ArticleHealth policy and planning2025
Bridging care hierarchies through regional global budget payment: evidence from county medical communities in Zhejiang Province, China.
Article in Health policy and planning, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
2 citing papers in PubMed.
- An unintended complementarity: how the outpatient pooling policy increases inpatient services in China.Health policy and planning · 2026Article
- The impact of the global budget payment on healthcare fund expenditure in integrated delivery systems: evidence from China's county-level medical alliance reform.Frontiers in public health · 2026Article
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Authors and funding
3 authors.
Funding
Abstract
A hierarchical medical system anchored in primary healthcare is a critical mechanism for global healthcare systems to alleviate financing pressures and enhance health outcomes. Leveraging panel data from Zhejiang Province (2017-2022), this study evaluates how regional global budget payment reforms, implemented within county medical communities, influence the progression of the hierarchical medical system. The reforms were associated with a 3.0% (90% CI: -6.3 to 0.3, P < 0.1) reduction in patient volumes at county-level hospitals and a 30.2% (95% CI: 3.1-57.4, P < 0.05) surge in downward referrals to primary institutions. Concurrently, primary facilities saw an 8.3% (95% CI: 0.56-16.0, P < 0.05) increase in outpatient visits and 6.9% (95% CI: 0.15-13.7, P < 0.05) revenue growth. From the perspective of health performance, there was a 1.33% (95% CI: -2.57 to -0.09, P < 0.05) reduction in premature mortality from major chronic diseases. Mechanism analysis reveals that the regional global budget payment reshapes the incentives for both county-level hospitals and primary healthcare institutions. Under cost-containment pressures, county-level hospitals strategically redirect non-critical patients to primary healthcare institutions through formal referral protocols, while the latter are financially incentivized to provide healthcare services. These findings demonstrate how payment reforms can recalibrate provider behavior in vertically integrated systems, offering an explorable pathway for building people-centered, integrated healthcare systems through health insurance leverage.
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