West meets east: Chinese and US doctors addressing the medical ecology and disease management from both countries’ perspectives

Background We presented the pattern of health care consumption, and the utilization of available resources by describing the ecology of medical care in Beijing on a monthly basis and by describing the socio-demographic characteristics associated with receipt care in different settings. Methods A cohort of 6,592 adults, 15 years of age and older were sampled to estimate the number of urban-resident adults per 1,000 who visited a medical facility at least once in a month, by the method of three-stage stratified and cluster random sampling. Separate logistic regression analyses assessed the association between those receiving care in different types of setting and their socio-demographic characteristics. Results On average per 1,000 adults, 295 had at least one symptom, 217 considered seeking medical care, 173 consulted a physician, 129 visited western medical practitioners, 127 visited a hospital-based outpatient clinic, 78 visited traditional Chinese medical practitioners, 43 visited a primary care physician, 35 received care in an emergency department, 15 were hospitalized. Health care seeking behaviors varied with socio-demographic characteristics, such as gender, age, ethnicity, resident census register, marital status, education, income, and health insurance status. In term of primary care, the gate-keeping and referral roles of Community Health Centers have not yet been fully established in Beijing. Conclusions This study represents a first attempt to map the medical care ecology of Beijing urban population and provides timely baseline information for health care reform in China.

The primary health care system (PHCS) is the portal and basis for the national health delivery system. There are a number of elements which comprise the PHCS, but the system cannot be established and developed without the support of “three essential elements,” including general practitioners (GPs), health insurance, and government health investment. Through comparative analysis of the “three essential elements” of the PHCS between California in the US and Guangdong in China, this article indicates that there are three important aspects in developing a PHCS in China, as follows: training qualified GPs; establishing a diversified health insurance system to strengthen the policy connections between health insurance and the PHCS thereby increasing government health investment; and broadening health financing channels.