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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 30

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          Harnessing the privatisation of China's fragmented health-care delivery

          Summary Although China's 2009 health-care reform has made impressive progress in expansion of insurance coverage, much work remains to improve its wasteful health-care delivery. Particularly, the Chinese health-care system faces substantial challenges in its transformation from a profit-driven public hospital-centred system to an integrated primary care-based delivery system that is cost effective and of better quality to respond to the changing population needs. An additional challenge is the government's latest strategy to promote private investment for hospitals. In this Review, we discuss how China's health-care system would perform if hospital privatisation combined with hospital-centred fragmented delivery were to prevail—population health outcomes would suffer; health-care expenditures would escalate, with patients bearing increasing costs; and a two-tiered system would emerge in which access and quality of care are decided by ability to pay. We then propose an alternative pathway that includes the reform of public hospitals to pursue the public interest and be more accountable, with public hospitals as the benchmarks against which private hospitals would have to compete, with performance-based purchasing, and with population-based capitation payment to catalyse coordinated care. Any decision to further expand the for-profit private hospital market should not be made without objective assessment of its effect on China's health-policy goals.
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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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              The Impact of Primary Care: A Focused Review

               Leiyu Shi (2012)
              Primary care serves as the cornerstone in a strong healthcare system. However, it has long been overlooked in the United States (USA), and an imbalance between specialty and primary care exists. The objective of this focused review paper is to identify research evidence on the value of primary care both in the USA and internationally, focusing on the importance of effective primary care services in delivering quality healthcare, improving health outcomes, and reducing disparities. Literature searches were performed in PubMed as well as “snowballing” based on the bibliographies of the retrieved articles. The areas reviewed included primary care definitions, primary care measurement, primary care practice, primary care and health, primary care and quality, primary care and cost, primary care and equity, primary care and health centers, and primary care and healthcare reform. In both developed and developing countries, primary care has been demonstrated to be associated with enhanced access to healthcare services, better health outcomes, and a decrease in hospitalization and use of emergency department visits. Primary care can also help counteract the negative impact of poor economic conditions on health.
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                Author and article information

                Journal
                FMCH
                Family Medicine and Community Health
                FMCH
                Compuscript (Ireland )
                2009-8774
                2305-6983
                September 2015
                October 2015
                : 3
                : 3
                : 41-51
                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
                Article
                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/.

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

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