How Hangzhou Gongshu District Community Health Centers Achieved 98% Patient Satisfaction and Increased Doctors’ Annual Income by RMB 70,000

When feeling unwell, the first choice is not to go to the hospital, but to visit one’s familiar general practitioner. What was once merely an aspiration has become a reality for residents of Gongshu District in Hangzhou.

Gongshu District in Hangzhou has a permanent population of 630,000, including 340,000 registered residents. In accordance with the requirements of the Hangzhou Municipal Health and Family Planning Commission, Gongshu District must achieve a family doctor signing coverage rate of 30% of its permanent population, which amounts to approximately 100,000 individuals. This implies that across the district’s 199 physician teams, each team will be responsible for signing contracts with an average of 700 residents.The burden is heavy and the road is long.

Recently, Wang Zhihua, Director of the Information Center at the Gongshu District Health and Family Planning Bureau and Deputy Director of the Gongshu District Community Health Service Management Center, shared insights on the informatization construction and chronic disease prevention and control at the Gongshu District Community Health Service Centers during China’s first National Workshop on Excellent Practices and Experience Promotion in Family Doctor Contract Services (hereinafter referred to as the “Workshop”) held in Hangzhou. What are the secrets behind the success of Gongshu District Community Health Service Centers? How have they achieved the goal of ensuring that minor illnesses are treated within the community?

Unfazed by immense pressure, Gongshu District clearly mapped out its development path in its First Five-Year Plan: launching smart medical services in 2014; establishing an appointment-based healthcare system interfacing with 26 platforms in 2015; and in 2016, building a general practitioner service support system, a two-way referral system based on the regional health information platform, and integrating the “Healthy Gongshu” initiative with public health business systems. According to Wang Zhihua, the tasks outlined in the five-year plan have now been basically completed.

Currently, there are eight community health service centers in Gongshu District. Among them, the Mishixiang Community Health Service Center has been recognized as one of the “Top 100 Community Health Service Centers in China.” As a pioneer of tiered diagnosis and treatment in China, the advanced “Hangzhou Model” has become a benchmark widely emulated across the country. Notably, Gongshu District’s “2+8+X” integrated medical-care-nursing model, along with Mishixiang’s “Four Beams and Eight Pillars” general practitioner service model, offers valuable references for the development of community health service centers in other regions.

“2”: Led by Zhejiang Geriatric Care Hospital and its Taoyuan Branch, establish a specialized hospital for geriatric diseases that integrates treatment, rehabilitation, nursing, traditional Chinese medicine, and hospice care, leveraging its role in technical leadership, guidance, and support.

“8”: Based on, supported by, and driven by 8 community health service centers, with 46 community health service stations serving as extensions, supplements, and support.

“X”: Actively integrate and collaboratively engage various social capital-run specialized hospitals, geriatric rehabilitation centers, nursing facilities, and traditional Chinese medicine hospitals. Implement general practitioner and team-based contract services, ensuring that home-based medical care meets basic needs, institutional medical care addresses rehabilitation needs for the disabled, and home hospital beds along with in-home services cater to special needs. Meanwhile, facilitate the stationing of community health service centers in elderly care institutions and conduct daytime ward rounds. Encourage social capital to establish infirmaries, clinics, and outpatient departments, achieving full coverage through government-purchased services. This will create a new pattern of health and elderly care services radiating across the entire district, providing high-quality health services to residents under effective contracts.

Mishixiang Center Pilots the Introduction of the U.S. Family Physician Service Model to Explore the Establishment of a “Four Beams and Eight Pillars” General Practitioner Service Model.

Four Pillars: General Practitioners, General Practice Nurses, Physician Assistants, and Specialists (Public Health Physicians, Traditional Chinese Medicine Physicians).

Eight Pillars: Family doctors as the leading force, population health as the goal, contracted services as the focus, appointment-based services as the lever, evidence-based medicine as the standard, traditional Chinese medicine as the distinctive feature, information technology as the foundation, and two-way referral as the support.

