Background: Three types of Medical Alliances (MAs) have been built in most county regions in China. These MAs are led by main three county hospitals to drive the development of township hospitals. This paper aims to evaluate the actual effect of China’s MAs reform in rural area on inpatient distribution especially among different categories of MAs.
Methods：We obtained 2008-2015 claims data on enrolled residents from the New Cooperative Medical Scheme (NCMS) in Y County, Hubei Province of China. We considered January 2008–December 2010 as the pre-reform period and January 2011–December 2015 as the post-reform period. Independent sample t-test and single-group interrupted time series analysis (ITSA) were used to compare the number of inpatients per month in the three MAs including 3 county hospitals and 10 township hospitals before and after the reform. Paired t-test and multiple-group ITSA were used between township hospitals within MAs and outside MAs.
Results：The MAs reform in Y County increased the number of inpatients and improved the service capacity of both county hospitals and township hospitals within MAs. After the reform, the number of inpatients per month in county hospitals had an upward trend, with a slope of 31.01 person/month (P < 0.000). Approximately 19.99 new inpatients were admitted to township hospitals monthly after the reform (P<0.000). Furthermore, township hospitals within MAs had a substantial increase in the number of inpatients (10.45 new inpatients monthly) compared with those outside MAs.
Conclusion: The MAs reform in Y county effectively improved the capability of medical services in the county and decreased health inequality significantly. However, it also caused further imbalance in the county region in terms of the medical institutions among the three county hospitals and the different township hospitals, which contained the risk of new health inequality.