The Luohu Model: A Template for Integrated Urban Healthcare Systems in China

Abstract

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.

How Do Type 2 Diabetes Patients Value Urban Integrated Primary Care in China? Results of a Discrete Choice Experiment

“…(Nanshan HFPC, 2018, unpublished data) Taking human resource cost into consideration, it may be optimal for the HFPC of Nanshan district to hire staff with a few years working experience and reduce the turnover rate of former employees in CHSs. Additionally, encouraging endocrinologists with rich experience from district hospitals of vertical medical consortia to set up clinics regularly in CHSs [34] would not only improve capacity of CHSs, but also promote interorganizational care coordination.…”

“…However, it is estimated that the number of the elderly is increasing by 6.52% yearly [25][26][27]. The 80 CHSs received 3.52 million outpatient visits, accounting for only 34.26% of all outpatient visits in the district in 2017, indicating that patients are bypassing CHSs for their care needs.…”

Building a People-Centred Integrated Care Model in Urban China: A Qualitative Study of the Health Reform in Luohu

“…As discussed in previous literature [24][25][26][27][28], the Luohu model generated valuable lessons for integrated care initiatives in China, particularly the establishment of ISDN. ISDN were faced with several shared challenges to achieving integrated care [40,41].…”

“…As an urban district of Shenzhen, Luohu had one million population, and it's per capita Gross Domestic Product was $31,517 in 2017 [23]. Luohu Hospital Group was established in August 2015 after integrating five district-level public hospitals and 23 public community health centres [24][25][26]. By July 2017, Luohu Hospital Group had more than 575 thousand registered clients [25].…”

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“…Additionally, the government should optimize the policy instruments according to the trend of social development. The selection of policy instruments should fully consider not only the process of integrated care reform but also the social contexts [60]. At present, the rapid development of the Internet has created new opportunities for health reform.…”