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

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机构： [1]Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China. [2]Medical Device Regulatory Research and Evaluation Center, West China Hospital, Sichuan University, Chengdu, China. [3]School of Management, Beijing University of Chinese Medicine, Beijing, China. [4]Office of Policy and Planning Research, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China. [5]Australian National Institute of Management and Commerce, Sydney, NSW, Australia. [6]Guangdong Institute for International Strategies, Guangdong University of Foreign Studies, Guangzhou, China. [7]School of Economics and School of Management, Tianjin Normal University, Tianjin, China. [8]Newcastle Business School, University of Newcastle, Callaghan, NSW, Australia. [9]University of Liverpool Management School, University of Liverpool, Liverpool, United Kingdom. [10]State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau, China. [11]National Institute of Traditional Chinese Medicine Strategy and Development, Beijing University of Chinese Medicine, Beijing, China.

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关键词： health service COVID-19 public hospital hierarchical medical system healthcare-seeking behavior

摘要：

The 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.Hospital 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.In 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.The 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.Copyright © 2023 Yang, Huang, Yan, Nicholas, Maitland, Bai and Shi.

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出版当年[2022]版：

大类 | 3 区医学

小类 | 3 区公共卫生、环境卫生与职业卫生

最新[2025]版：

大类 | 3 区医学

小类 | 3 区公共卫生、环境卫生与职业卫生

第一作者：

第一作者机构： [1]Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China. [2]Medical Device Regulatory Research and Evaluation Center, West China Hospital, Sichuan University, Chengdu, China. [3]School of Management, Beijing University of Chinese Medicine, Beijing, China.

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通讯作者：

通讯机构： [3]School of Management, Beijing University of Chinese Medicine, Beijing, China. [11]National Institute of Traditional Chinese Medicine Strategy and Development, Beijing University of Chinese Medicine, Beijing, China.

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

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