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Table 1 The Three-Tier Healthcare Delivery System in China

From: An integrated analysis of spatial access to the three-tier healthcare delivery system in China: a case study of Hainan Island

Tier Healthcare institution Function based on national documents Local policy in Hainan Province
Rural area Urban area
Tier 3 County Hospitals City Hospitals Diagnose and treat common and frequently-occurring diseases;
Provide emergency treatment of emergency/severe diseases and referrals for complicated diseases;
Provide training and guidance to primary healthcare institution personnel;
Provide relevant public health services and emergency medical treatment/first aid.
Plan on healthcare service system of Hainan Province (2015–2020) (Document number 2015 [53])
By the year 2020, set up five regional medical centers in the east, west, south, north, and center of Hainan Island, and construct healthcare institutions in populous areas, such as Wenchang, Wanning, and Dongfang, for the purpose of achieving “one-hour circle to hospital care”, and to treat the majority of diseases within island.
Tier 2 Township Health Centers Community Health Centers/Stations Provide basic public health services such as disease prevention and control;
Offer options for treatment, nursing, and rehabilitation of common health problems within the community;
Undertake management of public health services;
Provide management and technical guidance of village clinics;
Provide training of village doctors.
Action plan for standardized construction of primary healthcare institutions in Hainan Province (Document number 2018 [54])
Focus on constructing a “30-min to primary care in rural areas and 15-min to primary care in urban areas” healthcare system, to ensure safe, effective, economical, and convenient healthcare services for both urban and rural residents, to push forward the healthcare reform targets of “minor diseases not requiring travel to cities and major diseases not requiring island departure”.
Tier 1 Village Clinics Clinics Provide basic public health services;
Provide primary treatment of ordinary, common, and frequently occurring diseases in the village/community.
  1. Note: The function of the three tiers of healthcare institutions was depicted according to the State Council’s National Healthcare Policy-announcement of strategic plan on National Health Care Service System (2015–2020)