Primary Care in China

Around this time last year, before I had set foot in China to do anything legitimate, I had sat down with an econ professor of mine to discuss a study protocol for the summer internship. “I’m not familiar with the Chinese health system,” he had told me, “but you should use their version of the primary care physician as your unit of analysis.” It was only after speaking with some doctors who had been working in China, and doing some literature research, that I came to an astounding realization:

China has no primary care system.

None, at least, until the recent few years. The closest thing was probably the barefoot doctors system of old rural China, a system that was dismantled in the 80’s with the opening up of the economy and the privatization of health care provision.

Today we visited a community health center (CHC) in Changsha. The remarks of the doctor who welcomed us further confirmed for me the infancy of the Chinese primary care system: according to him, the concept of a community health center only came about in the year 2000, and the recognition of primary care (全科医生) as a medical specialty didn’t happen until 3 years ago.

What sets CHCs apart from regular hospitals is their smaller scale, their focus on treating minor illnesses, and their responsibility for preventive health services. A 2006 paper reviewing the utilization of CHCs compared to hospitals noted 6 official functions of CHCs:

  1. Disease prevention and control
  2. Health surveys
  3. Health education
  4. Family planning
  5. Medical treatment service (for basic illnesses)
  6. Community rehabilitation

Yet of these, only the highlighted three were recognized by the people (>75% of respondents), and many elicited dissatisfaction, including a meager 21.9% satisfaction rate for medical service. Further data from the study confirmed that despite the existence of these primary care centers, people were going straight to the large specialty hospitals for treatment of any illness, acute or chronic, serious or minor. People might have to wait for days just to see a doctor, and healthcare bills continue to surge (charges at a hospital for outpatient service are almost 4 times as much as those at a CHC), leading to the well-known saying, “看病贵、看病难” (“seeing a doctor is expensive and hard”).

“Oh, community health centers…” my host parents had remarked with a twinge of hesitation, as if unsure why our program would choose to take us to one of those. “They can treat very basic illnesses, and people only really go there because they’re conveniently located.” Their attitude reflects a common mistrust of CHCs among the Chinese population, a mistrust that is often legitimate given the lack of resources and inadequate personnel that CHCs are plagued with.

Before we left, I asked our host doctor whether he thought the current trend of pushing patients toward primary care was necessary. “非常必要,” he had said. Yet despite the urgency, the local government has issued no concrete policies to encourage utilization of CHCs (although the local governor has called for it). The specific CHC we visited seemed to have enjoyed a burst of funding to build a new center, and national policy offers free preventive services for children and mothers. Whether this government investment can be sustained or increased, only time can tell. As healthcare costs and the demand for medical personnel grow in countries around the world, a key question for China as it moves forward is how it can instill in its people a willingness to seek primary care.

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