Assessing policy element coverage in local plans for tightly integrated urban medical groups in China: an integrated care perspective

Περίληψη

Objective To examine policy instruments and the coverage of specified policy elements in local policies for tightly integrated urban medical groups in China from an integrated care perspective. Methods Twelve comprehensive local development plans issued in 2023–2024 were purposively selected. Content analysis identified policy instruments, and a Policy Modeling Consistency (PMC) index assessed coverage across nine primary dimensions and 36 binary indicators. Instrument frequencies were calculated from the main texts, while indicator scoring included both main texts and substantive appendices. Two experts independently scored all indicators, achieving 82.6% agreement before discussion. Sensitivity to weighting choices was examined using an alternative weighting scheme. Minimum primary dimension scores were also calculated as a supplementary non-compensatory measure. Results Environmental instruments accounted for 62.39% of 811 instrument coding occurrences. The mean PMC score was 8.06 out of 9, ranging from 6.97 to 8.75. All plans covered every indicator within the policy instruments and implementation support dimensions. Incentives, constraints and alignment of interests had the lowest mean dimension score (0.56); only 25% of plans specified health insurance budget settlement arrangements. All plans stated continuity-of-care objectives, but 75% specified arrangements for continuous management of chronic conditions. Evaluation openness was covered in 50% of plans. Rankings were similar under the two weighting schemes (Spearman’s ρ = 0.973). Minimum dimension scores ranged from 0 to 0.75, highlighting coverage gaps that additive totals could obscure. Conclusion The sampled plans broadly specified organizational arrangements and resource support, while certain payment, incentive and evaluation provisions were less consistently covered. High aggregate coverage could coexist with gaps in individual dimensions. These findings concern written policy provisions. Further research incorporating supplementary policies and implementation evidence is needed to establish how these provisions relate to collaboration and continuity of care in practice.