Impact of the Tiered-Network Healthcare Policy (TNHP) on the health resource allocation, patients flow and service efficiencies of Primary Healthcare Institutions (PHCIs) in China: an interrupted time series study

BACKGROUND: With the continuous advancement of China’s healthcare system reform, the Tiered Network Health Policy (TNHP) has emerged in 2015, aiming to optimize the allocation and utilization of health resources. However, the variation in the implementation outcomes of these policies across different regions necessitates further investigation. METHODS: Data Envelopment Analysis (DEA) was employed to assess the efficiencies of PHCIs from 2010 to 2021. Further, interrupted time series analysis was applied to estimate the TNHP on the structure of health resource allocation, patient flow and the service efficiencies of PHCIs. RESULTS: Since the implementation of China’s TNHP, the structure of health resource allocation and patients flow have been optimized. However, the technical efficiency and pure technical efficiency of PHCIs in most provinces showed a significant decrease. But as a typical pilot province for comprehensive healthcare reform, Fujian has achieved outstanding results in improving the service efficiencies of PHCIs. CONCLUSIONS: The Tiered-network Healthcare Policy has to some extent changed the structure of health resources and patient flow. Due to the mismatch between the growth of input and output in PHCIs, the efficiencies of PHCIs have not been significantly improved in most provinces after the implement of the TNHP. But the experiences in Fujian province can be referenced by other provinces.