The Shanghai Municipal Health Bureau has released its findings from a general practitioner (GP) pilot scheme run in 10 districts of the city from the beginning of 2011, according to a notice on the agency's website. The scheme follows announcements earlier this year encouraging private investment in China's hospitals, a sign of government efforts to improve primary services during the current health reform drive.
IHS Global Insight Perspective | |
Significance | The Shanghai Municipal Health Bureau on 5 July released a progress report on a general practitioner (GP) pilot scheme run in the city from the beginning of last year, which successfully enrolled 760,000 families in a Western-style scheme modelled primarily on the United Kingdom's National Health Service GPs, but also looking at Dutch, Swedish, Danish, and Australian practices. |
Implications | The scheme represents an attempt to relieve some of the burden on China's hospitals, which play an outsized role in the provision of primary care in China relative to other countries, but face severe restrictions on funding since the 2009–20 Health Reform Plan removed their ability to charge mark-ups on prescription drugs and services. |
Outlook | The conclusions of the report highlight the severe shortage of medical staff in China. The reforms are still a work in progress, and the government's announcements earlier this year encouraging private and foreign investment into hospitals for the first time are a sign of the government's desire for new models in this arena. |
The Shanghai Municipal Health Bureau (SMHB) has released a progress report on a general practitioner (GP) pilot scheme that has been running in the city since the beginning of 2011. Modelled primarily on the United Kingdom's GP system, but also drawing from Dutch, Swedish, Danish, and Australian practices, the scheme has been declared a success, according to a press release on the bureau's website.
The scheme was rolled out in Chongning and 10 other districts, and successfully enrolled 760,000 families, equating to 2.09 million permanent residents, through 122 community health centres, 387 health stations, and 597 village centres. A total of 1,982 health personnel were involved, of which 42% were qualified doctors, with another 1,066 health professionals attending the suburban village centres. The centres treated 1.1 million people during the pilot scheme, with 50.2% being transferred to a higher level of medical service, and the medical hotline dealt with 1.39 million calls.
Positive benefits from the scheme were identified as successfully establishing an intermediary system for referral of patients to hospitals for further treatment, establishing a platform for managing GP-related information for the public, establishing a successful administrative system, establishing a first point-of-call for the poor, and encouraging preventative check-ups. The SMHB also praised the scheme's success in providing more targeted, efficient healthcare services that also enabled greater control over costs. For the related press release in Chinese, see here.
The GP scheme introduces a new concept to China, the idea of a family doctor, familiar with each of his patients, who acts as an intermediary between the patient and hospitals. The Shanghai scheme has emphasised the benefits of such a role in terms of doctors acting as "gatekeepers" in relation to costs. Doctors are even described as "agents" working on behalf of the national insurance schemes to responsibly manage how medical resources are used. In this respect, Shanghai's GP community health model represents an alternative to the "Anhui model" of health reforms, which the central government tentatively adopted under the 2009–11 Priority Plan, part of the overarching 2009–20 Health Reform Plan.
The Anhui model was designed to tackle the problem of hospitals and doctors previously earning a substantial portion of their revenues/salaries through mark-ups on prescription drug sales, a practice that became prevalent during the 1980s and 1990s when central funding fell by 50% and provinces were effectively granted independence in terms of health budgets. Such mark-ups accounted for as much as 40–50% of hospital revenues (source: Asia Times), but the Anhui model established an Essential Drug List and declared that all listed drugs must be sold to patients with a 0% mark-up. This sledgehammer approach has led to unintended consequences, as reported by Caixin, with those listed drugs found to be in short-supply or of substandard quality, while the problem of finding alternative ways to adequately replace funding sources and motivate hospitals and doctors has yet to be resolved.
Under the Shanghai model, each health centre receives pre-paid fees from the national health insurance schemes upon residents signing up, and is responsible for how such monies are used, with doctors paid in relation to numbers treated. The idea is to avoid problems of doctors excessively prescribing drugs or recommending services on the basis of related fees, while simultaneously viewing them as valued members of the community who are adequately compensated; the accompanying SMHB press release makes specific reference to the central, respected role of GPs at the core of primary health services provision in European countries such as the UK. As quoted by Hong Kong Government News, Shanghai Health Bureau spokesperson Liu Hongwei stated: "Patients can receive health screenings, education and treatment at nearby community hospitals instead of going all the way to crowded big hospitals," with doctors paid "according to his or her service amount".
Outlook and Implications
The pilot GP scheme is set to continue in Shanghai, with the overall goal of full introduction of the scheme by the end of the health reform process in 2020. During the remainder of 2012 the SMHB plans to roll out the scheme to the entire city and surrounding suburbs, with the aim of gathering opinions from experts and third-party evaluations before eventually presenting their findings to the National People's Congress. Strong links are being built with the UK for training purposes, and the SHMB plans to continue to send selected health personnel to the University of Birmingham, as well as Canada and Sweden, for short-term training programmes, and a specific domestic GP training programme is still being drawn up. A lack of qualified personnel is identified by the bureau as a critical issue to be addressed, and this is a national problem for China, where the central government has identified a shortage of 200,000 qualified paediatricians in that speciality alone (source: Asia Times). While the scheme is designed to reduce wastage and make health spending more efficient in the long term, the expense of establishing such a scheme in provinces and cities less prosperous than Shanghai would also be a significant hurdle.
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