Research on the Equity and Optimal Allocation of Basic Medical Services in Guangzhou in the Context of COVID-19

Does a new case-based payment system promote the construction of the ordered health delivery system? Evidence from a pilot city in China

BACKGROUND

The construction of the ordered health delivery system in China aims to enhance equity and optimize the efficient use of medical resources by rationally allocating patients to different levels of medical institutions based on the severity of their condition. However, superior hospitals have been overcrowded, and primary healthcare facilities have been underutilized in recent years. China has developed a new case-based payment method called "Diagnostic Intervention Package" (DIP). The government is trying to use this economic lever to encourage medical institutions to actively assume treatment tasks consistent with their functional positioning and service capabilities.

METHODS

This study takes Tai'an, a DIP pilot city, as a case study and uses an interrupted time series analysis to analyze the impact of DIP reform on the case severity and service scope of medical institutions at different levels.

RESULTS

The results show that after the DIP reform, the proportion of patients receiving complicated procedures (tertiary hospitals: β3 = 0.197, P < 0.001; secondary hospitals: β3 = 0.132, P = 0.020) and the case mix index (tertiary hospitals: β3 = 0.022, P < 0.001; secondary hospitals: β3 = 0.008, P < 0.001) in tertiary and secondary hospitals increased, and the proportion of primary-DIP-groups cases decreased (tertiary hospitals: β3 = -0.290, P < 0.001; secondary hospitals: β3 = -1.200, P < 0.001), aligning with the anticipated policy objectives. However, the proportion of patients receiving complicated procedures (β3 = 0.186, P = 0.002) and the case mix index (β3 = 0.002, P < 0.001) in primary healthcare facilities increased after the reform, while the proportion of primary-DIP-groups cases (β3 = -0.515, P = 0.005) and primary-DIP-groups coverage (β3 = -2.011, P < 0.001) decreased, which will reduce the utilization efficiency of medical resources and increase inequity.

CONCLUSION

The DIP reform did not effectively promote the construction of the ordered health delivery system. Policymakers need to adjust economic incentives and implement restraint mechanisms to regulate the behavior of medical institutions.

Big data-driven spatio-temporal heterogeneity analysis of Beijing's catering service industry during the COVID-19 pandemic

The Catering Service Industry (CSI) experienced profound impacts due to the COVID-19 pandemic. However, the long-term and multi-timepoint analysis using big data remained limited, influencing governmental decision-making. We applied Kernel Density Estimation, Shannon Diversity Index, and the Geographic detector to explore the spatial heterogeneity and determinants of the CSI in Beijing during the pandemic, with monthly granularity. The temporal-spatial dynamics of the CSI presented a "W"-shaped trend from 2018 to 2023, with pivotal shifts aligning with key pandemic stages. Spatial characteristics exhibited heterogeneity, with greater stability in the city center and more pronounced shifts in peripheral urban zones. Districts facing intricate outbreaks showed lower catering income, and Chinese eateries exhibited heightened resilience compared to others. The CSI displayed strong interconnections with living service sectors. Development in each district was influenced by economic level, population distribution, service facilities convenience, and the risk of the COVID-19 pandemic. Dominant factors included total retail sales of consumer goods, permanent population, average Baidu Heat Index, density of transportation and catering service facilities, infection cases and the consecutive days with confirmed cases existing. Consequently, we suggested seizing post-pandemic recovery as an avenue to unlock the CSI's substantial potential, ushering a fresh phase of growth.