Primary healthcare professionals’ perspective on vertical integration of health care system in China: a qualitative study

Objective
This study aims to present perspectives of primary healthcare professionals (PHPs) on the impact of vertical integration on achievement of policy goals in China. To this purpose, we also explore underlying inter-professional collaboration processes based on D’Amour’s Model of Collaboration.
Design
A qualitative study involving individual interview and group interview was conducted between 2017 and 2018.
Setting
Primary healthcare institutions (PHIs) in five counties/districts of China.
Participants The major participants includes twelve heads of PHIs (by twelve individual interviews) and thirty-eight PHPs (by twelve group interviews). We also interviewed other stakeholders including twenty-four health policy makers (by five group interviews) and five hospital leaders (by five individual interviews) for triangulation analysis.
Results
Our study indicates that PHPs perceived vertical integration has resulted in improved professional competency, better care coordination, and stronger capacity to satisfy patients’ needs. The positive impacts have varied between integration types. Contributing factors for such progress are identified at administrative, organizational and service delivery levels. Other perceived effects are a loss of autonomy, increased workload, and higher turnover of capable PHPs. Higher level hospitals played a dominant role in the inter-professional collaboration, particularly regarding shared goals, vision and leadership. These findings are different from the evidence in high-income countries. Incentive mechanisms and the balance of power with hospitals management are prominent design elements.
Conclusions
Our findings are particularly valuable for other countries with a fragmented health service system and low competency of PHPs as China’s experience in integrated care provides a feasible path to strengthen primary care.