Effects of Vertical Integration Reform on Primary Healthcare Institutions in China: Evidence From a Longitudinal Study
Background Integrated care is a global trend in international healthcare reform, particularly for piloting vertical integration involving hospitals and primary healthcare institutions (PHIs). However, evidence regarding the impact of vertical integration on primary healthcare has been mixed and lim...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Kerman University of Medical Sciences
2022-09-01
|
| Series: | International Journal of Health Policy and Management |
| Subjects: | |
| Online Access: | https://www.ijhpm.com/article_4099_bf184ea865a7195a33ebe121c5a0c938.pdf |
| _version_ | 1811158761060958208 |
|---|---|
| author | Shasha Yuan Fengmei Fan Dawei Zhu |
| author_facet | Shasha Yuan Fengmei Fan Dawei Zhu |
| author_sort | Shasha Yuan |
| collection | DOAJ |
| description | Background Integrated care is a global trend in international healthcare reform, particularly for piloting vertical integration involving hospitals and primary healthcare institutions (PHIs). However, evidence regarding the impact of vertical integration on primary healthcare has been mixed and limited. Our study aims to evaluate the empirical effects of vertical integration reform on PHIs in China, and examines variations across integration intensity (tight integration vs. loose collaboration). Methods This study used a longitudinal design. The time-varying difference-in-difference (DID) method with a fixedeffect model for panel data was adopted. A total of 370 PHIs in the eastern, central, and western areas of China from 2009 to 2018 were covered. Outcome measures included the indicators at three dimensions regarding inpatient and outpatient service volume, patient flow between PHIs and hospitals and quality of chronic disease care (hypertension and diabetes). Results Significant increases in absolute (the number) and relative (the ratio between PHIs and hospitals) volume of inpatient admissions have been found after reform under tight integration, peaking at 183% and 15.0% respectively, in the third reform year. The quality of hypertension and diabetes care (by indicators of control rate of blood pressure and blood glucose) showed significant improvements under both types of vertical integration after reform. It was much more distinct for the PHIs under tight integration, which had the most significant increase of 34.0% and 22.8% under tight integration for the control rate of hypertension and diabetes compared to the peak of 21.2% and 22.1% respectively under loose collaboration. Conclusion Our findings suggest that vertical integration (especially tight integration) in China significantly contributed to strengthening primary healthcare in terms of inpatient services and quality of hypertension and diabetes care, providing empirical evidence to other countries on integrating primary healthcare-based health systems. |
| first_indexed | 2024-04-10T05:29:42Z |
| format | Article |
| id | doaj.art-f4b157a65fa1452eb02eff80fb42f55b |
| institution | Directory Open Access Journal |
| issn | 2322-5939 |
| language | English |
| last_indexed | 2024-04-10T05:29:42Z |
| publishDate | 2022-09-01 |
| publisher | Kerman University of Medical Sciences |
| record_format | Article |
| series | International Journal of Health Policy and Management |
| spelling | doaj.art-f4b157a65fa1452eb02eff80fb42f55b2023-03-07T09:11:35ZengKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59392022-09-011191835184310.34172/ijhpm.2021.934099Effects of Vertical Integration Reform on Primary Healthcare Institutions in China: Evidence From a Longitudinal StudyShasha Yuan0Fengmei Fan1Dawei Zhu2Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, ChinaBeijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, ChinaChina Center for Health Development Studies, Peking University, Beijing, ChinaBackground Integrated care is a global trend in international healthcare reform, particularly for piloting vertical integration involving hospitals and primary healthcare institutions (PHIs). However, evidence regarding the impact of vertical integration on primary healthcare has been mixed and limited. Our study aims to evaluate the empirical effects of vertical integration reform on PHIs in China, and examines variations across integration intensity (tight integration vs. loose collaboration). Methods This study used a longitudinal design. The time-varying difference-in-difference (DID) method with a fixedeffect model for panel data was adopted. A total of 370 PHIs in the eastern, central, and western areas of China from 2009 to 2018 were covered. Outcome measures included the indicators at three dimensions regarding inpatient and outpatient service volume, patient flow between PHIs and hospitals and quality of chronic disease care (hypertension and diabetes). Results Significant increases in absolute (the number) and relative (the ratio between PHIs and hospitals) volume of inpatient admissions have been found after reform under tight integration, peaking at 183% and 15.0% respectively, in the third reform year. The quality of hypertension and diabetes care (by indicators of control rate of blood pressure and blood glucose) showed significant improvements under both types of vertical integration after reform. It was much more distinct for the PHIs under tight integration, which had the most significant increase of 34.0% and 22.8% under tight integration for the control rate of hypertension and diabetes compared to the peak of 21.2% and 22.1% respectively under loose collaboration. Conclusion Our findings suggest that vertical integration (especially tight integration) in China significantly contributed to strengthening primary healthcare in terms of inpatient services and quality of hypertension and diabetes care, providing empirical evidence to other countries on integrating primary healthcare-based health systems.https://www.ijhpm.com/article_4099_bf184ea865a7195a33ebe121c5a0c938.pdfvertical integrationintegrated careprimary healthcarepolicy effectchina |
| spellingShingle | Shasha Yuan Fengmei Fan Dawei Zhu Effects of Vertical Integration Reform on Primary Healthcare Institutions in China: Evidence From a Longitudinal Study International Journal of Health Policy and Management vertical integration integrated care primary healthcare policy effect china |
| title | Effects of Vertical Integration Reform on Primary Healthcare Institutions in China: Evidence From a Longitudinal Study |
| title_full | Effects of Vertical Integration Reform on Primary Healthcare Institutions in China: Evidence From a Longitudinal Study |
| title_fullStr | Effects of Vertical Integration Reform on Primary Healthcare Institutions in China: Evidence From a Longitudinal Study |
| title_full_unstemmed | Effects of Vertical Integration Reform on Primary Healthcare Institutions in China: Evidence From a Longitudinal Study |
| title_short | Effects of Vertical Integration Reform on Primary Healthcare Institutions in China: Evidence From a Longitudinal Study |
| title_sort | effects of vertical integration reform on primary healthcare institutions in china evidence from a longitudinal study |
| topic | vertical integration integrated care primary healthcare policy effect china |
| url | https://www.ijhpm.com/article_4099_bf184ea865a7195a33ebe121c5a0c938.pdf |
| work_keys_str_mv | AT shashayuan effectsofverticalintegrationreformonprimaryhealthcareinstitutionsinchinaevidencefromalongitudinalstudy AT fengmeifan effectsofverticalintegrationreformonprimaryhealthcareinstitutionsinchinaevidencefromalongitudinalstudy AT daweizhu effectsofverticalintegrationreformonprimaryhealthcareinstitutionsinchinaevidencefromalongitudinalstudy |