Family doctors hold key to the future
Crucial component of new round of health reform in China must and will succeed
for referring residents to the specialist, helping to execute the treatment plan and monitoring the health conditions of residents. The health management specialist is responsible for daily health management and health promotion. The specialist makes a diagnosis and suggests a treatment plan. By August last year, around 29 percent of residents had signed up for the service.
What is happening in Rushan and Xiamen is part of a national program aimed at building the family doctor system in China. In 2016, the State Council issued the Guiding Opinions on Promoting Contracted Services of Family Doctors. The guideline set up an ambitious goal to allow every family in China to be served by family doctors by 2020. Once reaching the target, the healthcare system in China will be changed fundamentally. So far, the program is advancing at an amazing speed. According to the National Health Commission of China, more than 500 million people had enrolled in the service by the end of 2017.
Family doctors in China provide conventional healthcare to residents but are also expected to play an important role in disease prevention and health promotion. This is why a team of doctors is usually involved. The Chinese government has high hopes about the role that family doctors can play in health reform. This position has two functions: to reduce the flow of patients from primary care units to hospitals that are more specialized and to control medical expenses. They are the key to the success of the construction of a hierarchical healthcare system.
So far, the program has achieved mixed results. On the one hand, the program helps to increase the use of primary care by residents. For example, more than 2 million people used community health centers as their first stop for healthcare in Xiamen in the past five years. People in Xiamen are generally satisfied with the quality and convenience of the services. Similar findings were reported in Shanghai and other large cities. On the other hand, a common observation from cities all over China is that the system has not been used to its full potential. Typical issues include lack of interest from residents, inadequate staffing and financial resources, and low motivation among family doctors. These factors lead to underuse of the system.
We feel that in order to make the system more efficient, a balance needs to be achieved between the coverage and the quality of service. Due to the strong leadership of governments, the coverage of service has expanded exponentially in the past few years. Based on the current speed, there is no doubt that the target of full coverage can be achieved by 2020. However, while full coverage is desirable, it is not the ultimate goal. The ultimate goal is to promote health by making better use of primary care and reducing medical expenses.
Considerable efforts and resources need to be invested to improve the quality of service. If people cannot clearly see the advantage of using family doctor services, they are not likely to give up the habit of seeking treatment from specialists for any illness, large or small. In addition, family doctors in China still need to earn the trust of people. That means community health centers and clinics in rural areas need to be adequately staffed with well-trained general practitioners. Financial incentives also must be provided to encourage good performers to stay in primary care units. Regulations on medical insurance coverage and reimbursement have to be changed to encourage people to use the service more.
To implement these necessary changes, the government should play a leading role, but a marketing mechanism and the private sector need to be involved. All actions must be tailored to reflect the local situation; for example, different timetables for achieving full coverage should be allowed.
Although the family doctor system has been in use in Western countries for almost two centuries, it is a relatively new thing for both the health service sector and for people in China. There will be a deep learning curve. Nevertheless, it is the key to the success of the new round of health reform in China. We have every reason to believe that it must succeed and will succeed.