Chinese authorities plan to expand family doctor services to the entire population by 2020, according to guidelines released by China's State Council, National Health and Family Planning Commission (NHFPC), and four other agencies.
Implications | Under the proposals, family doctors would provide basic healthcare services, referring patients to larger hospitals where necessary. |
Outlook | It remains to be seen whether the expanded pilot programme will alleviate pressure on China's public healthcare system, given low public trust in primary healthcare institutions and entrenched patient behaviour; an additional point of focus will be whether Chinese authorities will undertake to link the pilot programme with patient health insurance. |
According to China's National Health and Family Planning Commission (NHFPC), the country's family doctor service has been piloted in several areas – including Beijing and Shanghai – since 2011. By the end of 2016, family doctor services will be introduced to the 200 Chinese cities that are currently piloting public healthcare reform, according to the source. In 2017, over one-third of China's population is expected to be covered by the programme, including more than 60% of "priority groups", which include senior citizens, pregnant women, children, handicapped individuals, patients with chronic diseases such as hypertension, diabetes and tuberculosis, and patients with severe mental disorders. In addition, the guidelines call for other regions to conduct similar pilot programmes.
Under the proposals, family doctors would provide basic healthcare services, and would refer patients to larger hospitals where necessary. According to a report by Xinhua News Agency, the move is expected to reduce China's healthcare costs, and expand patient access to healthcare. The family doctors entering the pilot scheme will be recruited from local public hospitals, healthcare clinics, and rural areas.
Under the pilot programme, family members are permitted to enter into one-year service contracts with family doctors, for a fee. In addition, the contract can be renewed at the end of the year, or the family member can opt to contract with a different doctor.
China's new family doctor pilot programme is based on research on other countries, including the United States, according to China Daily, citing Han Zhengzheng, director of Desheng Community Health Service Center in Beijing's Xicheng District.
Outlook and implications
Chinese authorities have been fighting an uphill battle in efforts to ease the pressure on over-stretched public hospitals, as well as attempting to expand access to basic healthcare for its rapidly-ageing population. Despite the rapid pace of pharmaceutical innovation and high-profile national healthcare reforms, the majority of China's citizens continue to face a shortage of basic or adequate healthcare, particularly in rural areas. According to the World Health Organization, in 2012 China had 1.9 physicians per 1,000 people (WHO, latest available figures); this compares with 2.3 in Japan, and 4.3 in Russia (both 2010).
It remains to be seen whether the expanded pilot programme will alleviate pressure on China's public healthcare system, given low public trust in primary healthcare institutions, and entrenched patient behaviour. In addition, as the contract system involves a patient fee, an additional point of focus will be whether Chinese authorities will seek to link the pilot programme with patient health insurance.
This is in large part due to China's shift in the early 1980s away from collective-based healthcare and the system of itinerant "barefoot doctors". While these were typically farmers with little medical training, the end of government funding effectively destroyed the system, forcing rural inhabitants to travel to cities to receive treatment. In time, lack of trust in the primary-care system developed into entrenched patient behaviour, whereby patients typically travel directly to city hospitals even for minor ailments. This has contributed to the current over-stretched state of public hospital resources, and has also raised the risk of catastrophic spending by patients, as well as corruption (see China: 28 January 2016: China targets scalpers who raise hospital consultation fees after public outcry).