Third-party governance and artificial intelligence for diabetes management in primary health care, China.

Abstract

Problem: Fragmented primary health care in China fails to tackle the growing burden of noncommunicable diseases. Despite substantial investment, fewer than half of patients with diabetes achieve glycaemic control. Approach: Tianjin's 2020-2023 reform established a public-private partnership model where WeDoctor managed community health centres under a capitation scheme. This strategy integrated: (i) monthly prepaid capitation covering all diabetes-related outpatient services; (ii) claims auditing and clinical decision support using artificial intelligence (AI); (iii) dedicated health managers for care coordination; and (iv) redesigned services incorporating complication screening and digital medication management. A pilot study including 494 945 patients with diabetes compared three care models from 2022 to 2023: WeDoctor-community health centre care, hospital care and usual care. Local setting: Tianjin city serves 15 million residents through 177 hospitals and 266 community health centres. Chronic disease management is fragmented: the Health Commission regulates care standards, while the Insurance Bureau controls funding. Relevant changes: Visits for diabetes at WeDoctor health centres increased 2.6% (0.7/26.6) but declined 10.6% (-3.8/35.7) for hospital-based care and 2.3% (-0.8/34.1) for usual care. All groups reduced outpatient expenditure. The WeDoctor model generated a 37.62 million United States dollars (US$) surplus, boosted health centre diabetes revenue by 65% (US$ 154 577/237 805) and raised physician annual salaries by 30% (US$ 5172/17 241). More than three quarters of patients expressed satisfaction with and trust in the WeDoctor model. Lessons learnt: Integrating capitation financing with third-party governance and AI support can strengthen primary health care, contain costs and enhance patient-centred care.