Does Primary Health Care Benefit Chinese? Evidence From The Model Districts For Chronic And Noncommunicable Disease Control And Prevention In China

China introduced the Model Districts for Chronic and Noncommunicable Disease Control and Prevention(hereinafter referred to as "model districts")in 2010,which aimed to select a number of national model districts for chronic and noncommunicable disease control and prevention every 1-2 years from 2011.Leading by the local government,the policy was carried out by the grassroots communities.Through carrying out a series of activities such as health education and health promotion,disease screening and standardized management of NCDs,the goal was to achieve early diagnosis and treatment of NCDs and to reduce the economic burden of NCDs in the model district,and guided patients with NCDs to visit lower-level medical institutions.Based on the medical administrative data of medical institutions and inpatients in two national central cities in China,this paper comprehensively and systematically evaluated the economic effects of the Model Districts for Chronic and Noncommunicable Disease Control and Prevention by using the Difference-inDifference model(DID)and Event study method.That is to analyze the static and dynamic effects of the model districts on health care demand and utilization,healthseeking behavior,medical expenditures,quality of health for all patients in the model districts.The main contents and conclusions of this paper are as follows:First,this paper analyzed the impact of the Model Districts for Chronic and Noncommunicable Disease Control and Prevention on patients with NCDs.The results showed that:(1)After being named as the model districts,the number of NCDs inpatients in the model districts had increased significantly,indicating that the model districts had released the medical and health demand of patients with NCDs,and the mechanism of the impact was to improve the intensity of the capability of primary institution and the strength of prevention and control,intervention and management of diseases.At the same time,the probability of surgery for patients with NCDs had increased significantly.Combined with the significant decrease of non-surgical treatment cost and surgical supplies cost of patients with NCDs,it showed that potential patients with NCDs in the model districts had realized early diagnosis and treatment of diseases;(2)The number of inpatients with NCDs in secondary hospitals increased significantly,while the number of inpatients in other tiers of hospitals did not change significantly;(3)The average total medical expenditure of inpatients decreased significantly,and the structure of concrete expenditures changed;(4)The quality of medical service was improved,which showed that there was no significant change in the length of stay and the hospital mortality decreased significantly;(5)The impact on patients with NCDs was different among patients of different ages,and there were also differences among NCDs with different prevention,control,intervention and management intensity.Second,this paper analyzed the dynamic impact of the Model Districts for Chronic and Noncommunicable Disease Control and Prevention on patients with NCDs.The results showed that:(1)Before being named as the model districts,the intensity of the capability of primary institution and the strength of prevention and control,intervention and management of NCDs were significantly improved to meet the relevant assessment indicators and selected as the model districts,but the longterm impact was not significant;(2)The number of NCDs inpatients in the model districts increased significantly from the previous year of naming,and increased significantly in the short term after naming the model districts,and the change of number of inpatients in the long-term were fluctuated;(3)From the previous year to the second year after the designation of the model districts,patients with NCDs in the model districts were more likely to be hospitalized in tertiary hospitals,while they were more likely to be hospitalized in secondary hospitals two years after the designation;(4)The average hospitalization cost decreased in the short term,but the long-term change was not obvious.The length of stay of patients did not change significantly before and after being named as the model districts,and the hospital mortality showed a downward trend as a whole;(5)The dynamic impact on patients with NCDs was different among patients of different ages,and there were also differences among NCDs with different prevention,control,intervention and management intensity.Third,this paper analyzed the impact of the Model Districts for Chronic and Noncommunicable Disease Control and Prevention on patients with non-NCDs.The results showed that:(1)there was a "spillover effect" in the construction of the model districts,that is,after it was named the model districts,the number of non-NCDs inpatients in the model districts increased significantly,and the mechanism of the impact was to improve the intensity of the capability of primary institution and the strength of prevention and control,intervention and management of diseases.In addition,combined with the significant increase in the probability of non-NCDs patients undergoing surgery and the significant decrease in the surgical supplies cost,it was inferred that the construction of the model districts also made the non-NCDs patients in the model districts realized the early diagnosis and treatment of the disease;(2)The number of inpatients with non-NCDs in secondary and tertiary hospitals increased significantly,while the number of inpatients in other tiers of hospitals did not change significantly;(3)There was no significant change in the total medical cost of hospitalization per time,but concrete expenditures changed slightly;(4)The quality of health services of patients with non-NCDs in the model districts had also improved,which showed that there was no significant change in the length of stay and the hospital mortality had decreased significantly.Based on the above conclusions,this paper found that the construction of the model districts had released the demand for medical and health services for patients with NCDs or non-NCDs,and made patient can earlier diagnosis and treatment the diseases.At the same time,the quality of health services had also been improved,but there were differences in the impact on the health-seeking behavior and reducing the medical burden of patients with different disease types.Therefore,policy makers should comply with the characteristics of healthseeking behavior of patients with NCDs and non-NCDs.On the one hand,they should actively promote the graded diagnosis and treatment of NCDs.On the other hand,they should also strengthen community intervention in patients with nonNCDs.At the same time,they should establish a long-term working mechanism of local governments,and strengthen the supervision of the behavior of medical service providers.The main contributions of this paper were as follows:(1)It systematically evaluated the construction effect of the model districts from the perspective of economics;(2)And based on large sample micro data,analyzed the impact of the construction of the model districts on medical services of inpatients.