Table 1 Summary of policies for hierarchical medical system in Xiamen

P₀

Reference period

P₁

x

Establishment of “Hospital-Community” integrated service model

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

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

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

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

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

x

Removal of upper limit on financial incentives to GPs for disease management