Medical service unity: an effective approach for medical care in rural areas in China.

Context: Medical care in rural China has long suffered because of a concentration of medical resources in major hospitals in cities. The patients in rural areas thus do not have affordable access to quality medical services. To tackle such issues, a tiered medical scheme (TMS) was promoted by the Chinese State Council in 2015. It divides hospitals into three tiers and encourages collaborations among different tiers within a region in order to provide better accessibility to medical care for patients in rural areas.

Issues: The implementation of the TMS policy has not been successful, because the previous funding model, which allocated funding to each hospital according to the number of patients treated, did not facilitate close collaborations between different hospitals. In this report, the medical service unity (MSU) approach, which has been piloted in Funan county, is reported. The MSU organises the tiered hospitals as a unity in terms of medical capabilities and financial abilities. With the radical reform of financial decentralisation, three flows are thereby enabled: the funding flow binds together the hospitals into a unity, the patient flow shares the load across the providers and eases barriers to access, and the resource flow ensures accessibility and affordability for patients.

Lessons Learned: The MSU approach has been shown by the pilot project in Funan to be effective for the realisation of the TMS policy, benefiting hospitals, doctors and patients. The successful experience of the Funan MSU could be introduced to other regions across China and other countries. In particular, future finance reform policies for the health system would largely benefit the health reforms and especially the decentralisation of medical resources to rural areas.