Navigating fragmented care: a qualitative study on multimorbidity management challenges in Beijing's tiered healthcare system.

Background: Multimorbidity is a growing public health concern, especially in countries with aging populations. Although a tiered healthcare system has been implemented to improve primary care, managing patients with multimorbidity has been challenging.

Methods: This study conducted focus group discussions involving 21 patients with multimorbidity in Beijing via a flexible topic guide to explore their experiences. Participants were sampled from urban and rural areas, ensuring a diverse representation of demographics and health conditions. The data were analyzed using the framework method. The themes and subthemes were identified through iterative coding and discussion.

Results: Four main themes emerged: (1) Living with multimorbidity, where patients view chronic conditions as an inevitable part of aging but struggle with self-management, particularly medication adherence and lifestyle modifications; (2) healthcare system challenges, driven by ineffective tiered policies and digital exclusion, especially among elderly patients; (3) financial burdens, with rural patients facing greater out-of-pocket costs due to insurance inequities and policy-induced strains; and (4) doctor-patient relationships, where communication gaps and a lack of continuity hinder patient-centered care. Patients emphasized the need for better care coordination, financial support, and empathetic communication.

Conclusion: This study underscores systemic gaps in China's healthcare system for multimorbidity care. To address these issues, policymakers should prioritize (1) strengthening primary care coordination through multidisciplinary teams, (2) expanding financial protection for chronic disease management to reduce urban-rural disparities, and (3) training providers in patient-centered communication and shared decision-making. These actionable steps can serve as a blueprint for LMICs aiming to build integrated, patient-centered systems for multimorbidity management.