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Primary health care, a concept to be fully understood and implemented in current China’s health care reform

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      Abstract

      The English concept “primary health care” (PHC) has been misunderstood and wrongly interpreted in Chinese as “entry-level health care” for more than a half century. On the other hand, specialty care was considered “advanced health care.” This misconception of PHC permeated the government and the health care field with many negative consequences for China’s vision of its health care and development strategy, in areas such as government policy-making, health care financing, infrastructure planning, and health care workforce training. This article elucidates how PHC has been misconstrued and translated into “entry-level health care” in China and why it is a wrong interpretation of the PHC concept from various angles, including the basic English meaning of “primary” and “health care,” the concept of comprehensive PHC, the global PHC experience, and the harmful consequences of the misconception in China’s PHC development and in society at large. China’s current new health care reform toward a PHC-centered health system has made significant early achievements, but also faces huge challenges, including the widespread and ingrained misconception of PHC. It is hoped that academic scholars in the health care field, medical professionals, and officials in the government will gain clearer insight into the PHC concept and rectify its harmful effects on PHC development in various sectors, and promote advancement of meaningful health care reform applicable to the masses.

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      Most cited references 33

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      Tackling the challenges to health equity in China.

      In terms of economic development, China is widely acclaimed as a miracle economy. Over a period of rapid economic growth, however, China's reputation for health has been slipping. In the 1970s China was a shining example of health development, but no longer. Government and public concerns about health equity have grown. China's health-equity challenges are truly daunting because of a vicious cycle of three synergistic factors: the social determinants of health have become more inequitable; imbalances in the roles of the market and government have developed; and concerns among the public have grown about fairness in health. With economic boom and growing government revenues, China is unlike other countries challenged by health inequities and can afford the necessary reforms so that economic development goes hand-in-hand with improved health equity. Reforms to improve health equity will receive immense popular support, governmental commitment, and interest from the public-health community worldwide.
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        The origins of primary health care and selective primary health care.

         Marcos Cueto (2004)
        I present a historical study of the role played by the World Health Organization and UNICEF in the emergence and diffusion of the concept of primary health care during the late 1970s and early 1980s. I have analyzed these organizations' political context, their leaders, the methodologies and technologies associated with the primary health care perspective, and the debates on the meaning of primary health care. These debates led to the development of an alternative, more restricted approach, known as selective primary health care. My study examined library and archival sources; I cite examples from Latin America.
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          China's human resources for health: quantity, quality, and distribution.

          In this paper, we analyse China's current health workforce in terms of quantity, quality, and distribution. Unlike most countries, China has more doctors than nurses-in 2005, there were 1.9 million licensed doctors and 1.4 million nurses. Doctor density in urban areas was more than twice that in rural areas, with nurse density showing more than a three-fold difference. Most of China's doctors (67.2%) and nurses (97.5%) have been educated up to only junior college or secondary school level. Since 1998 there has been a massive expansion of medical education, with an excess in the production of health workers over absorption into the health workforce. Inter-county inequality in the distribution of both doctors and nurses is very high, with most of this inequality accounted for by within-province inequalities (82% or more) rather than by between-province inequalities. Urban-rural disparities in doctor and nurse density account for about a third of overall inter-county inequality. These inequalities matter greatly with respect to health outcomes across counties, provinces, and strata in China; for instance, a cross-county multiple regression analysis using data from the 2000 census shows that the density of health workers is highly significant in explaining infant mortality.
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            Author and article information

            Affiliations
            1Johns Hopkins Community Physicians at Frederick, Johns Hopkins Medicine, Baltimore, MD 21702, USA
            2School of Public Health, Guangzhou Medical University, Guangzhou 510182, China
            Author notes
            CORRESPONDING AUTHOR: Jiaji Wang, School of Public Health, Guangzhou Medical University, Guangzhou 510182, China, E-mail: wjiaji@ 123456163.com
            Journal
            FMCH
            Family Medicine and Community Health
            FMCH
            Compuscript (Ireland )
            2009-8774
            2305-6983
            September 2015
            October 2015
            : 3
            : 3
            : 41-51
            fmch20150127
            10.15212/FMCH.2015.0127
            Copyright © 2015 Family Medicine and Community Health

            This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

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            Self URI (journal page): http://fmch-journal.org/
            Categories
            China Focus

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