Insights from the U.S. managed care system's primary healthcare framework for capacity building in Chinese community health service institutions

— An examination based on comparative institutional analysis and empirical data

Abstract

After two decades of development, China's community health service system has achieved the phased goal of achieving full institutional coverage; however, the issue of "capacity gaps" has become increasingly prominent. Over the course of four decades, managed care in the United States has evolved into a primary healthcare system centered on the "gatekeeper" model, per-capita payment, performance-based incentives, and clinical pathway management, serving as an important reference for primary healthcare systems worldwide. This paper conducts a multidimensional comparative analysis of the primary healthcare systems in China and the United States, supported by empirical data on healthcare investment, human resource allocation, and service efficiency in both countries. It further examines three representative cases—Kaiser Permanente in the U.S., Luohu District in Shenzhen, China, and Sanming City in Fujian Province, China—through in-depth analysis to explore the institutional logic underlying managed care and its implications for enhancing the capacity of China's community health service institutions. The paper proposes several policy recommendations: reshaping investment mechanisms through the "service procurement" approach; strengthening initial consultation capabilities via the "gatekeeper" function; stimulating endogenous motivation through payment method reforms; and empowering continuous care services through digital transformation.