Evolution of primary care in China 1997–2009

Bhattacharyya, Onil; Yin, Delu; Wong, Sabrina T.; Chen, Bowen

doi:10.1016/j.healthpol.2010.11.005

Cited by 109 publications

(102 citation statements)

References 17 publications

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“…Our findings contrast with the general public's perception of CHCs as "poorly equipped and of low quality." 20 We found underuse of CHCs; in fact, those offering more services and open longer hours were not more acceptable and used to greater extent by patients in our study. These findings suggest that patients are not supportive of community health work- ers even though these clinicians make services available in a primary care setting.…”

Section: Discussioncontrasting

confidence: 72%

Bridging the Gaps Between Patients and Primary Care in China: A Nationwide Representative Survey

et al. 2017

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PURPOSE China introduced a national policy of developing primary care in 2009, establishing 8,669 community health centers (CHCs) by 2014 that employed more than 300,000 staff. These facilities have been underused, however, because of public mistrust of physicians and overreliance on specialist care. METHODSWe selected a stratified random sample of CHCs throughout China based on geographic distribution and urban-suburban ratios between September and December 2015. Two questionnaires, 1 for lead clinicians and 1 for primary care practitioners (PCPs), asked about the demographics of the clinic and its clinical and educational activities. Responses were obtained from 158 lead clinicians in CHCs and 3,580 PCPs (response rates of 84% and 86%, respectively). RESULTSCHCs employed a median of 8 physicians and 13 nurses, but only onehalf of physicians were registered as PCPs, and few nurses had training specifically for primary care. Although virtually all clinics were equipped with stethoscopes (98%) and sphygmomanometers (97%), only 43% had ophthalmoscopes and 64% had facilities for gynecologic examination. Clinical care was selectively skewed toward certain chronic diseases. Physicians saw a median of 12.5 patients per day. Multivariate analysis showed that more patients were seen daily by physicians in CHCs organized by private hospitals and those having pharmacists and nurses.CONCLUSIONS Our survey confirms China's success in establishing a large, mostly young primary care workforce and providing ongoing professional training. Facilities are basic, however, with few clinics providing the comprehensive primary care required for a wide range of common physical and mental conditions. Use of CHCs by patients remains low. INTRODUCTIONT he importance of a strong primary care system providing first contact access, an emphasis on prevention, and person-focused comprehensive care with continuity and coordination is widely accepted. [1][2][3][4][5] The World Health Report and World Health Organization (WHO) have highlighted additional key components underlying primary health care, including an emphasis on universal coverage, 6,7 communityoriented perspectives, and governance supported by national health policies. Nonetheless, many countries have yet to develop effective and robust primary care since the Alma Ata Declaration in 1978 calling for increased national and international commitment to primary care. 8 Primary care today is often still characterized by inadequately resourced facilities; lack of appropriate training; inequalities in delivery of care, itself variable in quality; and fragmented care, which may be unsafe and often has little focus on prevention. 6 In China, these problems have been compounded by a deterioration in physician-patient relationships resulting from economic and health systems reforms. 9 Since the economic reforms in the late 1980s involving fiscal decentralization, commercialization of medical services, and underfunding of the public health care sector, community health workers 238hav...

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Section: Discussioncontrasting

confidence: 72%

Bridging the Gaps Between Patients and Primary Care in China: A Nationwide Representative Survey

et al. 2017

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“…Cultural factors and insurance arrangements lead patients to maintain a strong relationship with one particular hospital, where they receive a complete range of health care (Wang et al, 2007;Hu et al, 2008). Survey data in 2008 showed low levels (14%) of community health service utilization, suggesting that community health services are not yet the first point of contact with the health system in China (Bhattacharyya et al, 2011). Therefore, hospital outpatients in China are somewhat similar to ambulatory patients visiting GP clinics in Western counties.…”

Section: Discussionmentioning

confidence: 99%

Hospital Outpatients are Satisfactory for Case-control Studies on Cancer and Diet in China: A Comparison of Population Versus Hospital Controls

Li¹,

Zhang²,

Holman³

2013

Asian Pacific Journal of Cancer Prevention

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“…Recent reforms have increased government funding for building community health centers (CHCs) in cities and township hospitals and village clinics (VCs) in rural areas (Bhattacharyya et al, 2011;Yip et al, 2012), but there is still a lack of well-trained personnel on the supply side as well as public trust on the demand side of the primary care system (Liu et al, 2011;Mossialos et al, 2016;Wang et al, 2011). The weak primary care system leads to heavy reliance on hospitals for both inpatient and outpatient services.…”

Section: Hypothesismentioning

confidence: 99%

Does health insurance reduce out-of-pocket expenditure? Heterogeneity among China's middle-aged and elderly

Zhang

Nikoloski

Mossialos

2017

Social Science & Medicine

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China's recent healthcare reforms aim to provide fair and affordable health services for its huge population. In this paper, we investigate the association between China's health insurance and out-ofpocket (OOP) healthcare expenditure. We further explore the heterogeneity in this association. Using data of 32,387 middle-aged and elderly individuals drawn from the 2011 and 2013 waves of China Health and Retirement Longitudinal Study (CHARLS), we report five findings. First, having health insurance increases the likelihood of utilizing healthcare and reduces inpatient OOP expenditure. Second, healthcare benefits are distributed unevenly: while low-and mediumincome individuals are the main beneficiaries with reduced OOP expenditure, those faced with very high medical bills are still at risk, owing to limited and shallow coverage in certain aspects. Third, rural migrants hardly benefit from having health insurance, suggesting that institutional barriers are still in place. Fourth, health insurance does not increase patient visits to primary care facilities; hospitals are still the main provider of healthcare. Nonetheless, there is some evidence that patients shift from higher-tier to lower-tier hospitals. Last, OOP spending on pharmaceuticals is reduced for inpatient care but not for outpatient care, suggesting that people rely on inpatient care to obtain reimbursable drugs, putting further pressure on the already overcrowded hospitals. Our findings suggest that China's health insurance system has been effective in boosting healthcare utilization and lowering OOP hospitalization expenditure, but there still remain challenges due to the less generous rural scheme, shallow outpatient care coverage, lack of insurance portability, and an underdeveloped primary healthcare system.

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Evolution of primary care in China 1997–2009

Cited by 109 publications

References 17 publications

Bridging the Gaps Between Patients and Primary Care in China: A Nationwide Representative Survey

Bridging the Gaps Between Patients and Primary Care in China: A Nationwide Representative Survey

Hospital Outpatients are Satisfactory for Case-control Studies on Cancer and Diet in China: A Comparison of Population Versus Hospital Controls

Does health insurance reduce out-of-pocket expenditure? Heterogeneity among China's middle-aged and elderly

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