Table 3 Enabling and constraining factors in implementation of the Joint Health Centers (JHCs) for chronic care

Design features

Governments issued policies specific to integrated care and an explicit implementation plan.

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Governments and other stakeholders designed reasonable key elements of integrated care.

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Policy documents were remained uncertainties in the standards for integration of care and in the criteria for essential medical equipment in the JHCs.

Governance

Leadership teams were built from a top-down structure to guarantee efficient governance.

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CHCs can make decisions with regards to care delivery.

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Organizational structure and human resources

JHCs were established to link between the primary health care and specialist care, and meanwhile to strengthen the gatekeeper role of the chief GPs.

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Integration mechanism was based on cooperation agreement rather than official contracts between the primary health facilities and the hospitals.

Qualified staffs were selected from the existing pool of health personnel.

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Staffs only worked part-time in this pilot and primarily remained in their original positions.

An innovative capacity-building model, the mentorship system, was developed.

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Financing and payment mechanism

Lack of the shared financial incentives and payment mechanism across providers.

Insufficient financial incentives to motivate the medical staffs.

Health insurance system had little influence on patients’ health care seeking behaviors.

Information environment

The already-established health information platform was used to connect health information systems between CHCs and municipal hospitals.

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The current system was not designed and tailored specifically to implement this pilot and showed some incompatibilities across systems.

Performance management

Performance evaluation was applied to assess performance of CHCs and chief GPs.

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Lack of performance evaluation of hospitals and specialists.