ArticleBMJ global health2020
Effectiveness of primary care gatekeeping: difference-in-differences evaluation of a pilot scheme in China.
Article in BMJ global health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 2 of them syntheses that pooled it.
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Who cites it
18 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Health and health system impacts of China's comprehensive primary healthcare reforms: a systematic review.Health policy and planning · 2023Pooled it
- Exploring the impact of Patient Reported Outcome Measures (PROMs) among orthopaedic surgeons in mainland China: systematic review and survey-based study on hip and knee instruments.BMC musculoskeletal disorders · 2021Pooled it
- Older Men's Preferences for HIV Testing in Primary Care Setting: Evidence from a Best-Worst Scaling Study in China.The patient · 2026Article
- Disease burden of Streptococcus pneumoniae and Neisseria meningitidis meningitis in children and adolescents: A population-based study.Medicine · 2026Article
- Why do they sign but not consult? A study on the effectiveness of China's family doctor contract services from the perspective of patient-doctor interaction.Frontiers in medicine · 2026Article
- Enhancing health system efficiency in China: considering the interaction between use of primary care and the demand for secondary and tertiary care.Health policy and planning · 2025Article
- The association between china's primary health care reform and inequalities in primary care utilisation and maternal mortality: a quasi-experimental longitudinal study from 2010 to 2019.International journal for equity in health · 2025Article
- Analysis of the patient-sharing network in hypertension management: a retrospective study in China.BMJ open · 2025Article
- Impact of China's primary healthcare reforms on utilisation, payments and self-reported health: a quasi-experimental analysis of a middle-aged and older cohort 2011-2018.BMJ public health · 2025Article
- Network characteristics of referrals for chronic disease patients: results from hierarchical medical reform in Shenzhen, China.BMC public health · 2024Article
- Primary care quality and provider disparities in China: a standardized-patient-based study.The Lancet regional health. Western Pacific · 2024Article
- Mental health of general practitioners in Chongqing, China during COVID-19: a cross-sectional study.BMJ open · 2023Article
- Effectiveness of hierarchical medical system policy: an interrupted time series analysis of a pilot scheme in China.Health policy and planning · 2023Article
- Article
- Job burnout on subjective wellbeing among clinicians in China: the mediating role of mental health.Frontiers in psychology · 2023Article
- Policy Goals of Contract Arrangements in Primary Care in Jeopardy: A Cross-Sectional Consumer Satisfaction Survey of Community Residents in Hangzhou, China.Frontiers in public health · 2022Article
- Burnout and Well-Being Among Medical Professionals in China: A National Cross-Sectional Study.Frontiers in public health · 2021Article
- How Can One Strengthen a Tiered Healthcare System through Health System Reform? Lessons Learnt from Beijing, China.International journal of environmental research and public health · 2020Article
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThis paper evaluates the effectiveness of a gatekeeping pilot in shifting resources and patient visits from hospitals to primary care facilities under the Chinese New Rural Cooperative Medical Scheme.
methodsWe applied a difference-in-differences regression analysis using claims data from a pilot district in northern China. The study covered 200 685 enrollees in 17 townships in 2012 and followed-up the townships over 12 year-quarters until the end of 2014.
resultsThe gatekeeping pilot led to significantly more patients visiting primary care facilities (55.3%, p=0.001), but there was little evidence of increased ambulatory spending on primary care (1.6%, p=0.884). The pilot reduced hospital visits by 23.9% (p=0.048) and ambulatory spending at the hospitals by 22.4% (p=0.011).
conclusionsThis first impact evaluation of gatekeeping outside high-income countries found that gatekeeping policy did not seem to have expanded the care provided by primary care facilities, despite an increased volume of claimed visits. Although claimed patient visits and expenditure at hospitals reduced, we suspect this may have been because patients found it either cumbersome or difficult to obtain reimbursement for their care.
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