Table 1.
Summary of policies for hierarchical medical system in Xiamen
| Time | Category | Policy change/Intervention | |||
|---|---|---|---|---|---|
| A* | B** | C*** | |||
| P0 | 08/11 | NA | Reference period | ||
| P1 | 08/12 | x | Establishment of “Hospital-Community” integrated service model | ||
| 10/12 | x | Increase of Essential Drug List (EDL) for hypertension and diabetes to 48 types | |||
| x | Extension of the prescription interval at community health centers to 1 month | ||||
| P2 | 01/14 | x | Financial incentives to GPs for disease management at an average of ¥ 10,000/GP/year | ||
| x | Initiation of “1 + 1 + X” model: Paired specialists from tertiary hospitals with GPs from community health centers | ||||
| P3 | 10/14 | x | Financial incentives for disease management increased to an average of ¥ 40,000/GP/year | ||
| x | Initiation of “three-in-one” model: added health managers to specialist/GP pairs | ||||
| x | Establishment of diabetes patients network for enhanced disease management | ||||
| x | Increase of EDL for hypertension and diabetes to 84 types | ||||
| P4 | 04/15 | x | Establishment of the regional hierarchical medical system for chronic disease management, structured around an “overall health care network for diabetic and hypertensive patients”: • Full implementation of the “three-in-one” model • Enhanced information system for diabetic and hypertensive patients • Enhanced two-way patient referral system between GHs and CHCs |
||
| x | Change in the financial incentive to 600¥/person/year for diabetes patients and 300¥/person/year for hypertension patients | ||||
| x | Pilot in closing out-patient service in tertiary hospitals | ||||
| P5 | 07/15 | x | Formal establishment of health manager position in CHCs | ||
| x | Full implementation of the same EDL in community health centers as in general hospitals | ||||
| x | Extension of the prescription interval at community health centers to 2 months | ||||
| x | Change of periodical budget payment for CHCs to immediate payment settlement, and removal of the reimbursement limitations for CHCs | ||||
| P6 | 01/16 | x | Removal of upper limit on financial incentives to GPs for disease management | ||
*A: Hospital-CHC integration; **B: Financial incentives to CHC/GPs; ***C: Drug availability in CHC