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Table 1 Summary of policies for hierarchical medical system in Xiamen

From: Evaluation of the three-in-one team-based care model on hierarchical diagnosis and treatment patterns among patients with diabetes: a retrospective cohort study using Xiamen’s regional electronic health records

  Time Category Policy change/Intervention
A* B** C***
P0 08/11 NA Reference period
P1 08/12 x    Establishment of “Hospital-Community” integrated service model
10/12    x Increase of Essential Drug List (EDL) for hypertension and diabetes to 48 types
   x Extension of the prescription interval at community health centers to 1 month
P2 01/14   x   Financial incentives to GPs for disease management at an average of ¥ 10,000/GP/year
x    Initiation of “1 + 1 + X” model: Paired specialists from tertiary hospitals with GPs from community health centers
P3 10/14   x   Financial incentives for disease management increased to an average of ¥ 40,000/GP/year
x    Initiation of “three-in-one” model: added health managers to specialist/GP pairs
x    Establishment of diabetes patients network for enhanced disease management
   x Increase of EDL for hypertension and diabetes to 84 types
P4 04/15 x    Establishment of the regional hierarchical medical system for chronic disease management, structured around an “overall health care network for diabetic and hypertensive patients”:
• Full implementation of the “three-in-one” model
• Enhanced information system for diabetic and hypertensive patients
• Enhanced two-way patient referral system between GHs and CHCs
  x   Change in the financial incentive to 600¥/person/year for diabetes patients and 300¥/person/year for hypertension patients
x    Pilot in closing out-patient service in tertiary hospitals
P5 07/15 x    Formal establishment of health manager position in CHCs
   x Full implementation of the same EDL in community health centers as in general hospitals
   x Extension of the prescription interval at community health centers to 2 months
  x   Change of periodical budget payment for CHCs to immediate payment settlement, and removal of the reimbursement limitations for CHCs
P6 01/16   x   Removal of upper limit on financial incentives to GPs for disease management
  1. *A: Hospital-CHC integration; **B: Financial incentives to CHC/GPs; ***C: Drug availability in CHC