medical institutions. | |
| Comprehensive Advancement Stage | 2023 | Guiding Opinions on Comprehensively Promoting the Construction of Compact County-level Medical Communities | Put forward specific tasks and requirements for comprehensively advancing the construction of compact county-level medical communities: striving to basically complete the construction in over 90% of counties nationwide by the end of 2025, and achieving full coverage by the end of 2027. |
Figure 1
Operational Mechanism for the County-Level Medical Community (CMC) of Shaxian, Sanming.
Table 2
Contextual Comparison of Selected Integrated Care Arrangements.
| DIMENSIONS | UNITED STATES: KAISER-TYPE INTEGRATED DELIVERY | UNITED KINGDOM: GP-LED PRIMARY CARE | SINGAPORE: AIC-LED COORDINATION | JAPAN: COMMUNITY-BASED INTEGRATED CARE | CHINA: SHAXIAN CMC |
|---|---|---|---|---|---|
| Core Driver | Market Competition & Organizational Merger | Tax Funding & Regulation | Corporate Management & Market Competition | Legislation & Policy Mandate | Government-Led Systemic Reform |
| Key Integration Mechanism | Vertical Integration within a closed system | Strict Tiered Referral System | Horizontal Integration into Corporate Groups | Legally Enforced Medical Circles | Unified Legal Entity & Economic Incentive Realignment |
| Organizational Structure | Single HMO Entity | Purchaser-Provider Split | Competing Corporate Groups | Legally Defined Private Practices | One Leadership, Two Signboards; Unified County-Town-Village System |
| Management Focus | Standardized Care Protocols | National Standards & Targets | Corporate Profitability & Efficiency | Professional Autonomy within Rules | The “Eight Unifications”; HR, Finance, Procurement, IT, Performance, etc. |
| Primary Payment Method | Capitation | Capitation & Budgets | DRG & Global Budgets | Fee-for-Service | C-DRG Bundle Payment; Total Package Payment with Surplus Retention |
| Pharmaceutical Management | Internal Formulary & Supply Chain | National Price Negotiation | Market-based with Govt Control | Nationally Regulated Pricing | Centralized Volume-Based Procurement |
| Role of Government | Regulator | Planner, Funder, Regulator | Regulator & Market Architect | Regulator & Legislator | Top-Down Designer & Lead Reformer |
| Defining Unique Feature | Prepaid, integrated HMO | Universal, tax-funded system | Corporate groups with co-payments | Legally hierarchical private system | Incentive Realignment. Directly tackles the root cause through government-powered systemic overhaul. |