The world has experienced an unprecedented level of urbanization over the past 50 years, with the world’s urban population exceeding the rural population for the first time in the early years of this century. For health ministries, urbanization has the advantage of geographically concentrating the demand for services, and providing opportunities for more cost effective and more accessible health care provision. The corollary of this is a likely inequality arising between the health service provision available in urban and rural areas, with rural areas experiencing poorer, less accessible services [e.g. [1–6]. The issue has particular significance for China because of the absolute size of its population, the rapid economic growth it has enjoyed over recent years (with the characteristic increase in urbanization), and the fact that 50% of the population continues to live in rural areas .
In response to the concern about the rural–urban inequality, the government of China has, since 1997, focused health systems reform on narrowing this gap . Of the 21.7 billion Chinese Yuan (~3.4 billion USD) China had planned to invest into its health services development between 2006 and 2010, approximately 68% was marked for building capacity in rural health . Counterpart technical support policies aimed at mobilizing the greater capacity of top urban hospitals to improve rural hospital capacity have been in development since 2005. It commenced when the Ministry of Health, Ministry and Finance and the Bureau of Traditional Chinese Medicine jointly established the “Mobilization of 10,000 Doctors for Rural Health Project” in Western and Central China, and began as a pilot in 2009 . Services in rural communities have also been integrated into urban hospital policies which require urban doctors to serve in rural hospitals for an accumulated period of 12 months before being eligible for promotion . More recent policy developments have focused on the establishment of longer-term partnerships between rural and urban hospitals to strengthen rural hospital capacity .
Progress for implementing the national agenda for reducing the rural–urban gap in health services varies across China’s many administrative units. Beijing, the nation’s capital, has been at the forefront of the country’s rural health services reform, and serves as an exemplar case study for health reform in other parts of China. With an area of 16,801.25 km2 (the size of Wales) and a population of 20.19 million as of 2011, Beijing municipality is divided into five urban districts, eight suburban districts, and two rural counties . Urban Beijing is serviced by 13 general hospitals, while the 10 suburban and rural areas are serviced by 11 county hospitals. Implementation of rural support initiatives in Beijing can be traced back to 2003 before the counterpart technical support policy was formalized on a national level .
Beijing’s commitment to the counterpart initiative has gradually increased . In 2008, the Beijing Municipal Health Bureau formalized the partnership between all 24 hospitals targeted by the counterpart technical support policy. Memoranda of understanding (MOU) were signed between the 11 recipient rural hospitals and their 13 supporting urban partners. Nine recipient rural hospitals signed the MOU with nine urban supporting hospitals, while the remaining two rural hospitals formed partnerships with two urban hospitals each. The MOU covered three elements: (1) physicians from the supporting urban hospitals must each serve at least one month of every year in the recipient rural hospitals; (2) supporting hospitals must provide appropriate training to staff members of their recipient hospitals in areas where the recipient hospitals lack clinical capacity; (3) when a recipient hospital encounters clinical difficulties, external consultation must be provided by its partner urban hospital, and if necessary, have the patient transferred to the partner hospital.
An annual budget of approximately 2,500,000 yuan was set aside by the Beijing Municipal Health Bureau to remunerate the urban hospitals for their participation . The precise amount payable each year was dependent on the feedback contained in the recipient hospitals’ annual reports. By the end of 2010, approximately 1,200 doctors from the participating urban hospitals were mobilized to provide 50,000 workdays to their rural counterparts . During this period, the Chinese government’s general funding for rural hospitals was increased by 50.8%, while funding for large medical equipment purchase in rural hospitals was increased by 40.7%. This investment was in sharp contrast to funding provided for urban hospitals in the same period which was marked by a 24.4% increase in general funding, and 1.7% increase in funding for equipment purchases [17, 18].
This paper aims to evaluate the latest development of Beijing’s counterpart technical support policy from early 2008, when Beijing’s 13 leading urban general hospitals were appointed to each form partnerships with one appointed leading rural general hospital . Using hospital records from 2008 to 2010, this paper focuses on understanding changes in rural hospital capacity and services during the period of reform. More specifically, we compare the 2008 data from participating rural hospitals with the 2010 data. The following areas were compared: the scope of hospital services, medical safety, treatment success of difficult cases, length of inpatient stay, and treatment costs. For comparison purposes, changes in hospital capacity and services for the urban counterpart hospitals were also analyzed, specifically looking at the changes in the rural–urban gap in health services.