Quality of primary health care in China: challenges and recommendations

China has substantially increased financial investment and introduced favourable policies for strengthening its primary health care system with core responsibilities in preventing and managing chronic diseases such as hypertension and emerging infectious diseases such as coronavirus disease 2019 (CO...

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Published in:	The Lancet (British edition) Vol. 395; no. 10239; pp. 1802 - 1812
Main Authors:	Li, Xi, Krumholz, Harlan M, Yip, Winnie, Cheng, Kar Keung, De Maeseneer, Jan, Meng, Qingyue, Mossialos, Elias, Li, Chuang, Lu, Jiapeng, Su, Meng, Zhang, Qiuli, Xu, Dong Roman, Li, Liming, Normand, Sharon-Lise T, Peto, Richard, Li, Jing, Wang, Zengwu, Yan, Hongbing, Gao, Runlin, Chunharas, Somsak, Gao, Xin, Guerra, Raniero, Ji, Huijie, Ke, Yang, Pan, Zhigang, Wu, Xianping, Xiao, Shuiyuan, Xie, Xinying, Zhang, Yujuan, Zhu, Jun, Zhu, Shanzhu, Hu, Shengshou
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 06-06-2020 Elsevier Limited
Subjects:	China Chronic illnesses Continuity of care Continuity of Patient Care Coronavirus Infections Coronaviruses COVID-19 Digital data Fee-for-Service Plans Health care Health care policy Health services Humans Hypertension Infectious diseases Modernization Pandemics Payment systems Physicians Physicians, Primary Care - education Physicians, Primary Care - standards Pneumonia, Viral Primary Health Care - organization & administration Primary Health Care - standards Public health Quality of Health Care Review Strengthening Training Viral diseases China
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Abstract	China has substantially increased financial investment and introduced favourable policies for strengthening its primary health care system with core responsibilities in preventing and managing chronic diseases such as hypertension and emerging infectious diseases such as coronavirus disease 2019 (COVID-19). However, widespread gaps in the quality of primary health care still exist. In this Review, we aim to identify the causes for this poor quality, and provide policy recommendations. System challenges include: the suboptimal education and training of primary health-care practitioners, a fee-for-service payment system that incentivises testing and treatments over prevention, fragmentation of clinical care and public health service, and insufficient continuity of care throughout the entire health-care system. The following recommendations merit consideration: (1) enhancement of the quality of training for primary health-care physicians, (2) establishment of performance accountability to incentivise high-quality and high-value care; (3) integration of clinical care with the basic public health services, and (4) strengthening of the coordination between primary health-care institutions and hospitals. Additionally, China should consider modernising its primary health-care system through the establishment of a learning health system built on digital data and innovative technologies.
AbstractList	China has substantially increased financial investment and introduced favourable policies for strengthening its primary health care system with core responsibilities in preventing and managing chronic diseases such as hypertension and emerging infectious diseases such as coronavirus disease 2019 (COVID-19). However, widespread gaps in the quality of primary health care still exist. In this Review, we aim to identify the causes for this poor quality, and provide policy recommendations. System challenges include: the suboptimal education and training of primary health-care practitioners, a fee-for-service payment system that incentivises testing and treatments over prevention, fragmentation of clinical care and public health service, and insufficient continuity of care throughout the entire health-care system. The following recommendations merit consideration: (1) enhancement of the quality of training for primary health-care physicians, (2) establishment of performance accountability to incentivise high-quality and high-value care; (3) integration of clinical care with the basic public health services, and (4) strengthening of the coordination between primary health-care institutions and hospitals. Additionally, China should consider modernising its primary health-care system through the establishment of a learning health system built on digital data and innovative technologies. Summary China has substantially increased financial investment and introduced favourable policies for strengthening its primary health care system with core responsibilities in preventing and managing chronic diseases such as hypertension and emerging infectious diseases such as coronavirus disease 2019 (COVID-19). However, widespread gaps in the quality of primary health care still exist. In this Review, we aim to identify the causes for this poor quality, and provide policy recommendations. System challenges include: the suboptimal education and training of primary health-care practitioners, a fee-for-service payment system that incentivises testing and treatments over prevention, fragmentation of clinical care and public health service, and insufficient continuity of care throughout the entire health-care system. The following recommendations merit consideration: (1) enhancement of the quality of training for primary health-care physicians, (2) establishment of performance accountability to incentivise high-quality and high-value care; (3) integration of clinical care with the basic public health services, and (4) strengthening of the coordination between primary health-care institutions and hospitals. Additionally, China should consider modernising its primary health-care system through the establishment of a learning health system built on digital data and innovative technologies.
