Revitalising Primary Health Care: Lessons from China

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Revitalising Primary Health Care Lessons from
China

• Chaojie Liu, PhD David Legge, MD
• China Health Program
• La Trobe University

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Health Facility Development in China
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Primary Health Organisations and Health
Achievements
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Methods

• Qualitative
• Interview with administrators and general
  practitioners (n23)
• Observation (14 community health centres)
• Document analysis
• Quantitative
• questionnaire survey with community residents
  (n1041)
• National statistics

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Organisational and policy environment

• Lack of policy coherence across organisational
  incentives
• Devolved financial accountability
• Intensified competitions
• Lack of consumers support
• Half community residents considered community
  health services a choice, not a first contact

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What has happened to community health centres

• Even the big hospitals want to occupy the
  communities. They also provide home services. So,
  we have to try to find something special to
  survive. Thats not easy.
• We have been very successful to attract
  customers. Several private clinics have been
  forced out of our community. While our revenue
  increases, the revenue of a factory hospital
  nearby has declined.

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New strategies for vitalising PHC

• Revenue and expenditure separated to correct
  perverse incentives
• Zero pharmaceutical profit
• Central subsidise to less developed regions

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Government invest in health has imcreased
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More consumers start to seek medical help
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Challenge

• CHS not being seen in a holistic system
• Hospital reform lacks behind
• Unclear role of private facilities
• Central policy vs local implementation
• Competition
• Revenue generating (fee for services)
• Role of consumers
• Provider-focused reform

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Conclusions

• Primary care ? services of low quality
• Cost effectiveness ? low input services
• CHS (system change) ? institutional development