Research on Global Budget on One Certain Disease in
Multi-level Institutions: Integrated Service Orientation
Email: yanzhang@hust.edu.cn

Background

Objective

Intervention

Investigation

Finds
Background
Disorder flow
Lack of coordination
Fragmented Healthcare
Delivery System
Efficiency and Effectiveness
Health Reform
Quality
Access
Utilization of healthcare increasing
Efficiency

Integrated health care system:
International perspective and
China practice

Sep 1-3, 2012, Beijing


“Study on the Efficiency and Effectiveness of the Integrated Health
Care Services in Rural China” supported by the China Medical
Board；
“Research on the vertical Integration management model of Chinese
rural medical service based on complex adaptive system theory”
supported by the National Natural Science Fund.
Objective
 Overall goals:
Seamless care
Improved care
Better health
Lower cost
 Objective:
To explore the mechanism of Global Budget
of Multi-level Institutions on one certain
disease (GBMI) to stimulate health personnel
to supply integrated care in primary
institutions.
Intervention Design

Case-control study

Qianjiang District, Chongqing, China

4 similar township hospitals were divided
into intervention group and control group.

All residents with hypertension, 4176

1st July 2012 --- 31st December 2013
Integrated Service on Hypertension
Focus
Continuous
Service Team
(CST)
Member
Service
Commands
Rewards
Personalized
follow-up and
Monitoring




Follow-up
Monitoring
Education
…
Continuous
Service Path
 CPP
 CCP
 CMP
Global Budget
of Multi-level
Instituions





3 institutions
Calculation
Adjustment
Allocation
Punishments
Continuous Service Team (CST)

Member:
 Village health personnel;
 General practitioners, public health personnel in
township hospital;
 Hypertension specialists in county hospital;
 Coordinator et al.

Service:
 Supplied all managed hypertension patients with all
preventive and medical care
 Healthcare includes blood pressure monitoring,
health education, medical care and doctor visit.
Personalized Follow-up and Monitoring
Salt group
Obese group
Routine
Follow-up
Risk Factors
Assessment
Alcohol and
tobacco group
Personalized
Follow-up
Anxiety group
Motion group
Risk Factors
Criteria
Different
service forms
Elderly group
Difficult group
Drug group
Different
service
contents
Medical
treatment
Doctor Visit
Continuous Service Path, CSP
Continuous Primary-care Pathway，CPP
 Continuous Clinical-care Pathway，CCP
 Continuous-care Management Pathway，
CMP


CST supplied above 10000 personalized
health intervention services to 4167 managed
patients by December 2012.
County Hospital
Cardiology
Endocrinology
Continuous Clinicalcare Pathway
Township Hospital
GP
Coordinator
Pub. Hea. Per
Continuous Primarycare Pathway
Village Clinic
Village
Doc 1
Village
Doc 2
Village
Doc 3
Continuous Clinical-care Pathway，CCP
Insurance
Payment
Access
Standards
Enter
Form
CCP
Continuous
Diagnosis
Continuous
Treatment
Continuous
Medication
Variation Analysis
Out
Global Budget of Multi-level Instituions
Calculation
Though the actual costs of all residents with hypertension
in the past three years
Adjustment
By CPI, growth coefficient and inflation factor
Allocation
Possible budget balance belong to CST while budget shortfalls would be
apportioned into CST
Punishment
Discount the possible budget balance for rejecting essential services
and translating hypertension into other diseases
Investigation





2 investigations on 1st July and 31st
December 2012;
Multistage stratified random sampling,593:578;
The status of health self-assessment,
experiences of seeing doctors, doctor visits and
individual information.
The data of expenditure on all managed
patients were exported via Health Insurance
Information Management System;
The medical records were collected in medical
institutions regularly.
Results1
Management rate of hypertension increased from
58.1% to 93.5% (P<0.01) in intervention group;
 Standardized management rate from 37.1% to
42.3% (P<0.01) in intervention group;
 Medication adherence rate increased by 8.7% in
intervention group;
 The ratio of expenditure on township hospitals to
global expenditure increased from 21.3% to
25.4% (P=0.023), which were all higher than
those of control group.

Results2
Standard control ratio of hypertension is likely to
reach 65% by Dec 2013 by means of Markov
Prediction Model with continuous intervention;
 38 patients have received continuous clinical
services from CST while the average expenditure
is 7% lower than that without CST;
 Growth rate of hospitalized hypertension patient
in county hospital decreased from 15% to 12%
while that in township hospital decreased by 6.3%
in intervention group.

Finds



The expansion of patients with hypertension could be
controlled and the behavior could be changed.
The CST under GBMI can supply integrated care under
the existing global budget. Although the effect was not
significant, a longer intervention period may make it
better.
The cooperative mechanism established by CST and
GBMI between county and village can play positive role
in encouraging the health personnel to change service
concepts, strengthening multi-level collaboration and
improving effectiveness of service, thus it is in favor of
continuity of medical and preventive services.