According to data released by the Gongshu District Health and Family Planning Bureau in 2015, community health service centers had signed home-based elderly care medical service contracts with 8,672 residents aged 60 and above within their jurisdiction.

Following the achievement of certain results in home-based elderly care, and in response to the rising number of patients with chronic diseases, chronic disease management has become a key focus of current contracted services.

The "Medium- and Long-Term Plan for the Prevention and Control of Chronic Diseases in China," issued by the State Council in February this year, is the first policy document on chronic disease prevention and control released under the name of the State Council. Furthermore, it is the first to introduce the concept that "everyone is the primary person responsible for their own health."

Implementing the tiered diagnosis and treatment system, with priority given to including patients with chronic diseases in the scope of family doctor contract services; improving the quality of diagnosis and treatment services, and building an information platform for medical quality management and control are two specific requirements proposed in the plan.

This is reflected in the construction of community service centers in Gongshu District, where efforts have been focused on two key areas: implementing family doctor signing tasks and establishing a real-time monitoring platform for chronic disease prevention and control.

The plan emphasizes that the management rates of hypertension and comorbid hypertension and diabetes are key focus areas for family doctors. Survey data from the Zhejiang Provincial Center for Disease Control and Prevention and the Institute of Chronic Diseases at Zhejiang University show that although Zhejiang Province has been at the forefront of chronic disease prevention and control nationwide, the number of diabetic patients doubled between 2007 and 2015, with the prevalence rate rising from approximately 3% to 7.37%. Therefore, in the implementation of tiered diagnosis and treatment, patients with chronic diseases are prioritized for inclusion in the scope of family doctor contracted services.

In the face of such a severe situation for disease prevention and control, Hangzhou established resident health records in 2013. These health records are linked to doctors' workstations, enabling resource sharing through web browsers. "For all individuals with established health records, conditions such as diabetes, hypertension, hyperlipidemia, and mental health disorders can be managed comprehensively via the browser interface, covering the entire management process including follow-up visits and examination reports."

The General Practitioner Service Support System of Gongshu District comprises four modules—Contract Management, GP View, Performance Management, and Healthy Gongshu—forming an online support system dedicated to family doctor contract services.

At the training workshop, Wang Zhihua provided a detailed demonstration of the four major components of the General Practitioner Support System:

Contract Management primarily oversees outpatient information management. In essence, it provides an overview of key data, such as the number of contracted patients and follow-up status. “Through user role assignment, physicians can log in to access a one-stop query for all relevant information, including their outpatient patients, contracted patients, referred patients, and patient follow-up records.”

In the contract management section, it is also possible to identify which patients in the clinical population are under contract and which are not. For contracted patients with established health records, follow-up visits can be conducted concurrently to complete their information. Through one-stop information push services, physicians’ time is saved, thereby maximizing work efficiency.

The General Practice View module primarily displays individual data for registered patients, including personal basic information, outpatient referral records, and laboratory test results. On a single interface, physicians can comprehensively grasp and understand all current health information of the patient, thereby enabling them to provide enhanced services.

Performance management involves refined data, including the maintenance of basic indicators for both units and personnel. It encompasses over 40,000 indicators across the eight community health service centers under the jurisdiction of Gongshu District. Personnel assuming different roles within the team can access the system with assigned permissions via their unique employee IDs, allowing them to clearly view their current workload completion status and performance metrics, thereby achieving full data transparency.

The “Healthy Gongshu” module is primarily service-oriented and is divided into a public version and a physician version. The public version includes routine services such as appointment scheduling, queue number notification, report inquiries, and personal health records, along with sections for contract signing and “My Family Doctor.” Users can sign contracts directly on the platform and, after completing real-name registration, interact and consult with physicians online. The physician version mainly provides functions for querying signed-up patients and compiling visit statistics, enabling physicians to “clearly understand how many individuals they have enrolled and served,” monitor task completion progress, and leverage information technology to serve the public more efficiently.

