Practices of integrated care for the elderly in Wuxi, China: a qualitative case study

Introduction: Integrated care for the elderly has been widely discussed for its potential to address complex care demands, contribute to fragmented care system outcomes, enhance efficiency, and improve access to care. Objectives: This study aimed to investigate the government-driven practices of integrated care for the elderly in Wuxi, under China’s health reform. Methods: A qualitative case study was conducted in Wuxi in June 2023. A semi-structured interview was conducted by the research team, and interviewees included six government officials (three from the Municipal Health Commission, two from the Municipal Civil Affairs Bureau, and one from the Municipal Healthcare Security Bureau) and eight executives of medical and elderly care institutions. Qualitative data were then analyzed based on the framework of health system building blocks of World Health Organization. Results: A series of initiatives have been implemented as part of the health reform efforts, including coordination governance among government agencies, emphasis on the primary care system, adjustments to the health insurance system, development of the workforce through cultivation and utilization mechanism, and innovation in information and technology. A coordination mechanism was established among government authorities to build consensus on policy interventions. Primary healthcare institutions have been considered as the foundation for service delivery through family doctor contracts and home-based medical services for the elderly. Currently, a total of 1,159 family doctor teams are caring for 635,100 contracted residents aged 65 and above, with a contract rate of approximately 60%. Moreover, further construction of care facilities for the elderly was also put on the agenda, comprising geriatric hospitals, nursing homes, rehabilitation hospitals, and geriatric departments in general hospitals. Public-private partnerships were also encouraged to support these initiatives. Financing measures predominantly focused on health insurance system reform, including the development of the long-term care insurance scheme, an increase in reimbursement rates for family doctor contract services as well as home-based medical services (up to 95.8%) provided by primary healthcare institutions, and the introduction of a per-diem payment method in nursing homes. Workforce initiatives encompassed the establishment of training bases for medical professionals and informal caregivers, along with performance-based incentives for family doctors, especially those providing home-based services. In terms of information systems, elderly physical examination data and health records were integrated based on the Wuxi population database, and an integrated online hub for elderly services is in progress. However, the practices in Wuxi still face challenges, such as the absence of integrated government subsidies, fragmented disability assessments for the elderly, insufficient interdepartmental coordination within the government, and a shortage of workforce supply. Conclusions: The study identified key elements for implementing integrated care for the elderly, emphasizing strong coordination across different departments with a shared, people-centered vision of healthy aging, appropriate partnerships between public and private roles, the key functions of primary health care, and supportive measures of health insurance systems, care workforces, and technology innovations. Implications: Our findings offer valuable insights for bettering integrated care for the elderly in other regions of China and countries confronting population aging and fragmented care systems.