Health Affairs

From Health Affairs

In Rural China, a Successful Payment Reform Pilot Project

Bethesda, MD --Part of China's health reform effort, which began in 2009, was to refocus the public hospitals away from what health minister Chen Zhu called "profit chasing" and toward their intended public purpose. A new study, being released today as a Web First by Health Affairs, presents early results from a pilot project underway in several of China's rural provinces that combines new case-based payments for providers and evidence-based clinical pathways for management of patients. Before and after studies and analyses show a reduction in overall length of hospital stays, drug spending and usage, and patients' out-of-pocket spending. Patient-provider communication and relations reportedly improved, and hospitals did not experience any revenue losses.

This pilot, which was part of the China Rural Health Project, began in the fall of 2011 and is supported with grants from the UK Department for International Development and loans from the World Bank. In selected rural public hospitals, the pilot implemented evidence-based clinical pathways and case payments were applied to a set of medical conditions requiring treatment over time. Ten common medical conditions were targeted, and to gain the participation of the hospital personnel, pilot hospitals established incentive schemes to reward or sanction clinicians for their participation (or lack of participation) in the program. The author reports that results have been encouraging. "One can view evidence-based clinical pathways, along with the practice guidelines on which they are based, as ideal conduits for teaching medical practitioners and their staff about best clinical practices in their field," she concludes. "In a country as vast and varied as is China, that is a major advantage."

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