A multi-case study of the vertically integrated health-care at county-level in rural China: towards holistic and dynamic governance.

Background: In contrast to the Grading Diagnosis and Treatment System (GDTS), Vertically Integrated Health-care at County-level (VIHC) is a strategic policy in rural China. This research intends to analyze the shift in governance paradigm with regard to the adjustment of the power structure and interest relationships among various participants, using the building of VIHC as a cut-in point. Methods: We carry out a multi-case study to investigate the paradigms of health governance when building VIHC in three different rural counties in China. Results: There were exchanges between government and other participants, vertical and horizontal collaborations among government divisions, and prompt responses to public requirements. County C's local administration, in particular, placed a strong emphasis on bureaucratic power and collaboration between various departments both within and outside of administrative boundaries. In contrast, County B's local administration emphasized the independence of healthcare practitioners and worked to win their support. In contrast to the previous two governments, County A encouraged social actors to participate and saw a little improvement in performance. Conclusion: In examining the health reform in rural China, this study paints a picture of the development of the health governance paradigm. In rural China, a comprehensive and dynamic governance paradigm was created through the integration of the health decision-making process, which was driven by the public's health needs, the operation mechanism, which featured both competition and cooperation, and the action logic of sharing responsibility.

Can integrated care improve the efficiency of hospitals? Research based on 200 Hospitals in China.

BACKGROUND: The shift towards integrated care (IC) represents a global trend towards more comprehensive and coordinated systems of care, particularly for vulnerable populations, such as the elderly. When health systems face fiscal constraints, integrated care has been advanced as a potential solution by simultaneously improving health service effectiveness and efficiency. This paper addresses the latter. There are three study objectives: first, to compare efficiency differences between IC and non-IC hospitals in China; second, to examine variations in efficiency among different types of IC hospitals; and finally, to explore whether the implementation of IC impacts hospital efficiency. METHODS: This study uses Data Envelopment Analysis (DEA) to calculate efficiency scores among a sample of 200 hospitals in H Province, China. Tobit regression analysis was performed to explore the influence of IC implementation on hospital efficiency scores after adjustment for potential confounding. Moreover, the association between various input and output variables and the implementation of IC was investigated using regression techniques. RESULTS: The study has four principal findings: first, IC hospitals, on average, are shown to be more efficient than non-IC hospitals after adjustment for covariates. Holding output constant, IC hospitals are shown to reduce their current input mix by 12% and 4% to achieve optimal efficiency under constant and variable returns-to-scale, respectively, while non-IC hospitals have to reduce their input mix by 26 and 20% to achieve the same level of efficiency; second, with respect to the efficiency of each type of IC, we show that higher efficiency scores are achieved by administrative and virtual IC models over a contractual IC model; third, we demonstrate that IC influences hospitals efficiency by impacting various input and output variables, such as length of stay, inpatient admissions, and staffing; fourth, while bed density per nurse was positively associated with hospital efficiency, the opposite was shown for bed density per physician. CONCLUSIONS: IC has the potential to promote hospital efficiency by influencing an array of input and output variables. Policies designed to facilitate the implementation of IC in hospitals need to be cognizant of the complex way IC impacts hospital efficiency.

Combining Resource, Structure and Institutional Environment: A Configurational Approach to the Mode Selection of the Integrated Healthcare in County.

Integrated healthcare has received considerable attention and has developed into the highly important health policy known as Integrated Healthcare in County (IHC) against the background of the Grading Diagnosis and Treatment System (GDTS) in rural China. However, the causal conditions under which different integrated health-care modes might be selected are poorly understood, particularly in the context of China's authoritarian regime. This study aims to identify these causal conditions, and how they shape the mode selection mechanism for Integrated Healthcare in County (IHC). A theoretical framework consisting of resource heterogeneity, governance structure, and institutional normalization was proposed, and a sample of fifteen IHCs was selected, with data for each IHC being collected from news reports, work reports, government documents and field research for Fuzzy-sets Qualitative Comparative Analysis (fsQCA). This study firstly pointed out that strong governmental control and centralization are necessary conditions for the administration-oriented organization mode (MOA). Additionally, this research found three critical configured paths in the selection of organizational modes. Specifically, we found that the combination of low resource heterogeneity, weak governmental control, centralization, and normalization was sufficient to explain the selection path of the insurance-driven organization mode (MOI); the combination of low resource heterogeneity, strong governmental control, centralization, and normalization was sufficient for selecting MOA; and the combination of weak governmental control, weak centralization, and weak normalization was sufficient for selecting the contractual organization mode (MOC). Our study highlighted the necessity and feasibility of constructing different IHC modes separately and promoting their development gradually, as a result of the complex relationships among the causal conditions described above, thus helping to optimize the distribution of health resources and integrate the healthcare system.