Impact of a primary care-oriented shared savings model for patients with chronic conditions in China: An interrupted time-series analysis

Background: Social health insurance models that share savings among providers may promote more integrated and preventative healthcare but risk service under-provision to cut costs. There's limited evidence on optimal savings distribution to incentivise patients’ health outcomes. We explored a primary care-oriented shared savings model (PCO-SSM) in China, reallocating a greater portion of savings to primary care providers to boost primary care use and prevent costly hospital admissions.

Methods: We analysed claims data for 47,710 chronic condition patients from January 2020 to December 2022. Using an interrupted time series and controlling for individual characteristics, fixed effects, and seasonality, we evaluated service utilisation and expenditure changes post-reform in January 2021, including subgroup analyses for single and multiple conditions.

Results: PCO-SSM decreased monthly per-patient inpatient admissions by 0.03%, inpatient expenditure by 0.40%, and inpatient days by 0.14%. Trends in outpatient visits at primary care decreased by 0.72% and outpatient expenditure by 4.81%. Hospital outpatient visits saw a minor decline of 0.26%. Notably, inpatient admissions slightly increased at primary care facilities for patients with multimorbidity. Additionally, inpatient admissions slightly increased at primary care facilities for patients with multimorbidity.

Conclusion: Shifting a larger share of savings from hospitals to primary care providers under PCO-SSM reduced inpatient admissions and associated expenditures, reflecting potentially better management of chronic conditions. However, it also led to reduced primary care utilisation, suggesting possible undertreatment or limited service capacity. This underscores the need for robust support to primary care facilities, particularly in rural areas.

Keywords: shared savings, payment reform, primary care, integrated care, chronic conditions