Does the Implementation of the Hierarchical Medical System Promote Health efficiency in China?

PURPOSE  China has implemented the Hierarchical Medical System (HMS) in 2015. HMS ensures patients will receive initial diagnosis in grassroots clinics, with a goal of optimizing the allocation of medical resources. The study aims to examine whether the implementation of HMS is effective in promoting health efficiency (HE).

METHODS  To examine the effect of HMS on HE, we analyzed provincial-level data of 31 provinces from the China Health Statistical Yearbooks between 2010 and 2019 using quantile regression. Additionally, hospital competition between private and public hospitals (HHI) are applied to discuss its moderating effect on the relationship between HMS and HE. We modeled the HMS as a time-series step function.

RESULTS  After the implementation of HMS in 2015, HMS increased health efficiency by 0.494%. In additions, HHI is correlated with an increase in health efficiency. Specifically, this promotion is mainly reflected in areas with low health efficiency. The moderating effect of HHI is mirror and occurs only in areas with extremely low health efficiency.

CONCLUSIONS  HMS and HHI is associated with the improvement of the HE. This shows that the HMS may effectively reduce the possibility of disease deterioration through basic medical and health services, early detection, and early treatment of the disease. And HHI may lead to an increase in medical quality and a decrease in medical expenditures. However, this promotion effect of HMS and HHI is mainly reflected in areas with low health efficiency, which shows that in areas with high health efficiency, due to the siphon effect of large public hospitals, the role of primary medical institutions and private hospitals are still limited.