Fam­ily doc­tors hold key to the fu­ture

China Daily European Weekly - - Cover Story - Ma Xizhuo is the pres­i­dent of Rushan City Hospi­tal. Yang Jun is as­so­ciate pro­fes­sor in the Depart­ment of Earth Sys­tem Science at Ts­inghua Univer­sity. The views do not nec­es­sar­ily re­flect those of China Daily.

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.

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