China's Central Authorities Issue Guidelines to Advance Integrated Healthcare System, Endorsing Digital Health Community Models
Major Guideline Document on Healthcare Reform Released. Beijing, March 23 (Xinhua) — The General Office of the Communist Party of China Central Committee and the General Office of the State Council recently issued the “Opinions on Further Improving the Healthcare Service System” (hereinafter referred to as the “Opinions”), which set forth the goals of enhancing the equitable allocation of resources and services and building an integrated healthcare service system. Meanwhile, the “Opinions” put forward specific requirements on strengthening workforce development, promoting tiered diagnosis and treatment, and advancing the construction of medical consortia.
Notably, innovative explorations and practices from various regions in building an integrated healthcare delivery system—such as internet hospitals, joint outpatient clinics for chronic diseases, and capitation-based bundled payments under medical insurance—have been incorporated into the “Opinions” and designated as key areas for future encouragement.
In recent years, under the continuous guidance of national policies, emphasizing holistic consideration and integrated strategies, leveraging platforms and technologies such as digital hospitals, strengthening the training of healthcare professionals, promoting the development of medical consortia, and improving the tiered diagnosis and treatment system have become effective measures for localities to enhance their healthcare service systems. Particularly after five departments, including the National Development and Reform Commission, proposed in April 2022 to “guide localities in exploring the construction of grassroots digital health communities,” the digital health community model has garnered increasing attention and adoption across various regions, emerging as a paradigm for optimizing resource allocation, enhancing service equity, and advancing the development of an integrated healthcare service system.
The construction of an integrated healthcare service system proposed in the "Opinions" places higher demands on local governments' comprehensive considerations and top-level design. This is fully reflected in the development of grassroots digital health communities, which requires local governments to holistically promote the establishment of such systems across multiple dimensions, including government regulation, payment mechanisms, hospital management, platform development, and patient experience.
For example, during the development of Tianjin’s grassroots digital health consortium, the Tianjin Municipal Health Commission and the Municipal Healthcare Security Administration successively issued a series of documents, including the *Guidance Plan for the Construction of Digital Health Consortia in Grassroots Medical and Health Institutions in Tianjin*. These documents provided guidance for internet hospitals to take the lead in collaborating with 266 grassroots medical and health institutions across the city to establish a tightly integrated internet-based medical consortium characterized by unified management, standardized services, shared benefits, and joint responsibility.
Thanks to comprehensive planning and a relatively robust top-level design, Tianjin’s Primary Care Digital Health Consortium has successfully implemented a three-tier system for primary healthcare services through a three-phase approach: first, by establishing a digital and centralized service system to improve the efficiency of primary care resource utilization; second, by building a standardized and integrated service system to enhance the capacity of primary healthcare delivery; and third, by introducing a performance-based payment model with health accountability mechanisms to boost the motivation of primary care physicians.
Relevant data show that during the period of improving the construction of grassroots digital health communities in Tianjin, the outpatient volume of some primary healthcare institutions where reform measures were implemented increased by 100%, with a year-on-year increase of up to 280%. The public has voted with their feet, expressing trust in the grassroots medical service system.
As a “pioneer” in China’s healthcare reform, Sanming is also one of the earliest regions in the country to develop related models. Since 2018, building on a comprehensive summary of its healthcare reform experience, Sanming City has begun exploring the establishment of a “Health Community” supported by digitalization and centered on people’s health, while continuously refining its top-level design in light of its own medical and health standards and characteristics.
In November 2021, the Sanming Medical Reform Leading Group formulated the “Work Plan for Fully Leveraging the Complementary Role of Internet Hospitals to Enhance the City’s Digital Health and Medical Service Capabilities,” comprehensively planning and constructing a digital platform characterized by “horizontal coverage across all sectors, vertical integration down to the grassroots level, and full connectivity.” The city actively promoted the establishment of a unified “Hospital Internet Digital Service Platform” and a telemedicine service network, serving Sanming’s 12 general hospitals (medical consortia) and their member institutions. While achieving “full connectivity” in Sanming’s digital health and medical services, this initiative facilitated the expansion and downward distribution of high-quality medical resources, effectively promoting the development and improvement of the primary healthcare service system.
The release of the “Opinions” explicitly states in the section on “Advancing the Construction of Urban Medical Consortia” that “socially operated medical institutions may take the lead in forming or participate in medical consortia,” which also reflects recognition of the model for building digital health communities led by third-party digital hospital platforms across various regions.
While emphasizing top-level design, digital infrastructure platforms are also indispensable. The Guidelines propose developing “Internet + Healthcare” by building an industrial internet platform tailored to the healthcare sector, accelerating the application of internet technologies, blockchain, the Internet of Things (IoT), artificial intelligence (AI), cloud computing, and big data in the healthcare field, and strengthening the construction of systems for sharing, exchanging, and safeguarding health and medical big data. This underscores the importance of digital platforms in building an integrated healthcare service system.
The Digital Health Community is a typical representative of building an integrated healthcare service system based on digital hospitals. Taking Tai’an City in Shandong Province as an example, the city established China’s first internet hospital for chronic diseases in 2019. By focusing on chronic disease management and leveraging a comprehensive digital platform, it successfully developed a full-course management model for chronic diseases integrating “internet + medical insurance + healthcare + pharmaceuticals” within just over a year. Currently, as member hospitals have sequentially set up chronic disease service centers, the consultation time for chronic disease patients in Tai’an has been reduced from the previous 2–3 hours to 20–30 minutes, with more than 20% of outpatient pressure diverted from member hospitals.
