Research on Payment Mechanisms and Medical Practices Under China’s Universal Healthcare System

One of the key measures for China’s investment in good health is to establish and improve a universal medical insurance system and a basic healthcare service system centered on public hospitals. Medical insurance payments are not allocated based on bed capacity or per capita service costs; instead, a coordinated payment mechanism for the management of medical insurance funds and healthcare institutions needs to be established. In 2020, Zhejiang Province City J implemented the “Head-based weighted budgeting and bundled payment for primary healthcare institutions” (HWBBPP) payment policy. Based on data from all districts and healthcare institutions in City J from 2019 to 2023, this study evaluates the impact of HWBBPP on the utilization of primary healthcare services. Empirical results show that after the implementation of HWBBPP, the enthusiasm for primary healthcare services increased, the number of contracted service users grew, and healthcare services expanded; the utilization rate of primary healthcare services improved, while the number of contracted service users seeking care outside their affiliated healthcare institutions decreased. In summary, the objectives and measures of medical insurance payment policies, as well as the design of incentive mechanisms, are closely related to the behavior of healthcare institutions. Scientific and rational policy design facilitates the healthy development of healthcare institutions.