Sylvia Sable

Community-based Health Care Delivery in China: Le-Nest’s membership fee model could translate to low-income populations

“The idea for Le-Nest was formed when we realized the potential of preventive health care and improved health management skills among community members to lower costs and increase efficiency in the health care system. As it is, most people seeking health care completely bypass primary health care facilities, seeking care instead at overburdened tier-three hospitals. This method is not financially or operationally sustainable given China’s increasingly aging population and growing chronic disease burden.”

Limin Gao, Le-Nest founder

This quote highlights the lack of community-based preventive health care and health management services in the Chinese health care system that, if left underdeveloped, will hurt efficiency and increase costs.

China has one of the most rapidly aging populations in the world and as a consequence is experiencing an increasing burden of chronic diseases such as hypertension and diabetes. Le-Nest addresses the gap in preventive health care and health management by bringing appropriate and effective care and skills to its patients through existing community networks in Shanghai. (Editor’s note: The author works for the International Partnership for Innovative Healthcare Delivery which, as part of its mission, maintains a network of health care innovators to share and spread expertise and best practices. Le-Nest is part of that network.)

Le-Nest aims to improve patient wellbeing and patient flow through the health system, and decrease costs associated with avoidable treatment.

As it is, patients in China are able to self-refer to higher-level health care facilities, including the most prestigious and specialized hospitals, without first seeing a primary care provider. This practice leads to overburdened tier-three hospitals – the biggest hospitals in China – and has negative ramifications for patient outcomes.

Patients often arrive at tier-three hospitals in the early hours of the morning to wait all day for treatment for a common illness, sometimes returning the next day because they did not receive treatment at all. Elderly people in particular have trouble receiving the treatment they need at crowded tier-three hospitals because they are not as versed in navigating the health care system as their younger counterparts.

Le-Nest addresses these barriers to care by providing preventive care in the communities where their patients reside and by teaching self-management skills for chronic diseases in order to decrease future hospital visits (and in turn decrease costs incurred by the health system). Le-Nest also recognizes that the Chinese health care system can be very hard to navigate, especially for elderly patients, and has incorporated programs that help the elderly make appointment reservations and obtain necessary medications after their visit.

(A breakout session at the third annual IPIHD Forum, left, which included Le-Nest, on April 6.)

Le-Nest also encourages use of local primary care facilities first, before seeking treatment at tier-three hospitals, by giving patients information about local primary care providers, their specialties and even their bedside manner. This process, in combination with preventive care and disease self-management, has increased patient trust in the capabilities of primary care providers and led to a decrease in hospital visits among Le-Nest members.

Le-Nest’s programs decrease unnecessary hospital admissions and out-of-pocket expenditures as well as overall health system costs. Health system savings could mean that the Chinese government is better able to meet the increasing health needs of their population. The Le-Nest model also has clear potential to address inefficiencies in patient flow using a community-based model that decreases hospital admissions and addresses key barriers to seeking care at primary care facilities first.

While Le-Nest is currently servicing middle- and high-income individuals in Shanghai, similar community-based models have a clear potential to bring preventive care and health management skills to lower-income populations. The Le-Nest model provides care where their patients live and uses volunteers from within the community to deliver the care, making it a scalable solution.

Le-Nest’s membership fee model, intended to help the organization become more sustainable, also has potential to be translated to lower-income populations.

As the burden of chronic disease increases in China, community-based preventive care models like Le-Nest could help meet the growing demand for services.

A version of this blog originally appeared on the International Partnerships for Innovative Healthcare Delivery website. For more information about Le-Nest, see IPIHD’s white paper, “Initial Findings in a Landscaping Study of Healthcare Delivery Innovation in China.”

Sylvia Sable works as a graduate research fellow at the International Partnership for Innovative Healthcare Delivery on various research and knowledge development projects.

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