Policy practice People-centred care in urban China Xin Wang et al. a population of around 1.47 million in In February 2015,the Luohu gov- care to become the first point of an area of 78 km2,Luohu is the most ernment initiated a health-care reform contact;(ii)multidisciplinary teams; densely populated district ofShenzhen programme in cooperation with the lo- (iii)vertical integration;(iv)horizontal city,Guangdong province.In 2014,over cal ministries in Shenzhen (the Health integration;(v)eHealth;(vi)integrated 451000 people were estimated to live and Family Planning Commission,Min- clinical pathways and dual referral with chronic diseases in Luohu (Gong istry of Human Resources and Social systems;(vii)measurement and feed- F,Luohu hospital group,unpublished Security,and Ministry of Finance).The back;and (viii)certification and their data,2014).There was a city hospital stated goals of the Luohu people-centred accompanying strategies to achieve with 2000 beds,five district-level public integrated care model were better servic- people-centred integrated care.s The hospitals with a total of 1172 beds and es,less illness,fewer hospital admissions Luohu model implemented all the sug- 83 community health stations provid- and lower financial burdens.In August gested core actions except certification ing ambulatory care in the district.The 2015,an integrated organization -the (Table 1). growing size of the city hospital result- Luohu hospital group-was established, First,under the Luohu model,pa- ed in increasing numbers of patients at- comprising five district-level hospitals, tients are encouraged to sign a contract tending.Since patients had greater trust 23 community health stations and an in- with a general practitioner based at a in providers at the city-level hospital stitute of precision medicine.A council community health station and use him than the community health stations, composed of government officials and or her as the first point of contact with they often sought services directly at representatives from local communities the Luohu hospital group.However, the hospital despite receiving a lower managed the group with the support of the gatekeeping system is not manda- reimbursement of medical expenses. a local supervisory board,expert com- tory and allows an element of choice Furthermore,many patients stayed in mittee and workers'congress.The group for patients. hospital for post-acute care rather than established six resource-sharing centres Second,in community health sta- accessing this care in community health and six administrative centres (Fig.1) tions each primary health-care team stations,because city-and district-level by reorganizing the relevant centres of consists of essential members:a general hospitals and community health sta- the previous 29 institutions,to improve practitioner,a nurse,a public health tions operated independently and com- the efficiency of both resource use and physician and a health promotion peted for patients.The government of administration. practitioner.Teams may also include Shenzhen city and Luohu district were Actions and strategies a pharmacist,psychologist or other concerned about the unmet needs of specialist physician (e.g.geriatrician, the population and the increased health The policy report Deepening health paediatrician,internist)according to expenditure associated with inappro reform in China recommended eight the needs of local residents.General priate hospital use and lengths of stay. core action areas:(i)primary health practitioners lead in developing team Fig.1.Organizational structure of the Luohu hospital group,Shenzhen city,China Supervisory board Expert committee Manage Recall Council Luohu hospital group Workers'congress Party committee President Accountant 5 hospitals institute of 6 resource-sharing 6 administrative 23 community mediane centres centres health stations Traditional General Zhongxun Medical Human Chinese nospital precision testing centre Quality resources medicine medical Radiography management centre institute centre hospital centre Maternity and child Disinfection Financial health-care and supply centre Rehabilitation hospital Information centre Research and hospital centre education centre Community health Geriatric Health stations hospital Logistic and management General distribution centre management management centre centre centre 844 Bull World Hea/th Organ 2018;96:843-852 doi:http://dx.doi.org/10.2471/BLT.18.214908844 Bull World Health Organ 2018;96:843–852| doi: http://dx.doi.org/10.2471/BLT.18.214908 Policy & practice People-centred care in urban China Xin Wang et al. a population of around 1.47 million in an area of 78 km2 , Luohu is the most densely populated district of Shenzhen city, Guangdong province. In 2014, over 451 000 people were estimated to live with chronic diseases in Luohu (Gong F, Luohu hospital group, unpublished data, 2014). There was a city hospital with 2000 beds, five district-level public hospitals with a total of 1172 beds and 83 community health stations provid￾ing ambulatory care in the district. The growing size of the city hospital result￾ed in increasing numbers of patients at￾tending. Since patients had greater trust in providers at the city-level hospital than the community health stations, they often sought services directly at the hospital despite receiving a lower reimbursement of medical expenses. Furthermore, many patients stayed in hospital for post-acute care rather than accessing this care in community health stations, because city- and district-level hospitals and community health sta￾tions operated independently and com￾peted for patients. The government of Shenzhen city and Luohu district were concerned about the unmet needs of the population and the increased health expenditure associated with inappro￾priate hospital use and lengths of stay. In February 2015, the Luohu gov￾ernment initiated a health-care reform programme in cooperation with the lo￾cal ministries in Shenzhen (the Health and Family Planning Commission, Min￾istry of Human Resources and Social Security, and Ministry of Finance). The stated goals of the Luohu people-centred integrated care model were better servic￾es, less illness, fewer hospital admissions and lower financial burdens. In August 2015, an integrated organization – the Luohu hospital group – was established, comprising five district-level hospitals, 23 community health stations and an in￾stitute of precision medicine. A council composed of government officials and representatives from local communities managed the group with the support of a local supervisory board, expert com￾mittee and workers’ congress. The group established six resource-sharing centres and six administrative centres (Fig. 1) by reorganizing the relevant centres of the previous 29 institutions, to improve the efficiency of both resource use and administration. Actions and strategies The policy report Deepening health reform in China recommended eight core action areas: (i) primary health care to become the first point of contact; (ii) multidisciplinary teams; (iii) vertical integration; (iv) horizontal integration; (v) eHealth; (vi) integrated clinical pathways and dual referral systems; (vii) measurement and feed￾back; and (viii) certification and their accompanying strategies to achieve people-centred integrated care.15 The Luohu model implemented all the sug￾gested core actions except certification (Table 1). First, under the Luohu model, pa￾tients are encouraged to sign a contract with a general practitioner based at a community health station and use him or her as the first point of contact with the Luohu hospital group. However, the gatekeeping system is not manda￾tory and allows an element of choice for patients. Second, in community health sta￾tions each primary health-care team consists of essential members: a general practitioner, a nurse, a public health physician and a health promotion practitioner. Teams may also include a pharmacist, psychologist or other specialist physician (e.g. geriatrician, paediatrician, internist) according to the needs of local residents. General practitioners lead in developing team Fig. 1. Organizational structure of the Luohu hospital group, Shenzhen city, China Manage Recall Supervise Recall Supervisory board Expert committee Council Luohu hospital group Workers’ congress President 6 resource-sharing centres 6 administrative centres 23 community health stations 5 hospitals 1 institute of medicine Zhongxun precision medical institute Medical testing centre Human resources centre General hospital Disinfection and supply centre Financial centre Maternity and child health-care hospital Health management centre Community health stations management centre Geriatric hospital Radiography centre Quality management centre Traditional Chinese medicine hospital Information centre Research and education centre Rehabilitation hospital Logistic and distribution centre General management centre Party committee Accountant