Clinical pathways in China: An evaluation

Purpose: Clinical pathways are multidisciplinary care plans with essential care steps for patients with specific clinical problems. Clinical pathways were introduced in China in 2009 to assure quality, reduce risks, increase resource efficiency and control costs. We present a Chinese public hospital case study where a clinical pathway pilot was undertaken where we evaluate two main outcomes: stay and hospitalization costs for a tertiary hospital from 2010 to 2012 using a mixed methods approach. Design/methodology/approach: Data were drawn from hospital records and in-depth interviews with hospital staff in a Shanxi Province tertiary hospital, northern China. Findings: We found that the main objectives: to standardize treatment procedures by reducing stay and containing costs, were not fully achieved. Staff implementing clinical pathways clearly encountered several barriers; i.e., managers did not see the pilot as a useful managerial instrument driven by revenue generation. Physicians, too, lacked incentive to follow the guidelines due to income concerns. Practical implications: We point to the daunting challenges brought about by perverse incentives embedded in the country’s health system. We argue that concerted efforts are needed to undertake difficult health policy reforms in China. Originality/value: We present the first empirical study in the English-language literature that examines China’s ongoing clinical pathway pilots from a micro perspective. We combine qualitative and quantitative methods and reveal the hospital-level dynamics in its implementation. Copyright © 2015 Emerald Group Publishing Limited.