ArticleInternational journal of environmental research and public health2020
How Can One Strengthen a Tiered Healthcare System through Health System Reform? Lessons Learnt from Beijing, China.
Article in International journal of environmental research and public health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Primary health care reforms: a scoping review.Primary health care research & development · 2025Article
- Did China's hospital reforms improve curative care expenditures? Evidence from Beijing hospitals.BMC health services research · 2025Article
- Healthcare preferences of chronic disease patients under China's hierarchical medical system: an empirical study of Tianjin's reform practice.Scientific reports · 2024Article
- Factors underlying burnout among rural village physicians in Southwestern China.Health care science · 2023Article
- Horizontal Integration and Financing Reform of Rural Primary Care in China: A Model for Low-Resource and Remote Settings.International journal of environmental research and public health · 2022Article
- Experience of Dry Eye Patients With Anxiety and Depression: A Qualitative Study.Frontiers in medicine · 2022Article
- Patients' Willingness of First Visit in Primary Medical Institutions and Policy Implications: A National Cross-Sectional Survey in China.Frontiers in public health · 2022Article
- Exploring the barriers of patients with diabetic foot complications in China: a qualitative interview study.Annals of translational medicine · 2021Article
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Authors and funding
7 authors.
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Abstract
How one can reshape the current healthcare sector into a tiered healthcare system with clarified division of functions between primary care facilities and hospitals, and improve the utilization of primary care, is a worldwide problem, especially for the low and middle-income countries (LMICs). This paper aimed to evaluate the impact of the Beijing Reform on healthcare-seeking behavior and tried to explain the mechanism of the change of patient flow. In this before and after study, we evaluated the changes of outpatient visits and inpatient visits among different levels of health facilities. Using the monitored and statistical data of 373 healthcare institutions 1-year before and 1-year after the Beijing Reform, interrupted time series analysis was applied to evaluate the impact of the reform on healthcare-seeking behavior. Semi-structured interviews were used to further explore the mechanisms of the changes. One year after the reform, the flow of outpatients changed from tertiary hospitals to community health centers with an 11.90% decrease of outpatients in tertiary hospitals compared to a 15.01% increase in primary healthcare facilities. The number of ambulatory care visits in primary healthcare (PHC) showed a significant upward trend (
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.