A community-based approach to non-communicable chronic disease management within a context of advancing universal health coverage in China: progress and challenges

Abstract

Paralleled with the rapid socio-economic development and demographic transition, an epidemic of non-communicable chronic diseases (NCDs) has emerged in China over the past three decades, resulting in increased disease and economic burdens. Over the past decade, with a political commitment of implementing universal health coverage, China has strengthened its primary healthcare system and increased investment in public health interventions. A community-based approach to address NCDs has been acknowledged and recognized as one of the most cost-effective solutions. Community-based strategies include: financial and health administrative support; social mobilization; community health education and promotion; and the use of community health centers in NCD detection, diagnosis, treatment, and patient management. Although China has made good progress in developing and implementing these strategies and policies for NCD prevention and control, many challenges remain. There are a lack of appropriately qualified health professionals at grass-roots health facilities; it is difficult to retain professionals at that level; there is insufficient public funding for NCD care and management; and NCD patients are economically burdened due to limited benefit packages covering NCD treatment offered by health insurance schemes. To tackle these challenges we propose developing appropriate human resource policies to attract greater numbers of qualified health professionals at the primary healthcare level; adjusting the service benefit packages to encourage the use of community-based health services; and increase government investment in public health interventions, as well as investing more on health insurance schemes.

Changes in chronic disease management among community health centers (CHCs) in China: Has health reform improved CHC ability?

“…Combined with a lack of effective policy guidance and restrictions on the referral system, more patients could access big hospitals . Under these circumstances, people were not used to seeking preventive care, and no matter the severity of the disease, they were inclined to choose big hospitals because of better medical technology and perceived technical quality, although the expenditure at the hospital setting is much higher than that at the community . As shown in one study, the average cost for chronic disease inpatients in the hospital per time point in urban and rural areas accounted for over 50% and 150% of their annual income, respectively .…”

China’s National Health Policies: An Ontological Analysis

“…It may be partly because China has already achieved universal insurance coverage [2]. Despite the coverage there are many significant issues in translating it into significant health outcomes—for example, in the managing non-communicable chronic diseases [3] and access to rural health care [24]. The results above suggest the need for a greater focus on insurance in conjunction with different combinations of outcomes and types of care.…”

“…However, relatively less emphasis on Illness-Chronic (51) appears to limit the comprehensiveness of the care, especially in light of the growing importance of chronic disease management in China [3,25]. …”

“…For example, ‘[p]aralleled with the rapid socio-economic development and demographic transition, an epidemic of non-communicable chronic diseases (NCDs) has emerged in China over the past three decades, resulting in increased disease and economic burdens… [and encouragement] to use community-based health services.’ [3] Between 1950-2009 it ‘shifted public financing to private sources; it turned public hospitals and clinics into commercial, for-profit enterprises; it decentralized China’s health system and it altered the price structure for public facilities, thereby enabling them to earn profits.’ [1] In 2009, the ‘Chinese government committed USD 124 billion of additional public spending for the first three years of health care reform.’ [1] These three years had five specific targets. They were: ‘ [1] expanding insurance coverage [2]; making public health service available and equal for all [3]; improving the primary care delivery system to provide basic health care [4]; establishing a national essential drug system; and [5] piloting public hospital reform.’ [1]…”

The Role of the Public Health Service Equalization Program in the Control of Hypertension in China: Results from a Cross-sectional Health Interview Survey

“…From 2009 to 2013, over 140 billion CNY (or around USD 21 billion) was invested in this program. It has been estimated that about 18% of this investment was spent on management of patients with hypertension for a total of around 25.2 billion RMB (or USD 3.8 billion) [9]. By the end of 2013, the number of primary health care facilities providing services under the PHSE reached 2.96 million, including 476,073 community health service centers (or stations), 1,244,054 township hospitals, and 1,238,022 village clinics [10].…”