Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 9;25(1):1722.
doi: 10.1186/s12889-025-22979-8.

Does capitation payment influence healthcare service behavior in county medical community? Evidence from patients with diabetes in rural China

Jiani Zhang  1 , Jincao Yan  2 , Yunke Shi  1 , Xingxing Li  1 , Youqing Xin  3 , Ning Zhang  4
Affiliations

Does capitation payment influence healthcare service behavior in county medical community? Evidence from patients with diabetes in rural China

Jiani Zhang et al. BMC Public Health. .

Abstract

Objective: Amid efforts to develop primary healthcare, China has been working to establish an integrated care system through the county medical community model, incorporating capitation payment to improve chronic disease management. This study investigates the impact of capitation payment reform on diabetes-related healthcare service behaviors across different levels of healthcare facilities within the county medical community.

Methods: We conducted interrupted time series analysis to evaluate the changes in healthcare service behavior before and after the implementation of the capitation model. Using F County, as the sample area, we collected outpatient reimbursement records of type 2 diabetes mellitus (T2DM) patients from six townships that initiated reform in April 2015. The dataset, covering January 2014 to December 2019, includes 49,326 records from primary healthcare facilities and 1,628 from county hospitals, with information on medical costs, service items, and other details.

Results: Following the implementation of capitation, both the average medical costs per visit and proportion of examination and testing costs showed a deceleration in growth in primary healthcare facilities (-0.615, p < 0.05; -1.554, p < 0.01). The proportion of medication costs, the proportion of insulin or combination therapy and the average number of medications exhibited a significant downward trend prior to the reform, while all reversed to upward trends after reform. In county hospitals, the proportion of medication costs increased by 19.115% immediately post-reform, and both the level and slope of average number of medications significantly rose (2.041, p < 0.01; 0.244, p < 0.01). Although the proportion of examination and testing costs increased before the reform, both the instantaneous level and the trend declined afterward (-19.684, p < 0.05; -1.833, p < 0.05).

Conclusions: In the sample area, the average medical costs for T2DM outpatients were effectively controlled after the capitation reform. Township health centers showed improved standardization in prescribing practices, while county hospitals focused more on comprehensive examinations and testing services. Medication prescription intensity increased across all facilities, contributing to enhanced chronic disease management.

Keywords: Capitation; County medical community; Healthcare service behavior; Interrupted time series; Type 2 diabetes mellitus.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: We confirm that all procedures were conducted adherence to the Declaration of Helsinki. Informed consent was obtained from all participants and/or their legal guardians. This study was approved by the Medical Ethics Committee of Capital Medical University. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Interrupted time series analysis of healthcare service behavior in village clinics and township health centers, 2014-2019. Note: A Medical costs per visit (RMB), B Proportion of medication costs (%), C Proportion of examination and testing Proportion of examination and testing costs (%), D Proportion of insulin or combination therapy(%), E Average number of medications per visit (Types), F Ratio of outpatient to inpatient visits. Dots are the average or ratio of the observed monthly indicators, and solid line is the predicted value of the monthly indicators derived from the ordinary least squares regression with Newey-West standard errors. Baseline: from January 2014 to March 2015; Intervention stage: from April 2015 to December 2019. Across all models, rare monthly points fell outside the 95% prediction interval
Fig. 2
Fig. 2
Interrupted time series analysis of healthcare service behavior in county hospitals, 2014-2019. Note: A Medical costs per visit (RMB), B Proportion of medication costs (%), C Proportion of examination and testing costs (%), D Proportion of insulin or combination therapy(%), E Average number of medications per visit (Types), F Ratio of outpatient to inpatient visits. Dots are the average or ratio of the observed monthly indicators, and solid line is the predicted value of the monthly indicators derived from the ordinary least squares regression with Newey-West standard errors. Baseline: from January 2014 to March 2015; Intervention stage: from April 2015 to December 2019. Across all models, rare monthly points fell outside the 95% prediction interval
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Kleinert S, Horton R. From universal health coverage to right care for health. Lancet. 2017;390(10090):101–2. 10.1016/S0140-6736(16)32588-0. - PubMed
    1. Yu H. Universal health insurance coverage for 1.3 billion people: what accounts for China’s success? Health Policy. 2015;119(9):1145–52. 10.1016/j.healthpol.2015.07.008. - PMC - PubMed
    1. Yip W, Fu H, Chen AT, et al. 10 years of health-care reform in China: progress and gaps in Universal Health Coverage. Lancet. 2019;394(10204):1192–204. 10.1016/S0140-6736(19)32136-1. - PubMed
    1. Wei L. Continuity—fragmentation—integration: historical review of health service delivery modes from three-level health service networks in rural China [in Chinese]. Chin J Health Policy. 2014;7(12):24–30.
    1. General Office of the State Council. Guiding opinions on promoting the construction of hierarchical diagnosis and treatment system. Beijing: Government of China; 2015. https://www.gov.cn/zhengce/content/2015-09/11/content_10158.htm.

LinkOut - more resources