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Table 1 Outstanding CMOs in the 7 pilot cities

From: Evaluation and learning in complex, rapidly changing health systems: China’s management of health sector reform

Pilot Cities Main policy interventions Contexts + Mechanisms + Outcome patterns
Beijing Pilots covering all city districts; defining role and responsibilities of care givers; resources pooling; encouraging public-private partnership (PPP); incentivizing timely and continuous care. - C: previous trials on rehabilitation care delivery; strong political and professional commitment; strong financing capacity; public tertiary hospitals packed with patients; limited acute rehabilitative competence in tertiary public hospitals.
- M: promoting bedside acute rehabilitation; commissioning care from competent private rehabilitative hospitals; capacity-building on long-term rehabilitation; managed transfer-out.
-O: improved accessibility and effectiveness, proved cost-effectiveness;
Shanghai Pilots in 2 city districts; defining role and responsibilities of care givers; increasing rehabilitation resources and input; care coordination. -C: political commitment; good cooperation between government agencies; public tertiary hospitals packed with patients; strong acute rehabilitative competence in tertiary hospitals; inadequate rehabilitation resources.
- M: competent tertiary hospitals taking lead in building service network; encouraging training and staff exchanging to build up post-acute rehabilitation capacity in secondary and primary care; rehabilitative resource planning; financial incentives for therapists; managed transfer-out.
- O: improved accessibility, affordability and effectiveness, no evidence for cost-effectiveness.
Harbin Initial pilots in the major teaching tertiary hospital and its hospital alliances; defining role and responsibilities of care givers; optimizing resources allocation; incentivizing care integration and referral. - C: good cooperation between the municipal health authority and disabled people’s federation; attention to regional rehabilitative capacity planning; strong acute rehabilitative competence in tertiary hospitals.
- M: contract-based cooperation of rehabilitation care providers; encouraging training and staff exchanging to build up post-acute rehabilitation capacity in secondary and primary care; incentivizing therapists in the tertiary hospital for providing care in secondary and primary care facilities; managed transfer-out.
-O: improved accessibility and effectiveness; proved cost-effectiveness.
Zibo Pilots in all health facilities; defining role and responsibilities of care givers; leadership development; resource pooling; stress on use of TCM; public awareness building; -C: strong political commitment; multi-agency cooperation; development of traditional Chinese medicine; payment-based referral incentives.
-M: clinical protocol and guidance development; intensifying capacity building on post-acute rehabilitation care; financial incentives for therapists; managed transfer-out.
-O: improved accessibility and effectiveness, no evidence of cost-effectiveness.
Changsha Initial pilot selected hospital; defining role and responsibilities of care givers; encouraging PPP; increasing service provision by private sector; resource pooling. -C: strong medical rehabilitative capacity; political commitment in developing public-private partnership; acute rehabilitative competence in tertiary public hospitals; well-developed private sector.
-M: pooled resources for developing a private tertiary rehabilitation center; contract-based cooperation of rehabilitation care providers; managed transfer-out.
-O: improved accessibility of rehabilitation, but no evidence for cost-effectiveness.
Kunming Initial pilot in a care alliance set up by the largest teaching hospital; defining role and responsibilities of care givers; resource pooling. -C: Pre-existing collaboration between the Provincial Disabled People’s Federation, the Medical Rehabilitation Association and the pilot teaching hospital; strong clinical leadership; incentivizing therapists for providing timely acute care and supporting long-term care in community health centers; acute rehabilitative competence in tertiary public hospitals.
-M: incentivizing therapists for providing timely acute care; contract-based care coordination and integration; efficient performance management; stress on pathway-based management and quality improvement; managed transfer-out.
-O: Improved accessibility and effectiveness; proved cost-effectiveness.
Urumqi Initial pilots in competent health facilities; defining role and responsibilities of care givers. -C: Strong professional commitment; inadequate financing and payment policy support; strong care coordination capacity of the pilot hospitals; acute rehabilitative competence in tertiary public hospitals.
-M: care alliance initiated by the pilot teaching hospital; financial incentives for bedside acute rehabilitative care; technical support for facilities providing post-acute rehabilitative care.
-O: improved accessibility; no evidence for cost-effectiveness.