Owing to its remarkable achievements, the “Tai’an Model” has begun to be replicated and promoted across all 16 prefecture-level cities in Shandong Province. It has been integrated and upgraded into the Shandong Provincial Internet Health Platform, which provides assisted services—such as follow-up consultations and prescription issuance, medical insurance payment, home delivery of medications, and in-home nursing care—to elderly individuals, those with partial or total disability, and patients with chronic diseases throughout the province. As of the end of December 2022, the Shandong Provincial Internet Health Platform had established more than 40 chronic disease service centers in cities including Jinan, Tai’an, Weifang, and Dezhou, cumulatively serving over 4.5 million person-visits among the chronic disease population.
The importance of digital platforms and integrated strategies is also evident in the development of grassroots digital health communities in other regions. Supported by the construction of a unified “Four Clouds” platform—comprising cloud management, cloud services, cloud pharmacy, and cloud diagnostics—across 266 primary healthcare institutions citywide, Tianjin’s Grassroots Digital Health Community has not only enhanced primary hospitals’ capabilities in digital governance, specialized disease services, and health management by “building platforms, integrating the three medical sectors, and establishing mechanisms,” but also shifted the delivery point of high-quality medical services closer to the grassroots level.
Taking the “Cloud Pharmacy” as an example, primary healthcare institutions previously stocked an average of fewer than 400 drug varieties. Currently, through the “Cloud Pharmacy” platform, these institutions selectively supplement their formularies with medications in demand by residents, achieving effective alignment between the drug catalogs of primary healthcare institutions and secondary and tertiary medical institutions in Tianjin. The range of supplied drugs now covers 1,560 varieties, with a total of 2,785 specific product specifications. Furthermore, the “Cloud Pharmacy” effectively supports the extension of prescriptions and the provision of long-term prescription services, strengthens prescription review and evaluation processes, and provides residents with convenient pharmaceutical care services such as home delivery and online guidance.
As of the end of December 2022, leveraging the “Four Clouds” platform, Tianjin’s Primary Care Digital Health Consortium had partnered with 204 primary healthcare institutions and seven secondary hospitals to establish chronic disease management centers, creating health records and providing managed care for over 1.68 million patients with chronic diseases. Meanwhile, Tianjin continues to promote the downward expansion of the Primary Care Digital Health Consortium, gradually integrating community health service stations and village clinics into the consortium’s “cloud platform,” thereby continuously strengthening the foundational layer of urban and rural primary healthcare services.
Based on the construction experiences of grassroots digital health communities across various regions, in the process of enhancing resource allocation and service equity and promoting the development of an integrated healthcare delivery system, the establishment of a long-term performance evaluation system and incentive mechanism based on value-based healthcare will be the decisive factor determining whether local initiatives can be effectively implemented and yield tangible results.
The Opinion proposes, under the section “Improving the Mechanism for Purchasing Healthcare Services,” to “advance reforms in medical insurance payment methods and improve a diversified, composite medical insurance payment system,” “explore global budgeting for closely integrated medical consortia, strengthen supervision and assessment, and implement policies allowing retention of surpluses and reasonable sharing of deficits,” and “improve the outcome-oriented evaluation, feedback, and incentive mechanisms for service quality data systems.”
In the process of establishing a pay-for-performance system and implementing the health stewardship responsibility model, Tianjin’s Primary Care Digital Health Consortium aligns closely with the Guidelines, fully embodying the concept of value-based healthcare. Driven by the Tianjin Municipal Healthcare Security Administration and the Municipal Health Commission, primary care hospitals within the consortium that serve as health stewards for outpatient special care programs for diabetes have explored the implementation of diagnosis-related group (DRG) and capitation payment models from medical insurance funds. By enforcing the medical insurance payment policy of “retaining surpluses and not covering deficits,” these institutions have established a health-oriented performance incentive mechanism, using chronic disease management as the entry point.
Under this mechanism, medical insurance is shifting from “paying for disease treatment” to “paying for health,” thereby incentivizing primary care physicians to proactively provide health management services to patients. Relevant data show that in pilot primary healthcare institutions, the standardized management rate for diabetes patients reached 81.5%, and the blood glucose control rate improved by more than 12.1%. As this mechanism has been gradually established and refined at the primary care level, it has also laid the foundation for Tianjin to accelerate the comprehensive implementation of the health stewardship responsibility system.
In November 2022, the Tianjin Municipal Healthcare Security Administration issued the “Notice on Accelerating the Implementation of the Health Steward Responsibility System for Outpatient Special Diseases Related to Diabetes.” Effective December 1, 2022, the management model for outpatient special diseases related to diabetes in Tianjin shifted from medical care administration to health management, with the aim of gradually incorporating all patients with these conditions into health management programs and promoting a transition in healthcare institutions from a treatment-centered approach to a people’s health-centered approach. To date, out of the 420,000 diabetic patients in Tianjin, 220,000 have signed up and selected designated health steward institutions. Among them, more than 110,000 diabetic patients have enrolled through contracts with primary care hospitals within the Tianjin Primary Digital Health Community and are included under the health steward responsibility system for outpatient special diseases related to diabetes.
Based on the construction experiences and outcomes in Shandong, Tianjin, Sanming, and other regions, the Digital Health Community has proven to be an effective pathway for enhancing the equity of resource allocation and service delivery, as well as for advancing the development of an integrated healthcare service system. With the issuance of the “Opinions,” the construction experiences and models of the Digital Health Community have gained further recognition, serving as a benchmark for improving resource allocation and service equity and promoting the establishment of an integrated healthcare service system.