Does global capitation prospective payment promote integrated delivery networks? Evidence from China's compact county medical communities.

Background: Compact county medical communities (CCMCs) have emerged as a key strategy to strengthen primary healthcare delivery in China. The objective of this study was to assess the impact of the global capitation prospective payment (GCP) reform on CCMCs performance.

Methods: This research collected data from 2018 to 2022 across three pilot regions in China. Using interrupted time series analysis (ITSA), we assessed how the implementation of GCP affected CCMCs development.

Results: The ITSA results show that the average length of stay at the lead hospital decreased by 0.105 days (P < 0.001) after the reform in pilot A, while the average hospital cost increased by 62.272 yuan per month (P < 0.05). The lead hospital in Pilot B had a decrease in average inpatient costs of 54.203 yuan per month (P < 0.001). Conversely, Pilot C's the lead hospital had an increase in average inpatient costs of 26.610 yuan per month (P < 0.001), and the average length of stay at the lead hospital increased by 0.028 days (P < 0.05).

Conclusion: GCP has reasonably promoted the benign development of CMCCs. However, the diversity of strategies and operations has resulted in a different focus on effectiveness. Based on local resource endowments, future reforms should pay more attention to the synchronization of payment reforms and organizational changes.