The “Healthy Gongshu” initiative is currently operational only within the Gongshu District and has not yet been rolled out more broadly.

According to Wang Zhihua, in accordance with the unified arrangements of the Hangzhou Municipal Health and Family Planning Commission, each community health service center, organized by district, is required to upload daily data on physical examinations, laboratory tests, and outpatient visits to the health information platform. On the following day, community physicians can access the system through their outpatient workstations to review the current health status of patients or examine test results from municipal-level hospitals. This reflects the interoperability initiatives implemented by the Community Health Service Centers in Gongshu District.

In October 2013, the Gongshu District Community Health Service Center established a business system based on a B/S (Browser/Server) architecture, with regional exchange and a data exchange platform at its core. All business systems operate on this regional exchange platform, which currently supports more than thirty systems.

Resident data within this business system enables interoperability and sharing. Through this platform, data sharing has been achieved not only among all community health centers and community health service stations within the district, but also connectivity with higher-level platforms in Hangzhou City and even Zhejiang Province has been established.

“Our platform is connected to 26 provincial and municipal hospitals, enabling appointment scheduling for outpatient visits, specialist consultations, diagnostic tests, and hospital admissions. With the support of the Hangzhou Municipal Health and Family Planning Commission, 30% of specialist appointments at Hangzhou’s municipal-level hospitals are prioritized for community health centers. These slots are made available to the general public one week in advance, while community health centers gain access two weeks in advance, reflecting a strong emphasis on community-based healthcare services.”

After signing up for the integrated medical, nursing, and elderly care services, residents of Gongshu District can access the following basic medical services at eight community health service centers within the district:

General Practice Appointment and Consultation Services. Contracted physicians prioritize providing general practice appointment and consultation services to enrolled residents, streamlining the medical care process and reducing waiting times for enrolled residents at hospitals; enabling patients to see top-tier physicians in the shortest possible time.

Priority Referral Services. Based on the specific medical conditions of enrolled residents, targeted referrals are made or appointments are scheduled with specialists in the corresponding departments at partnered tertiary hospitals, followed by post-referral tracking and follow-up. The medication needs of enrolled residents are basically met.

Home Hospital Bed Services. In accordance with relevant medical insurance regulations, contracted physicians provide home hospital bed services to enrolled patients who are long-term bedridden or undergoing postoperative rehabilitation, with the associated medical expenses covered by medical insurance reimbursement.

Health Consultation Services. Contracted physicians will proactively provide their contact information to enrolled residents and offer complimentary health consultations.

According to relevant policies in Hangzhou, the funding for medical-nursing-care contracted services is set at RMB 120 per person per visit, with the municipal government covering 25%, district-level finance covering 65%, and individuals bearing 10%. Therefore, the individual’s share of the integrated medical-nursing-care contracted service fee is RMB 12.

Not only are individual signing fees subsidized, but incentives for family doctors are also direct and evident. According to He Wei, a division-level health and family planning supervision commissioner at the Hangzhou Municipal Health and Family Planning Commission, who introduced this during a training session, the current policy aims to ensure that all funds related to medical, nursing, and elderly care contracted services cover performance quotas, with rewards directly allocated to the corresponding institutions and contracted doctor teams. Of the 120 yuan per capita funding for contracted services, 70% is used to incentivize the contracted doctor teams.

Meanwhile, the supporting price adjustment plan has raised the fees for home bed establishment, home visits, and house calls by family doctors. The fee for home bed establishment has been adjusted from RMB 10 per bed to RMB 80 per bed; the fee for home visits is RMB 40 per visit; and the fee for house calls made by medical personnel with associate senior professional titles or above is RMB 60 per visit.

The direct effect of policy support and financial subsidies has been an increase in doctors’ income. According to figures disclosed by He Wei, since the launch of contracted services in Hangzhou, each member of a 1,000-strong physician team can see an average annual income increase of RMB 70,000—a figure that is clearly attractive.