Bridging the Gaps Between Patients and Primary Care in China: A Nationwide Representative Survey

The Article in Brief

Bridging the Gaps Between Patients and Primary Care in China: A Nationwide Representative Survey

William C.W. Wong , and colleagues

Background China's commitment to develop a strong primary care system through the establishment of community health centers has succeeded in creating more than 8,600 centers. However, there is a lack of trust in the newly-revamped system. This study examines the current quality of community health centers in China.

What This Study Found China's community health centers are underused in part because of public mistrust of the physicians and because few centers are equipped to provide comprehensive primary care for a wide range of common physical and mental conditions. A survey of the structure and organization of the Chinese primary care system found less than one-half of physicians employed by CHCs were registered as primary care practitioners and few nurses had training specifically for primary care. Clinics were equipped with basic primary care equipment such as stethoscopes and sphygmomanometers, but only 43 percent had opthalmoscopes and 64 percent had facilities for gynecologic examination. Most CHCs had inpatient beds for their patients; however, only 38 percent had microbiology support and only 53 percent offered Pap screening. Clinical care was selectively skewed toward certain diseases. Virtually all CHCs provided management of common ailments, chronic diseases, hypertension, diabetes, traditional Chinese medicine, maternal and infant health care, and vaccinations, however large proportions did not provide management for other common conditions such as dyslipidemia, mental illness, sexually transmitted infections, and chronic obstructive pulmonary disease. Use of services by patients was poor at each CHC: despite serving 50,000 people, the centers had an average of only 41,000 patient contacts a year, and each physician saw a median of only 12.5 patients per day.

Implications

• Based on these findings, the authors conclude that Chinese policy makers need to reconceptualize health care training and policy in order to alter the public perception of primary care in the country. There is a need, they write, to develop tools to evaluate primary care activities more clearly, integrate community-oriented thinking into primary care, and teach an integrated comprehensive approach (such as multidisciplinary teams), rather than selected care with a purely biomedical approach.