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The innovations in China’s primary health care reform: Development and characteristics of the community health services in Hangzhou

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      Abstract

      Objective: This study focuses on Hangzhou, a Chinese city with a population of nine million urban and rural residents, to examine the successful development and innovation experience of its primary health care service system during the new health reform in China since 2009 and then disseminate the findings through international third parties.

      Methods: Measures such as data analysis, study of documents and regulations, fieldwork, and expert discussions were used to systematically investigate primary health care in Hangzhou. The findings will have a profound practical impact on the health reform for nine million rural and urban residents throughout Hangzhou’s municipal boroughs.

      Results: Community health services in Hangzhou are characterized as follows: They are government led; they are guaranteed with enough financing, personnel, facilities, and regulation; supported by the unified information platform; general practitioners have been assigned the key role of health ‘gatekeepers’; they provide primary care combined with basic public health services; there are integrated urban and rural health services and insurance coverage; and there is health care–pension–nursing integration and general practitioner – contracted ‘smart’ services. Preliminary data collection and analysis indicate that the basic health status of Hangzhou residents is superior to that of residents of China as a whole, and some health indicators in Hangzhou are comparable to those in Western developed countries.

      Conclusion: It is reasonable to believe that the primary health care level in China, including Hangzhou, will be further developed and promoted with indexed performance evaluations and more effective implementation of additional measures.

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      Most cited references 27

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      Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce

      Access to good-quality health services is crucial for the improvement of many health outcomes, such as those targeted by the Millennium Development Goals (MDGs) adopted by the international community in 2000. The health-related MDGs cannot be achieved if vulnerable populations do not have access to skilled personnel and to other necessary inputs. This paper focuses on the geographical dimension of access and on one of its critical determinants: the availability of qualified personnel. The objective of this paper is to offer a better understanding of the determinants of geographical imbalances in the distribution of health personnel, and to identify and assess the strategies developed to correct them. It reviews the recent literature on determinants, barriers and the effects of strategies that attempted to correct geographical imbalances, with a focus on empirical studies from developing and developed countries. An analysis of determinants of success and failures of strategies implemented, and a summary of lessons learnt, is included.
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        Theory and practice of managed competition in health care finance

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          How to make rural jobs more attractive to health workers. Findings from a discrete choice experiment in Tanzania.

          The geographical imbalance of the health workforce in Tanzania represents a serious problem when it comes to delivering crucial health services to a large share of the population. This study provides new quantitative information about how to make jobs in rural areas more attractive to newly educated clinical officers (COs). A unique data set stemming from a discrete choice experiment with CO finalists in Tanzania is applied. The results show that offering continuing education after a certain period of service is one of the most powerful recruitment instruments the authorities have available. Increased salaries and hardship allowances will also substantially increase recruitment in rural areas. Offers of decent housing and good infrastructure, including the provision of equipment, will increase recruitment to rural remote areas but not as much as higher wages and offers of education. Women are less responsive to pecuniary incentives and are more concerned with factors that directly allow them to do a good job, while those with parents living in a remote rural area are generally less responsive to the proposed policies. When the willingness to help other people is a strong motivating force, policies that improve the conditions for helping people appear particularly effective.
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            Author and article information

            Affiliations
            1ACON Primary Care Research Center, 4F Tower B, Union Plaza, No.2 Zijinghua Road, Hangzhou, Zhejiang 310023, China
            2Walter H. Shorenstein Asia-Pacific Research Center, Freeman Spogli Institute for International Studies, Stanford University, 616 Serra St., Encina Hall E311, Stanford, CA 94305, USA
            Author notes
            CORRESPONDING AUTHOR: Feng Lin, ACON Primary Care Research Center, 4F Tower B, Union Plaza, No.2 Zijinghua Road, Hangzhou, Zhejiang 310023, China, E-mail: feng.lin8@123456yahoo.com
            Journal
            FMCH
            Family Medicine and Community Health
            FMCH
            Compuscript (Ireland)
            2009-8774
            2305-6983
            September 2015
            October 2015
            : 3
            : 3
            : 52-66
            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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