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Abstract：
BACKGROUND: Inadequate financing constrains primary healthcare (PHC) capacity in many low- and middle-income countries, particularly in rural areas. This study evaluates an innovative PHC financing reform in rural China that aimed to improve access to healthcare services through supply-side integration and the establishment of a designated PHC fund.
METHODS: We employed a quasi-experimental synthetic difference-in-differences (SDID) approach to analyze county-level panel data from Chongqing Province, China, spanning from 2009 to 2018. The study compared the impact of the reform on PHC access and per capita health expenditures in Pengshui County with 37 other control counties (districts). We assessed the reform\'s impact on two key outcomes: the share of outpatient visits at PHC facilities and per capita total PHC expenditure.
RESULTS: The reform led to a significant increase in the share of outpatient visits at PHC facilities (14.92% points; 95% CI: 6.59-23.24) and an increase in per capita total PHC expenditure (87.30 CNY; 95% CI: 3.71-170.88) in Pengshui County compared to the synthetic control. These effects were robust across alternative model specifications and increased in magnitude over time, highlighting the effectiveness of the integrated financing model in enhancing PHC capacity and access in rural China.
CONCLUSIONS: This research presents compelling evidence demonstrating that horizontal integration in PHC financing significantly improved utilization and resource allocation in rural primary care settings in China. This reform serves as a pivotal model for resource-limited environments, demonstrating how supply-side financing integration can bolster PHC and facilitate progress toward universal health coverage. The findings underscore the importance of sustainable financing mechanisms and the need for policy commitment to achieve equitable healthcare access.
METHODS: We employed a quasi-experimental synthetic difference-in-differences (SDID) approach to analyze county-level panel data from Chongqing Province, China, spanning from 2009 to 2018. The study compared the impact of the reform on PHC access and per capita health expenditures in Pengshui County with 37 other control counties (districts). We assessed the reform\'s impact on two key outcomes: the share of outpatient visits at PHC facilities and per capita total PHC expenditure.
RESULTS: The reform led to a significant increase in the share of outpatient visits at PHC facilities (14.92% points; 95% CI: 6.59-23.24) and an increase in per capita total PHC expenditure (87.30 CNY; 95% CI: 3.71-170.88) in Pengshui County compared to the synthetic control. These effects were robust across alternative model specifications and increased in magnitude over time, highlighting the effectiveness of the integrated financing model in enhancing PHC capacity and access in rural China.
CONCLUSIONS: This research presents compelling evidence demonstrating that horizontal integration in PHC financing significantly improved utilization and resource allocation in rural primary care settings in China. This reform serves as a pivotal model for resource-limited environments, demonstrating how supply-side financing integration can bolster PHC and facilitate progress toward universal health coverage. The findings underscore the importance of sustainable financing mechanisms and the need for policy commitment to achieve equitable healthcare access.
摘要：
背景：融资不足限制了许多低收入和中等收入国家的初级医疗保健（PHC）能力，特别是在农村地区。本研究评估了中国农村创新的PHC融资改革，旨在通过供应方整合和建立指定的PHC基金来改善获得医疗保健服务的机会。
方法：我们采用准实验合成差异（SDID）方法分析了重庆市县级面板数据，中国,从2009年到2018年。该研究比较了彭水县与其他37个对照县（区）改革对PHC可及性和人均卫生支出的影响。我们评估了改革对两个关键结果的影响：PHC设施的门诊就诊比例和人均PHC总支出。
结果：改革导致彭水县PHC设施的门诊就诊比例显着增加（14.92％；95％CI：6.59-23.24），人均PHC总支出增加（87.30元；95％CI：3.71-170.88）。这些影响在替代模型规格中表现强劲，并且随着时间的推移而增加，强调综合融资模式在提高中国农村地区初级保健能力和准入方面的有效性。
结论：这项研究提供了令人信服的证据，表明在中国农村初级保健机构中，PHC融资的横向整合显著提高了利用和资源分配。这项改革是资源有限环境的关键模式，展示供应方融资整合如何支持PHC并促进全民健康覆盖的进展。调查结果强调了可持续融资机制的重要性以及实现公平医疗服务的政策承诺的必要性。
方法：我们采用准实验合成差异（SDID）方法分析了重庆市县级面板数据，中国,从2009年到2018年。该研究比较了彭水县与其他37个对照县（区）改革对PHC可及性和人均卫生支出的影响。我们评估了改革对两个关键结果的影响：PHC设施的门诊就诊比例和人均PHC总支出。
结果：改革导致彭水县PHC设施的门诊就诊比例显着增加（14.92％；95％CI：6.59-23.24），人均PHC总支出增加（87.30元；95％CI：3.71-170.88）。这些影响在替代模型规格中表现强劲，并且随着时间的推移而增加，强调综合融资模式在提高中国农村地区初级保健能力和准入方面的有效性。
结论：这项研究提供了令人信服的证据，表明在中国农村初级保健机构中，PHC融资的横向整合显著提高了利用和资源分配。这项改革是资源有限环境的关键模式，展示供应方融资整合如何支持PHC并促进全民健康覆盖的进展。调查结果强调了可持续融资机制的重要性以及实现公平医疗服务的政策承诺的必要性。
