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Quality of primary health care in China: challenges and recommendations.
Metadata
Journallancet60.392Date
2020-06-06
Type
Review
Research Support, Non-U.S. Gov't
Journal Article
Volume
2020-06-06 / 395 : 1802-1812
Author
Li X 1, Krumholz HM 2, Yip W 3, Cheng KK 4, De Maeseneer J 5, Meng Q 6, Mossialos E 7, Li C 8, Lu J 1, Su M 9, Zhang Q 10, Xu DR 11, Li L 6, Normand ST 12, Peto R 13, Li J 1, Wang Z 9, Yan H 1, Gao R 9, Chunharas S 14, Gao X 15, Guerra R 16, Ji H 17, Ke Y 18, Pan Z 19, Wu X 20, Xiao S 21, Xie X 22, Zhang Y 23, Zhu J 24, Zhu S 19, Hu S 25
Affiliation
  • 2. Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine and the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, USA.
  • 3. Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
  • 4. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA; General Practice Development and Research Center, Peking University Health Science Center, Beijing, China.
  • 5. Department of Public Health and Primary Care, Center of Family Medicine, Ghent University, Ghent, Belgium.
  • 6. School of Public Health, Peking University Health Science Center, Beijing, China.
  • 7. Department of Health Policy, London School of Economics and Political Science, Institute of Global Health Innovation, Imperial College London, London, UK.
  • 8. Health Commission of Shenzhen Municipality, Shenzhen, China.
  • 9. National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
  • 10. National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
  • 11. Sun Yat-sen Global Health Institute, Sun Yat-sen University School of Public Health, and Institute of State Governance, Guangzhou, China.
  • 12. Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA; Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
  • 13. Nuffield Department of Population Health, University of Oxford, Oxford, UK.
  • 14. National Health Foundation, Bangkok, Thailand.
  • 15. Xizhuangzi Village Clinic, Jinchang, China.
  • 16. Director General Office, WHO Headquarters, Geneva, Switzerland.
  • 17. Yaojia Township Primary Care Clinic, Zhengzhou, China.
  • 18. School of Oncology, Peking University Health Science Center, Beijing, China.
  • 19. Department of General Practice, Zhongshan Hospital of Shanghai Medical College Fudan University, Shanghai, China.
  • 20. Sichuan Center for Disease Control and Prevention, Chengdu, China.
  • 21. Xiangya School of Public Health, Central South University, Changsha, China.
  • 22. Health Commission of Yunnan Province, Kumming, China.
  • 23. Jijie Township Primary Care Clinic, Gejiu, China.
  • 24. National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China.
  • 25. National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China. Electronic address: [email protected]
Doi
PMIDMESH
China
Continuity of Patient Care
Coronavirus Infections
Fee-for-Service Plans
Humans
Pandemics
Physicians, Primary Care
Pneumonia, Viral
Primary Health Care
Quality of Health Care
Abstract
China has substantially increased financial investment and introduced favourable policies for strengthening its primary health care system with core responsibilities in preventing and managing chronic diseases such as hypertension and emerging infectious diseases such as coronavirus disease 2019 (COVID-19). However, widespread gaps in the quality of primary health care still exist. In this Review, we aim to identify the causes for this poor quality, and provide policy recommendations. System challenges include: the suboptimal education and training of primary health-care practitioners, a fee-for-service payment system that incentivises testing and treatments over prevention, fragmentation of clinical care and public health service, and insufficient continuity of care throughout the entire health-care system. The following recommendations merit consideration: (1) enhancement of the quality of training for primary health-care physicians, (2) establishment of performance accountability to incentivise high-quality and high-value care; (3) integration of clinical care with the basic public health services, and (4) strengthening of the coordination between primary health-care institutions and hospitals. Additionally, China should consider modernising its primary health-care system through the establishment of a learning health system built on digital data and innovative technologies.
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LocationEngland
FromELSEVIER SCIENCE INC

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