Art.3,page4 of 10 Wang et al:The Luohu Model for establishment of the hospital group.In the hospital paid by the group.To avoid physicians'reducing services group.Detailed integrated care was provided for the resi- to increase the balance of health insurance,the quality dents,especially for the elderly and patients with chronic management center is responsible for supervising physi- conditions. cians'practices. The third strategy involved building family doctor teams Three core strategies in each community health station.Family doctor teams The first strategy was the establishment of a hospital group play an important role in promoting effective resource in the form of an independent corporation.Six resource utilization,reducing costs and improving patient sat- sharing centers were organized using the resources of the isfaction [28.However,a dearth of general practition- respective centers in the former five hospitals,including a ers hindered the development of family doctor teams in medical testing center,a radiographic center,an informa- China[29].The Luohu hospital group recruited general tion center,a health management center,a logistics and practitioners throughout the world,hired international distribution center and a disinfection and supply center, general practitioner experts for on-site clinical train- along with six administrative centers to manage all insti- ing and encouraged position shifts for some specialists. tutions in the group,including a human resource center,a In community health stations,each family doctor team financial center,a quality management center,a research consists of a general practitioner (leader),nurses,health and education center,a community health station man- promotion staff and a public health physician and may agement center and an integrated management center. also include specialists,pharmacists,nutritionists,and Twelve centers provide resources and management for psychologists.Specialists are provided with an incentive the entire hospital group.After the organizational inte- of $100 per day to set up clinics in the community health gration,there were 1,172 beds,3,479 staff,and 778 stations or serve as a member of a family doctor team in physicians in the group.The president is responsible for community health stations in their spare time.A list of the group under the leadership of a council.Among 12 ten identified tasks of the family doctor team (including council members,there are policy makers from the Dis- health education,case management for pregnant women trict Government,Health and Family Planning Commis- etc.)was widely publicized to make residents understand sion and resident representatives.The president has the the team's responsibilities.The family doctor team was capacity to make plans and coordinate activities for all expected to change the behavior of staff in community institutions in the group.All institutions in the group health stations and provide a platform for the transition share management,services,benefits and responsibilities from hospital-centered treatment-dominated care to com- The second strategy was the development of a new munity-based prevention-first care. health insurance policy,"Global budget,balance retained". Shenzhen's Social Insurance Fund Administration,which Integrated care for the elderly is affiliated with the Human Resources and Social Security In Aug 2014,a Rehabilitation Center for the elderly was Bureau,is responsible for collecting and managing the introduced by the general district hospital in Luohu and social insurance fund of the entire city.Coordinated by began to explore integrated care for the elderly [301.After Shenzhen's Health and Family Planning Commission, the establishment of the Luohu hospital group,an inte- Luohu became the first pilot for this new health insur- grated care system for the elderly was formed based on ance policy.The global budget of the hospital group in home care and community care supplemented by hospi- 2016 was given by the total cost of health insurance for talization. registered residents in the previous year multiplied by the Home care.Staff in community health stations provide average growth rate of the health insurance fund in 2016. nursing,rehabilitation,and palliative care for the disa- It should be noted that registered residents could seek bled elderly by setting up beds in the patients'homes.The health care in any institutions inside or outside the hos District's Ministry of Finance provides a subsidy for home pital group.Wherever the residents received health care, care.Community care delivery varies between communi- the hospital group had to pay for them,unlike a Health ties.First,through collaboration with community health Maintenance Organizations model where the organization stations,day care centers in the community provide drug is only accountable for care provided within the organiza- management,rehabilitation and health education for tion.Any surplus at the end of the year is retained and the elderly.Second,day care centers affiliated with hos- can be used for staff bonuses.The incentive and restraint pitals provide treatment,nursing,rehabilitation,and mechanisms formed by this policy aimed to change the case management for the elderly using multi-profession behavior of district hospitals.On the one hand,hospitals teams.Third,social service centers inside each commu- have to pay more attention to helping community health nity health station provide integrated care for the elderly. stations provide prevention and case management.Only Hospitalization care.The geriatric hospital in the hospital in this way can they reduce illnesses and the demand for group provides not only nursing and rehabilitation services hospitalization and hence reduce the health insurance but also diagnostic and treatment services for the elderly. cost of the group.On the other hand,hospitals will make efforts to improve the quality of health services and gain Integrated care for patients with chronic conditions the residents'trust to avoid patients seeking health ser- The Luohu hospital group explored integrated care and vices outside the group.The cost for registered patients case management for patients with chronic diseases. seeking treatment in hospitals outside the group will be Public health physicians were allocated to communityArt. 