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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2017

Open Access 01-12-2017 | Research

Integrated care reform in urban China: a qualitative study on design, supporting environment and implementation

Authors: Yi Qian, Zhiyuan Hou, Wei Wang, Donglan Zhang, Fei Yan

Published in: International Journal for Equity in Health | Issue 1/2017

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Abstract

Background

Initiatives on integrated care between hospitals and community health centers (CHCs) have been introduced to transform the current fragmented health care delivery system into an integrated system in China. Up to date no research has analyzed in-depth the experiences of these initiatives based on perspectives from various stakeholders. This study analyzed the integrated care pilot in Hangzhou City by investigating stakeholders’ perspectives on its design features and supporting environment, their acceptability of this pilot, and further identifying the enabling and constraining factors that may influence the implementation of the integrated care reform.

Methods

The qualitative study was carried out based on in-depth interviews and focus group discussions with 50 key informants who were involved in the policy-making process and implementation. Relevant policy documents were also collected for analysis.

Results

The pilot in Hangzhou was established as a CHC-led delivery system based on cooperation agreement between CHCs and hospitals to deliver primary and specialty care together for patients with chronic diseases. An innovative learning-from-practice mentorship system between specialists and general practitioners was also introduced to solve the poor capacity of general practitioners. The design of the pilot, its governance and organizational structure and human resources were enabling factors, which facilitated the integrated care reform. However, the main constraining factors were a lack of an integrated payment mechanism from health insurance and a lack of tailored information system to ensure its sustainability.

Conclusions

The integrated care pilot in Hangzhou enabled CHCs to play as gate-keeper and care coordinator for the full continuum of services across the health care providers. The government put integrated care a priority, and constructed an efficient design, governance and organizational structure to enable its implementation. Health insurance should play a proactive role, and adopt a shared financial incentive system to support integrated care across providers in the future.
Appendix
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Metadata
Title
Integrated care reform in urban China: a qualitative study on design, supporting environment and implementation
Authors
Yi Qian
Zhiyuan Hou
Wei Wang
Donglan Zhang
Fei Yan
Publication date
01-12-2017
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2017
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-017-0686-8

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