In an interview with iNewsweek (Chinese: 中国新闻周刊), Dr. Winnie Yip discusses the historical transition in China’s health system towards its current hospital-centric care delivery model. Prior to China’s health reforms, village-level doctors were the main providers of patient care. The quality of services provided by these village doctors was highly variable, and many of them exhibited profit maximization behavior by limiting provision of services with lower subsidies.
This began to change with the introduction of the China’s New Cooperative Medical Scheme (NCMS, Chinese: 新农合) in 2003. With NCMS, inpatient services became eligible for reimbursement while outpatient services were excluded. In response to this incentive structure, people began seeking inpatient care at town and city-level hospitals, even if their health conditions could have been addressed through outpatient services at village clinics. Compounding this trend, China’s strong economic growth led to the strengthening of tertiary hospitals through increased levels of investment while the development of primary care lagged behind. Village-level doctors previously served as the entry point into the health system, but these changes meant that people were able receive higher quality care still covered by social health insurance by bypassing primary care in favor of care at large tertiary hospitals.
Given the complex interplay of forces drawing patients to tertiary hospitals, Dr. Yip argues that no single policy will be able to address the inability of local primary care providers to attract and keep patients. Such a change will require a broader policy mechanism that re-aligns patient incentives at many different levels.