Author	Ke, Yang De Maeseneer, Jan Zhang, Yujuan Li, Chuang Li, Liming Chunharas, Somsak Xie, Xinying Wang, Zengwu Meng, Qingyue Su, Meng Xu, Dong Roman Wu, Xianping Zhu, Shanzhu Gao, Runlin Xiao, Shuiyuan Yan, Hongbing Pan, Zhigang Hu, Shengshou Gao, Xin Krumholz, Harlan M Cheng, Kar Keung Guerra, Raniero Mossialos, Elias Peto, Richard Li, Jing Li, Xi Normand, Sharon-Lise T Lu, Jiapeng Ji, Huijie Yip, Winnie Zhu, Jun Zhang, Qiuli
Author_xml	– sequence: 1 givenname: Xi surname: Li fullname: Li, Xi organization: National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China – sequence: 2 givenname: Harlan M surname: Krumholz fullname: Krumholz, Harlan M organization: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine and the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA – sequence: 3 givenname: Winnie surname: Yip fullname: Yip, Winnie organization: Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA – sequence: 4 givenname: Kar Keung surname: Cheng fullname: Cheng, Kar Keung organization: Department of Health Care Policy, Harvard Medical School, Boston, MA, USA – sequence: 5 givenname: Jan surname: De Maeseneer fullname: De Maeseneer, Jan organization: Department of Public Health and Primary Care, Center of Family Medicine, Ghent University, Ghent, Belgium – sequence: 6 givenname: Qingyue surname: Meng fullname: Meng, Qingyue organization: School of Public Health, Peking University Health Science Center, Beijing, China – sequence: 7 givenname: Elias surname: Mossialos fullname: Mossialos, Elias organization: Department of Health Policy, London School of Economics and Political Science, Institute of Global Health Innovation, Imperial College London, London, UK – sequence: 8 givenname: Chuang surname: Li fullname: Li, Chuang organization: Health Commission of Shenzhen Municipality, Shenzhen, China – sequence: 9 givenname: Jiapeng surname: Lu fullname: Lu, Jiapeng organization: National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China – sequence: 10 givenname: Meng surname: Su fullname: Su, Meng organization: National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China – sequence: 11 givenname: Qiuli surname: Zhang fullname: Zhang, Qiuli organization: National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China – sequence: 12 givenname: Dong Roman surname: Xu fullname: Xu, Dong Roman organization: Sun Yat-sen Global Health Institute, Sun Yat-sen University School of Public Health, and Institute of State Governance, Guangzhou, China – sequence: 13 givenname: Liming surname: Li fullname: Li, Liming organization: School of Public Health, Peking University Health Science Center, Beijing, China – sequence: 14 givenname: Sharon-Lise T surname: Normand fullname: Normand, Sharon-Lise T organization: Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA – sequence: 15 givenname: Richard surname: Peto fullname: Peto, Richard organization: Nuffield Department of Population Health, University of Oxford, Oxford, UK – sequence: 16 givenname: Jing surname: Li fullname: Li, Jing organization: National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China – sequence: 17 givenname: Zengwu surname: Wang fullname: Wang, Zengwu organization: National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China – sequence: 18 givenname: Hongbing surname: Yan fullname: Yan, Hongbing organization: National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China – sequence: 19 givenname: Runlin surname: Gao fullname: Gao, Runlin organization: National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China – sequence: 20 givenname: Somsak surname: Chunharas fullname: Chunharas, Somsak organization: National Health Foundation, Bangkok, Thailand – sequence: 21 givenname: Xin surname: Gao fullname: Gao, Xin organization: Xizhuangzi Village Clinic, Jinchang, China – sequence: 22 givenname: Raniero surname: Guerra fullname: Guerra, Raniero organization: Director General Office, WHO Headquarters, Geneva, Switzerland – sequence: 23 givenname: Huijie surname: Ji fullname: Ji, Huijie organization: Yaojia Township Primary Care Clinic, Zhengzhou, China – sequence: 24 givenname: Yang surname: Ke fullname: Ke, Yang organization: School of Oncology, Peking University Health Science Center, Beijing, China – sequence: 25 givenname: Zhigang surname: Pan fullname: Pan, Zhigang organization: Department of General Practice, Zhongshan Hospital of Shanghai Medical College Fudan University, Shanghai, China – sequence: 26 givenname: Xianping surname: Wu fullname: Wu, Xianping organization: Sichuan Center for Disease Control and Prevention, Chengdu, China – sequence: 27 givenname: Shuiyuan surname: Xiao fullname: Xiao, Shuiyuan organization: Xiangya School of Public Health, Central South University, Changsha, China – sequence: 28 givenname: Xinying surname: Xie fullname: Xie, Xinying organization: Health Commission of Yunnan Province, Kumming, China – sequence: 29 givenname: Yujuan surname: Zhang fullname: Zhang, Yujuan organization: Jijie Township Primary Care Clinic, Gejiu, China – sequence: 30 givenname: Jun surname: Zhu fullname: Zhu, Jun organization: National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China – sequence: 31 givenname: Shanzhu surname: Zhu fullname: Zhu, Shanzhu organization: Department of General Practice, Zhongshan Hospital of Shanghai Medical College Fudan University, Shanghai, China – sequence: 32 givenname: Shengshou surname: Hu fullname: Hu, Shengshou email: huss@fuwaihospital.org organization: National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Snippet	China has substantially increased financial investment and introduced favourable policies for strengthening its primary health care system with core... Summary China has substantially increased financial investment and introduced favourable policies for strengthening its primary health care system with core...
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SubjectTerms	China Chronic illnesses Continuity of care Continuity of Patient Care Coronavirus Infections Coronaviruses COVID-19 Digital data Fee-for-Service Plans Health care Health care policy Health services Humans Hypertension Infectious diseases Modernization Pandemics Payment systems Physicians Physicians, Primary Care - education Physicians, Primary Care - standards Pneumonia, Viral Primary Health Care - organization & administration Primary Health Care - standards Public health Quality of Health Care Review Strengthening Training Viral diseases
Title	Quality of primary health care in China: challenges and recommendations
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