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I studied family medicine in Cuba for seven years, public health in Spain for four years, edited a primary care journal in China for four years, and am currently continuing research in this field.
I'd like to present a perspective shaped by living under different national systems and experiencing various healthcare systems: The fundamental strength of primary care is not a creation of medical technicians, nor a gift from the government. It is inherently intertwined with the needs of the people, bound closely to a state and system that serves the people. The desire to do something for those less fortunate, driven by people's needs and empathy, incites some doctors to take action. These individuals can be supported and organized by a government dedicated to serving its people, fostering the development and growth of primary care.
China's healthcare system, like others, has been entwined with and distorted by capital in the past four decades, making the development of primary care in China incredibly difficult and securing research funding challenging. In recent years, I have been deeply saddened: I may be limited in what I can accomplish in this era, but what I can do is leave knowledge and experience for those possibly born in a better age.
Despite these hurdles, I believe in the power of moral authority that can inspire future generations to act, transcending capital and personal interests. Five years ago, I read seven editorials by Professor Stange and Professor Green's historical review of PBRNs, detailing the challenging work undertaken by respected predecessors. Today, I am diligently researching the key path to developing primary care in China and have participated in the establishment of what may be China's first PBRN, paying a personal price for this. Yet, I don't regret it, as I firmly believe: If my respected predecessors could do it, why can't I?
So, I suggest that we trust more in the course of history and the power of future generations: in a way, I believe primary care belongs to a more advanced healthcare system in a future society. As we change and develop it, we're transforming our society. As long as it coexists with the people, as long as its spirit endures, future generations can compensate for our regrets and create something better than us.
Also, based on China's historical experience, I want to discuss another potential path for primary care detached from the mainstream healthcare system. Forty years ago, China's primary care of the previous era declined in this way. The government abandoned much of its funding and management of primary care and public health sectors, effectively allowing primary care physicians to develop independently in the free market by charging patients. Consequently, without sufficient capital and equipment, many primary care phycisions were outcompeted by large hospitals, with many shifting to specializations or turning to selling drugs to patients as a primary source of income. Even today, despite a government-led healthcare reform aiming to rebuild primary care initiated a decade ago, China's primary care has not yet fully recovered.
The crucial historical lesson here is: The prosperity of primary care requires the government to regard it as a public system providing merit goods, akin to water, electricity, and the internet, supporting it through public subsidies. Without sufficient support, primary care may gradually decline. If, however, primary care is thrown directly into a free market competition, China's past tragedy serves as a valuable cautionary tale.
Reference：
Blumenthal D, Hsiao W. Privatization and its discontents—the evolving Chinese health care system. New England Journal of Medicine. 2005 Sep 15;353(11):1165-70.
Tang S, Meng Q, Chen L, Bekedam H, Evans T, Whitehead M. Tackling the challenges to health equity in China. The Lancet. 2008 Oct 25;372(9648):1493-501.