Do medical alliances truly work? Perspectives on health service utilisation among outpatients with chronic diseases in Shanghai, China
Wanju Sun A # , Haiyan Zhu A # , Linyi Zhang A , Zhaoxin Wang B C D , Li Luo E , Weigang Qi A , Hualin Qi A , Yingxue Hua F , Xiang Gao D , Ling Yuan D * and Jianwei Shi G H *
+ Author Affiliations
- Author Affiliations
A Shanghai Pudong New Area People’s Hospital, Shanghai 201299, China.
B The First Affiliated Hospital of Hainan Medical University, Haikou 571199, China.
C School of Management, Hainan Medical University, Haikou 571199, China.
D School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
E School of Public Health, Fu Dan University School of Medicine, Shanghai 200433, China.
F Community Healthcare Centre of Heqing Town, Shanghai 201201, China.
G Department of General Practice, Yangpu Hospital, School of Medicine, Tongji University, Shanghai 200090, China.
H Department of Social Medicine and Health Management, School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
* Correspondence to: yuanling093@163.com, shijianwei_amy@126.com
# These authors contributed equally to this paper
Australian Journal of Primary Health 29(4) 332-340 https://doi.org/10.1071/PY22115
Submitted: 8 June 2022 Accepted: 29 December 2022 Published: 31 January 2023
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Background: To achieve proper health utilisation among various health institutions and improve primary care capacity, China implemented medical alliance (MA) reform as part of healthcare reforms in 2009. With chronic disease management as the focus and priority of primary health institutions, this study aimed to analyse the specific distribution and trends of outpatient visits to various levels of health institutions (community health centres (CHCs) vs hospitals) in MAs.
Methods: All outpatient data were extracted from the Chuansha MA in Pudong New Area, Shanghai, between 2016 and 2020, and submitted to descriptive analysis, Chi-Square tests and correlation analysis.
Results: This article found that outpatients aged >60 years visited CHCs more than hospitals for some chronic diseases. The adjusted average costs of outpatients presented upward trends both in hospitals and in CHCs.
Conclusions: The Chuansha MA worked in guiding older outpatients to visit CHCs, but did not control the increasing medical costs. The Shanghai government should further improve medical capability of CHCs to attract all community-dwelling residents at all ages to implement hierarchical diagnosis and treatment systems, as well as make more efforts to control increasing medical costs.
Keywords: China, chronic disease management, community health centres, distribution, health service utilisation, healthcare reform, medical alliance, trend.
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