In most countries, the demand for integrated care for people with chronic diseases is increasing as the population ages. This demand requires a fundamental shift of health-care systems towards more integrated service delivery models. To achieve this shift in China, the World Health Organization, the World Bank and the Chinese government proposed a tiered health-care delivery system in accordance with a people-centred integrated care model. The approach was pioneered in Luohu district of Shenzhen city from 2015 to 2017 as a template for practice. In September 2017, China’s health ministry introduced this approach to people-centred integrated care to the entire country. We describe the features of the Luohu model in relation to the core action areas and implementation strategies proposed and we summarize data from an evaluation of the first two years of the programme. We discuss the challenges faced during implementation and the lessons learnt from it for other health-care systems. We consider how to improve collaboration between institutions, how to change the population’s behaviour about using community health services as the first point of contact and how to manage resources effectively to avoid budget deficits. Finally, we outline next steps of the Luohu model and its potential application to strengthen health care in other urban health-care systems.

Introduction:Emerging from the epidemiological transition and accelerated aging process, China’s fragmentated healthcare systems struggle to meet the demands of the population. On Sept 1st 2017, China’s National Health and Family Planning Commission encouraged all cities to learn from the Luohu model of integration adopted in Luohu as an approach to meeting these challenges. In this paper, we study the integration process, analyze the core mechanisms, and conduct preliminary evaluations of integrated policy development in the Luohu model.Policy development:The Luohu hospital group was established in Aug 2015, consists of five district hospitals, 23 community health stations and an institute of precision medicine. The group adopted a series of professional, organizational, system, functional and normative strategies for integrated care, which was provided for the residents of Luohu, especially for the elderly population and patients with chronic conditions. According to a preliminary evaluation of the past two years, the Luohu model showed improvement in the structure and process towards integrated care. New preventive programs conducted in the hospital group resulted in changes of disease incidence. Residents were more satisfied with the Luohu model. However, spending exceeded the global budget for health insurance because of short-term increases in the demand for health care.Lessons learned:First, engagement of multiple stakeholders is essential for the design and implementation of reform. Second, organizational integration is a prerequisite for integrated care in China. Third, effective care integration requires alignment with payment reforms. Fourth, normative integration could promote collaboration in an integrated healthcare system.Conclusion:Core strategies and mechanisms of the Luohu model will promote integrated care in urban China and other countries facing the same challenges. However, it is necessary to study the effects of the Luohu model over the long term and continue to strive for integrated care.

COVID-19 has affected primary health-care delivery in metropolitan areas. An integrated health-care system offers advantages in response to the community outbreak and transmission of highly infectious diseases. On the basis of practitioner experience with a pioneering integrated health-care system in Shenzhen, China, this article presents the following effective strategies in response to the epidemic: (1) enhance the public workforce in primary health care; (2) integrate resources to allow regional sharing and efficient use; (3) employ teams centered on general practitioners for community containment; and (4) adopt e-health and telemedicine for health-care delivery. An integrated health-care system is usually very specific to a particular regional context; however, the core strategies and mechanisms based on the Luohu model can contribute to improving the public health capacity in emergency responses; they can transform health-care delivery in the COVID-19 epidemic. The experience in Shenzhen may help other cities in enhancing and coordinating the preparedness of their health-care systems in dealing with future public health emergencies.

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Background Following the implementation of the Healthy China 2030 strategy, China’s health-care system must shift from being disease-centered to health-centered. Medical insurance funds are the main economic resource for medical health-care service providers in China; therefore, the Chinese medical insurance system has become an important economic lever for adjusting the behavior of medical health-care providers. In the new round of medical reform, substantial progress has been made in the construction of a medical treatment insurance system. The world’s largest medical insurance network has been created in a relatively short period in China and basically achieves universal medical insurance coverage. However, this system mainly provides full coverage to the amount and has yet to fully achieve the principle of “health-care for all” proposed by the Healthy China 2020 strategy. China must promote reform in the medical insurance system and establish a medical insurance guidance mechanism to ensure that medical service providers consider and promote health care. Methods Using Luohu Hospital Group in Shenzhen City, Guangdong Province as the research object, the details of the health maintenance organization’s reform of its medical insurance payment patterns to be more health-oriented are introduced. Comparing the summarized characteristics of the health maintenance organization’s payment patterns, the relevant data for the medical insurance operation and health status of the insured before and after the reform were analyzed statistically. Results The data show that after the reform, the total hospitalization cost of the insured, number of inpatients, and hospitalization rate all decreased. The growth rate of expenditure in the medical insurance fund slowed and initial results were shown in preventive health-care work. The incidence of some infectious diseases and the hospitalization rate of patients with chronic diseases decreased. Conclusions The medical service providers form positive incentives and appropriate medical orientations, while patients demanding health care may form good habits of seeking medical treatment and healthy life, but not pursuing economic benefits through the medical insurance reform.