Effects of close-knit county-level medical alliance on primary health care efficiency: a quasi-experimental study from Sichuan, China
Zhenyan Bo, Kun Zou, Hailong Li, Linan Zeng, Yong Tang, Shaoyang Zhao, Yongmu Jiang, Lingli ZhangAbstract
Background:
The Close-knit County-level Medical Community (CCMC) policy has been implemented to strengthen the health service capacity of the primary health care (PHC) system and optimize medical resource allocation to achieve the goal of health for all in China. The aim of this study was to evaluate the effect of the policy on health resource allocation efficiency in the PHC system.
Method:
This was a quasi-experimental study based on data of 183 county-level districts across Sichuan Province from 2013 to 2023. The super-efficiency slacks-based measure model was used to assess the health resource allocation efficiency. The difference-in-difference (DID) model was adopted to evaluate the policy effect of CCMC. The propensity score matching DID (PSM-DID) method was used to test the robustness of the policy effect.
Result:
The number of institutions, beds, and health workers of the PHC system in Sichuan Province showed a steady upward trend from 2013 to 2023. The medical resource allocation efficiency of the PHC system in almost all county-level districts in Sichuan Province was lower than one. The average efficiency of the PHC system in both pilot and non-pilot districts remained at a low level both before and after the implementation of the CCMC policy. The policy might have a negative impact on the efficiency of the PHC system, but this negative association was only demonstrated statistically in the PSM-DID weight model ( β = −0.0499, P < 0.1). However, when excluding data during the COVID-19 pandemic, the significant negative effect in the PSM-DID weighted model disappeared, all the coefficients of the policy interaction in different models became non-significant while maintaining a negative direction.
Conclusion:
The CCMC policy did not demonstrate a statistically significant positive effect on the efficiency of the PHC system during the current observation period. The Chinese government should comprehensively regulate and support the health resources of the medical alliance through policy guidance, medical insurance regulation, and financial support to integrate not only different levels of medical institutions, but also medical resource of these institutions, making the medical alliance a unified interest community. A reasonable remuneration strategy should be established to encourage health workers to work in the PHC system for improving the health service capability.