Wang,X,et al.The Luohu Model:A Template for Integrated Urban mesd18 Healthcare Systems in China.International Journal of Integrated Care2018;18(4):3,1-10.DOl:https:/1doi.org/10.5334/jic.3955 POLICY PAPER The Luohu Model:A Template for Integrated Urban Healthcare Systems in China Xin Wang,Xizhuo Sunt,Fangfang Gongt,Yixiang Huang,Lijin Chen', Yong Zhang'and Stephen Bircht Introduction:Emerging from the epidemiological transition and accelerated aging process,China's fragmentated healthcare systems struggle to meet the demands of the population.On Sept 1st 2017, China's National Health and Family Planning Commission encouraged all cities to learn from the Luohu model of integration adopted in Luohu as an approach to meeting these challenges.In this paper,we study the integration process,analyze the core mechanisms,and conduct preliminary evaluations of integrated policy development in the Luohu model. Policy development:The Luohu hospital group was established in Aug 2015,consists of five district hospitals,23 community health stations and an institute of precision medicine.The group adopted a series of professional,organizational,system,functional and normative strategies for integrated care, which was provided for the residents of Luohu,especially for the elderly population and patients with chronic conditions.According to a preliminary evaluation of the past two years,the Luohu model showed improvement in the structure and process towards integrated care.New preventive programs conducted in the hospital group resulted in changes of disease incidence.Residents were more satisfied with the Luohu model.However,spending exceeded the global budget for health insurance because of short-term increases in the demand for health care. Lessons learned:First,engagement of multiple stakeholders is essential for the design and implementa- tion of reform.Second,organizational integration is a prerequisite for integrated care in China.Third, effective care integration requires alignment with payment reforms.Fourth,normative integration could promote collaboration in an integrated healthcare system. Conclusion:Core strategies and mechanisms of the Luohu model will promote integrated care in urban China and other countries facing the same challenges.However,it is necessary to study the effects of the Luohu model over the long term and continue to strive for integrated care. Keywords:integrated care;hospital group;district healthcare system Introduction efficiency,cost escalation,and poor patient experiences Healthcare systems worldwide have been designed pri-[6,7].As a developing country getting old before getting marily to deal with single,acute,and short-term illnesses rich,China's healthcare systems are facing considerable [1,2].However,emerging from the epidemiological tran-challenges of fragmented care.In China,there were 231 sition and an accelerated population aging process,frag- million people aged 60 years or over in China(16.7%of mentated healthcare provided by traditional healthcare the population)[8]in 2016.Among them,more than 100 systems in most countries cannot meet the demands of million had at least one chronic noncommunicable dis- the population,especially the elderly,many of whom ease [9].Further,626 deaths,21,020 disability adjusted often have chronic diseases 3-5.Moreover,the tradi- of life years(DALY)and 8,879 years lived with disability tional healthcare system has suffered from low levels of (YLDS)per 100,000 population were attributed to chronic noncommunicable disease [10].It is predicted that the percentage of people aged 60 or over will increase from School of Public Health,Health Development Research Center, 12.4%in 2010 to 28%in 2040 [11].These challenges Sun Yat-sen University,74 Zhongshan 2nd Road, Guangzhou,CN indicate a need for urgency in transition from fragmented t Shenzhen Luohu Hospital Group,No.47 Youyi Road, care to integrated care in China's healthcare systems. Shenzhen,CN Current fragmented healthcare delivery in China is hos- Centre for the Business and Economics of Health,University pital-centered and treatment-dominated,with little effec- of Queensland,AU tive collaboration among institutions in different tiers of Corresponding author:Yixiang Huang (huangyx@mail.sysu.edu.cn) the system [12].In the 1980s,China moved to a marketIntroduction Healthcare systems worldwide have been designed pri￾marily to deal with single, acute, and short-term illnesses [1, 2]. However, emerging from the epidemiological tran￾sition and an accelerated population aging process, frag￾mentated healthcare provided by traditional healthcare systems in most countries cannot meet the demands of the population, especially the elderly, many of whom often have chronic diseases [3–5]. Moreover, the tradi￾tional healthcare system has suffered from low levels of efficiency, cost escalation, and poor patient experiences [6, 7]. As a developing country getting old before getting rich, China’s healthcare systems are facing considerable challenges of fragmented care. In China, there were 231 million people aged 60 years or over in China (16.7% of the population) [8] in 2016. Among them, more than 100 million had at least one chronic noncommunicable dis￾ease [9]. Further, 626 deaths, 21,020 disability adjusted of life years (DALY) and 8,879 years lived with disability (YLDS) per 100,000 population were attributed to chronic noncommunicable disease [10]. It is predicted that the percentage of people aged 60 or over will increase from 12.4% in 2010 to 28% in 2040 [11]. These challenges indicate a need for urgency in transition from fragmented care to integrated care in China’s healthcare systems. Current fragmented healthcare delivery in China is hos￾pital-centered and treatment-dominated, with little effec￾tive collaboration among institutions in different tiers of the system [12]. In the 1980s, China moved to a market POLICY PAPER The Luohu Model: A Template for Integrated Urban Healthcare Systems in China Xin Wang* , Xizhuo Sun† , Fangfang Gong† , Yixiang Huang* , Lijin Chen* , Yong Zhang* and Stephen Birch‡ Introduction: Emerging from the epidemiological transition and accelerated aging process, China’s fragmentated healthcare systems struggle to meet the demands of the population. On Sept 1st 2017, China’s National Health and Family Planning Commission encouraged all cities to learn from the Luohu model of integration adopted in Luohu as an approach to meeting these challenges. In this paper, we study the integration process, analyze the core mechanisms, and conduct preliminary evaluations of integrated policy development in the Luohu model. Policy development: The Luohu hospital group was established in Aug 2015, consists of five district hospitals, 23 community health stations and an institute of precision medicine. The group adopted a series of professional, organizational, system, functional and normative strategies for integrated care, which was provided for the residents of Luohu, especially for the elderly population and patients with chronic conditions. According to a preliminary evaluation of the past two years, the Luohu model showed improvement in the structure and process towards integrated care. New preventive programs conducted in the hospital group resulted in changes of disease incidence. Residents were more satisfied with the Luohu model. However, spending exceeded the global budget for health insurance because of short-term increases in the demand for health care. Lessons learned: First, engagement of multiple stakeholders is essential for the design and implementa￾tion of reform. Second, organizational integration is a prerequisite for integrated care in China. Third, effective care integration requires alignment with payment reforms. Fourth, normative integration could promote collaboration in an integrated healthcare system. Conclusion: Core strategies and mechanisms of the Luohu model will promote integrated care in urban China and other countries facing the same challenges. However, it is necessary to study the effects of the Luohu model over the long term and continue to strive for integrated care. Keywords: integrated care; hospital group; district healthcare system * School of Public Health, Health Development Research Center, Sun Yat-sen University, 74 Zhongshan 2nd Road, Guangzhou, CN † Shenzhen Luohu Hospital Group, No. 47 Youyi Road, Shenzhen, CN ‡ Centre for the Business and Economics of Health, University of Queensland, AU Corresponding author: Yixiang Huang (huangyx@mail.sysu.edu.cn) Wang, X, et al. The Luohu Model: A Template for Integrated Urban Healthcare Systems in China. International Journal of Integrated Care, 2018; 18(4): 3, 1–10. DOI: https://doi.org/10.5334/ijic.3955