Clinical pathways in China - an evaluation.

PURPOSE: Clinical pathways (CPs) are multidisciplinary care plans with essential care steps for patients with specific clinical problems. CPs were introduced in China in 2009 to assure quality, reduce risks, increase resource efficiency and control costs. The purpose of this paper is to present a Chinese public hospital case study where a CP pilot was undertaken to evaluate two main outcomes: length of stay and hospitalization costs for a tertiary hospital from 2010 to 2012 using a mixed-methods approach. DESIGN/METHODOLOGY/APPROACH: Data were drawn from hospital records and in-depth interviews with hospital staff in a Shanxi Province tertiary hospital, northern China.
FINDINGS: The authors found that the main objectives: to standardize treatment procedures by reducing length of stay and containing costs, were not fully achieved. Staff implementing CPs clearly encountered several barriers; i.e., managers did not see the pilot as a useful managerial instrument but were still driven by revenue generation. Physicians, too, lacked incentive to follow the guidelines due to income concerns. PRACTICAL IMPLICATIONS: The authors point to the daunting challenges brought about by perverse incentives embedded in the country's health system. The authors argue that concerted efforts are needed to undertake difficult health policy reforms in China. ORIGINALITY/VALUE: The authors present the first empirical study in the English-language literature that examines China's ongoing CP pilots from a micro perspective. The authors combine qualitative and quantitative methods and reveal the hospital-level dynamics in its implementation.