Longitudinal study of the earliest pilot of tiered healthcare system reforms in China: Will the new type of chronic disease management be effective?

Background: In 2016, the tiered healthcare model featuring specialists + general practitioners + health managers in Xiamen was recognized by the Medical Reform Office of State Council and was promoted as a model to replace hospital-centric care with community-based care. This study evaluated the impact of the Xiamen's tiered healthcare system reform on health outcomes and healthcare spending among chronic disease patients. Methods: Data were derived from Xiamen's electronic health record (EHR) and medical claims systems. The sample included 154,651 individuals with hypertension and 50,722 individuals with diabetes from Xiamen between 2012 and 2016. The dependent variables included rates of disease under control and total treatment costs. Patients were grouped by the types of chronic disease management: precision management, regular management, or without management. Kaplan-Meier, Cox survival analysis and PSM + DID method (Propensity score matching and difference-in-difference method) were used to compare the management outcomes by group. Findings: The precision management group showed better clinical quality performance than the regular management group. Under-control disease rates in the precision management group showed a continuous improvement trend, while the regular management group showed a ceiling effect after ten months. Under-control rates in the precision management group increased over 40% for hypertension and over 30% for diabetes, higher than that increases found in the regular management group. Reform was also associated with consistent reductions in annual per capita total treatment costs across groups. The cost-savings in the precision management group between 2014 and 2016 was 381 Chinese yuan (CNY) for hypertension and 1117 CNY for diabetes, compared with the group without management. Interpretation: The results in this study demonstrated the associations between tiered healthcare system reform and better clinical quality performance and improved treatment cost-saving. Developing methods to promote the policy and increase implementation are also important aspects of healthcare reform.

Automated summary

The study demonstrated that the tiered healthcare system reform in Xiamen has positive impact on clinical quality performance and treatment cost-saving, with the precision management group showing better outcomes compared to the regular management group.