Abstract Introduction To assess whether the comprehensive reforms in 2017 (Reform 1) and 2019 (Reform 2) in Beijing have achieved the antici
Abstract Introduction To assess whether the comprehensive reforms in 2017 (Reform 1) and 2019 (Reform 2) in Beijing have achieved the anticipated targets by analyzing the changes in curative care expenditure (CCE) and related indicators before and after the reforms. Methods Due to the Covid-19 pandemic, data are not comparable for the period after 2019, we obtained records of patients from the Hospital Information System (HIS) between January 1, 2016 and December 31, 2019. The multistage stratified cluster random sampling was used to obtain sample data, and the System of Health Accounts 2011 was applied to account for the CCE of all hospitals in Beijing. We used an interrupted time series analysis (ITSA) to compare the changes in levels and trends before and after the reforms. Results Overall, the reforms failed to impact the rising trend in CCE, but successfully lowered the level of drug and consumable prices in all hospitals and optimized the hospital revenue structure. The reforms’ impact on patient burden was also mixed. For Reform 1, outpatient costs rose in tertiary hospitals, fell for inpatients in tertiary and secondary hospitals, and exhibited no change in all other hospitals. In terms of the trend, Reform 1 saw a fall in patient burden except for a rise inpatients in tertiary and primary hospitals. For Reform 2, the level of total expenditures per outpatient visit fell in primary hospitals, rose per inpatient bed day in secondary hospitals and had no change in all other hospitals. The impact of reforms on Beijing’s hierarchical medical system (HMS) was not significant. Conclusion The reform outcomes were only partially in line with the reforms’ aims. While echoing the call for more resources for primary hospitals, only major patient medical service pricing changes would shift patients away from tertiary and secondary hospitals towards primary hospitals. We suggest that several measures be taken to enhance the service capacity of primary hospitals and that an advertising campaign be launched to inform and encourage patients to use primary hospitals as gatekeepers.
