Coping with COVID: Performance of China’s hierarchical medical system during the COVID-19 pandemic

Abstract

ObjectiveThe COVID-19 pandemic has challenged the health system worldwide. This study aimed to assess how China’s hierarchical medical system (HMS) coped with COVID-19 in the short-and medium-term. We mainly measured the number and distribution of hospital visits and healthcare expenditure between primary and high-level hospitals during Beijing’s 2020–2021 pandemic relative to the 2017–2019 pre-COVID-19 benchmark period.MethodsHospital operational data were extracted from Municipal Health Statistics Information Platform. The COVID-19 period in Beijing was divided into five phases, corresponding to different characteristics, from January 2020 to October 2021. The main outcome measures in this study include the percentage change in inpatient and outpatient emergency visits, and surgeries, and changing distribution of patients between different hospital levels across Beijing’s HMS. In addition, the corresponding health expenditure in each of the 5 phases of COVID-19 was also included.ResultsIn the outbreak phase of the pandemic, the total visits of Beijing hospitals declined dramatically, where outpatient visits fell 44.6%, inpatients visits fell 47.9%; emergency visits fell 35.6%, and surgery inpatients fell 44.5%. Correspondingly, health expenditures declined 30.5% for outpatients and 43.0% for inpatients. The primary hospitals absorbed a 9.51% higher proportion of outpatients than the pre-COVID-19 level in phase 1. In phase 4, the number of patients, including non-local outpatients reached pre-pandemic 2017–2019 benchmark levels. The proportion of outpatients in primary hospitals was only 1.74% above pre-COVID-19 levels in phases 4 and 5. Health expenditure for both outpatients and inpatients reached the baseline level in phase 3 and increased nearly 10% above pre-COVID-19 levels in phases 4 and 5.ConclusionThe HMS in Beijing coped with the COVID-19 pandemic in a relatively short time, the early stage of the pandemic reflected an enhanced role for primary hospitals in the HMS, but did not permanently change patient preferences for high-level hospitals. Relative to the pre-COVID-19 benchmark, the elevated hospital expenditure in phase 4 and phase 5 pointed to hospital over-treatment or patient excess treatment demand. We suggest improving the service capacity of primary hospitals and changing the preferences of patients through health education in the post-COVID-19 world.

Evaluating China's primary healthcare services' efficiency and spatial correlation: a three-stage DEA-Malmquist model

“…This may be for the following two reasons: First, there are pronounced regional differences in Chinese government health expenditure ( 76 ), with an overall tendency to favor regions with higher economic levels ( 77 ), and given regional disparities in economic development, government health expenditure has had other impacts on PHC institutions of various regions. Second, COVID-19 has posed a significant challenge to the PHC system ( 10 , 78 ), and efficiency must be improved despite the continuous increase in government investment in health. Of course, this situation may change after COVID-19.…”

“…Throughout the pandemic, primary healthcare facilities faced numerous challenges, including a surge in patient numbers, resource limitations, and service disparities. Research has demonstrated that optimizing resource allocation, strengthening human resource management, implementing digital healthcare solutions (9)(10)(11), and boosting community engagement can substantially improve service efficiency and alleviate epidemicrelated pressures. Nonetheless, technical, policy, and sociocultural hurdles continue to impede efficiency enhancements.…”

The cross-regional settlement methods in hospitals and the treatment-seeking behavior of patients with malignant tumors in China: an evolutionary game model

“…Besides, the impacts of COVID-19 or similar public health emergencies are not considered. During the pandemic, the localized management of health policies in China temporarily restricted cross-regional medical treatment ( 46 ), which returned to pre-pandemic conditions post-COVID-19. Given the intensified focus on healthcare in the post-pandemic era and the enhanced mobility of the population, there is a potential increase in the demand for cross-regional medical services ( 47 ).…”