3, page 4 of 10 Wang et al: The Luohu Model for establishment of the hospital group. In the hospital group. Detailed integrated care was provided for the resi￾dents, especially for the elderly and patients with chronic conditions. Three core strategies The first strategy was the establishment of a hospital group in the form of an independent corporation. Six resource￾sharing centers were organized using the resources of the respective centers in the former five hospitals, including a medical testing center, a radiographic center, an informa￾tion center, a health management center, a logistics and distribution center and a disinfection and supply center, along with six administrative centers to manage all insti￾tutions in the group, including a human resource center, a financial center, a quality management center, a research and education center, a community health station man￾agement center and an integrated management center. Twelve centers provide resources and management for the entire hospital group. After the organizational inte￾gration, there were 1,172 beds, 3,479 staff, and 778 physicians in the group. The president is responsible for the group under the leadership of a council. Among 12 council members, there are policy makers from the Dis￾trict Government, Health and Family Planning Commis￾sion and resident representatives. The president has the capacity to make plans and coordinate activities for all institutions in the group. All institutions in the group share management, services, benefits and responsibilities. The second strategy was the development of a new health insurance policy, “Global budget, balance retained”. Shenzhen’s Social Insurance Fund Administration, which is affiliated with the Human Resources and Social Security Bureau, is responsible for collecting and managing the social insurance fund of the entire city. Coordinated by Shenzhen’s Health and Family Planning Commission, Luohu became the first pilot for this new health insur￾ance policy. The global budget of the hospital group in 2016 was given by the total cost of health insurance for registered residents in the previous year multiplied by the average growth rate of the health insurance fund in 2016. It should be noted that registered residents could seek health care in any institutions inside or outside the hos￾pital group. Wherever the residents received health care, the hospital group had to pay for them, unlike a Health Maintenance Organizations model where the organization is only accountable for care provided within the organiza￾tion. Any surplus at the end of the year is retained and can be used for staff bonuses. The incentive and restraint mechanisms formed by this policy aimed to change the behavior of district hospitals. On the one hand, hospitals have to pay more attention to helping community health stations provide prevention and case management. Only in this way can they reduce illnesses and the demand for hospitalization and hence reduce the health insurance cost of the group. On the other hand, hospitals will make efforts to improve the quality of health services and gain the residents’ trust to avoid patients seeking health ser￾vices outside the group. The cost for registered patients seeking treatment in hospitals outside the group will be paid by the group. To avoid physicians’ reducing services to increase the balance of health insurance, the quality management center is responsible for supervising physi￾cians’ practices. The third strategy involved building family doctor teams in each community health station. Family doctor teams play an important role in promoting effective resource utilization, reducing costs and improving patient sat￾isfaction [28]. However, a dearth of general practition￾ers hindered the development of family doctor teams in China [29]. The Luohu hospital group recruited general practitioners throughout the world, hired international general practitioner experts for on-site clinical train￾ing and encouraged position shifts for some specialists. In community health stations, each family doctor team consists of a general practitioner (leader), nurses, health promotion staff and a public health physician and may also include specialists, pharmacists, nutritionists, and psychologists. Specialists are provided with an incentive of $100 per day to set up clinics in the community health stations or serve as a member of a family doctor team in community health stations in their spare time. A list of ten identified tasks of the family doctor team (including health education, case management for pregnant women etc.) was widely publicized to make residents understand the team’s responsibilities. The family doctor team was expected to change the behavior of staff in community health stations and provide a platform for the transition from hospital-centered treatment-dominated care to com￾munity-based prevention-first care. Integrated care for the elderly In Aug 2014, a Rehabilitation Center for the elderly was introduced by the general district hospital in Luohu and began to explore integrated care for the elderly [30]. After the establishment of the Luohu hospital group, an inte￾grated care system for the elderly was formed based on home care and community care supplemented by hospi￾talization. Home care. Staff in community health stations provide nursing, rehabilitation, and palliative care for the disa￾bled elderly by setting up beds in the patients’ homes. The District’s Ministry of Finance provides a subsidy for home care. Community care delivery varies between communi￾ties. First, through collaboration with community health stations, day care centers in the community provide drug management, rehabilitation and health education for the elderly. Second, day care centers affiliated with hos￾pitals provide treatment, nursing, rehabilitation, and case management for the elderly using multi-profession teams. Third, social service centers inside each commu￾nity health station provide integrated care for the elderly. Hospitalization care. The geriatric hospital in the hospital group provides not only nursing and rehabilitation services but also diagnostic and treatment services for the elderly. Integrated care for patients with chronic conditions The Luohu hospital group explored integrated care and case management for patients with chronic diseases. Public health physicians were allocated to community