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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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          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.

          Most cited references24

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          Peer support in health care and prevention: cultural, organizational, and dissemination issues.

          As reviewed in the article by Perry and colleagues (2014) in this volume, ample evidence has documented the contributions of peer support (PS) to health, health care, and prevention. Building on that foundation, this article discusses characteristics, contexts, and dissemination of PS, including (a) fundamental aspects of the social support that is often central to it; (b) cultural influences and ways PS can be tailored to specific groups; (c) key features of PS and the importance of ongoing support and backup of peer supporters and other factors related to its success; (d) directions in which PS can be expanded beyond prevention and chronic disease management, such as in mental health or interventions to prevent rehospitalization; (e) other opportunities through the US Affordable Care Act, such as through patient-centered medical homes and chronic health homes; and (f) organizational and policy issues that will govern its dissemination. All these demonstrate the extent to which PS needs to reflect its contexts--intended audience, health problems, organizational and cultural settings--and, thus, the importance of dissemination policies that lead to flexible response to contexts rather than constraint by overly prescriptive guidelines.
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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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              Hong Kong: embracing a fast aging society with limited welfare.

              With a noninterventionist government and an ideology emphasizing family self-reliance, yet one of the oldest populations around the world, Hong Kong faces many unresolved policy issues in aging, including public financial support, long-term care, and the lack of health or mental health care policies for older people. Despite funding limitations, research is vibrant and population aging is drawing more researchers into the field. Following a review of some of the major research activities, we conclude with some observations on a few key issues for the field of gerontology to move forward with in Hong Kong.

                Author and article information

                Family Medicine and Community Health
                Compuscript (Ireland )
                September 2015
                October 2015
                : 3
                : 3
                : 52-66
                [1] 1ACON Primary Care Research Center, 4F Tower B, Union Plaza, No.2 Zijinghua Road, Hangzhou, Zhejiang 310023, China
                [2] 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
                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/.

                : 22 June 2015
                : 26 August 2015
                China Focus

                General medicine,Medicine,Geriatric medicine,Occupational & Environmental medicine,Internal medicine,Health & Social care
                Health care reforms,community health services,China,health status,Hangzhou


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