Tracking the effectiveness of health care reform in China: a case study of community health centers in a district of Beijing.
OBJECTIVE
To track and evaluate the effectiveness since 2007 of urban health reform policies in Beijing that provided universal health insurance and strengthened local government-owned community health centers (CHCs).


METHODS
Pre- and post-reform data on outpatient visits, staff, and financial statements among all CHCs in a district in Beijing were analyzed by the nonparametric Kruskal-Wallis method. Field surveys were also conducted to supplement the statistical analysis.


RESULTS
The post-reform data showed a substantial increase in outpatient visits at the district level, but the number of outpatient visits was flat at the CHC level. In addition, short-term CHC responses to reform policies, such as employment growth, and operating expense-to-revenue ratio, have not been cost effective.


CONCLUSIONS
The overall increase in outpatient visits at the district level, including at large hospitals, conceals the fact that CHCs within the district were unable to attract a greater number of patients. The lack of operational efficiency in the process of establishing and transforming CHCs may put the primary care system at financial risk in the long run. Well-synchronized policy measures should be considered in future reforms, especially in shaping the behaviors of patients, CHCs, and physicians.
School of Public Policy and Management, Tsinghua University, Beijing 100084, PR China.
Xuanchuan
X
Zhang
Li-Wu
LW
Chen
Keith
K
Mueller
Qiao
Q
Yu
Jiapeng
J
Liu
Ge
G
Lin
D002681:China; D003151:Community Health Centers / Q000458:organization & administration*; D018166:Health Care Reform / Q000592:standards*; D019538:Health Care Surveys; D011050:Policy Making