While China’s healthcare system has seen remarkable growth over the past decade, the COVID-19 outbreak has exposed capacity issues in China’s healthcare system, particularly at the primary care level. At the start of the pandemic in Wuhan, only 10 of the city’s community health centres were equipped to admit and treat patients with coronavirus symptoms, leading to hospitals being overwhelmed.
China has a three tiered system for healthcare delivery: with primary or community care acting as gatekeeper for early diagnosis, Class I & II hospitals providing care for rehabilitation and chronic diseases, and finally Class III hospitals offering specialty and critical care services. However, patients in China still tend to visit hospitals rather than primary care providers, leading to many hospitals facing capacity crunch. A study published in The Lancet, a leading medical journal, attributed this to ‘widespread gaps in quality of primary healthcare’ across the country, leading to distrust amongst the patients.
A need to improve primary care quality
The Lancet study looked into possible causes of the uneven quality of primary care. One reason cited was a shortage of qualified doctors practising in primary care settings; in 2018, “25% of doctors in community health centres and 42% of those in township health centres had less than a junior medical college level of education.” In addition, many of these healthcare professionals do not receive continuing training, due to their heavy workload and busy schedule.
A fragmented system, with a lack of collaboration between health institutions, is also a structural issue affecting the delivery of continual care. Hospitals and primary care institutions in China are essentially competing for patients, and hence “have few incentives to coordinate”. Electronic patient records are not integrated and seldom shared between the different tiers of health facilities.
China’s efforts to develop primary care
The World Health Organization has noted that primary healthcare, staffed by well-trained health professionals and accessible to the masses, is the most efficient and cost-effective way to meet the health needs of a country’s populations.
The Chinese government has been cognizant of the need to reform the country’s primary care services. A round of healthcare reforms was carried out in the past decade, based on the “Opinions on deepening health system reform” policy document issued by the Chinese government in 2009. The State Council Health System Reform Office was set up to coordinate the development of the reform policies at the different ministries and the implementation of the plans.
Based on statistics from China’s National Health Commission, the funding to primary institutions has increased by more than tenfold, from ¥19 billion in 2008 to ¥197 billion in 2018. The allocation of quality medical resources will be an incentive to attract more qualified professionals to work there. The Healthy China 2020 Plan, announced by the State Council in 2016, includes directives to prioritise disease prevention and primary care.
China has led large-scale reforms in medical insurance coverage for its citizens in the last two decades. By the end of 2016, basic medical insurance has reached over 1.3 billion citizens nationwide, accounting for more than 95 percent of the total population. A large number of people are now able to access medical services that they previously could not afford, and it is expected that primary care will play an ever-larger role in healthcare delivery in China.
While there is clearly work to be done in bridging the quality of primary care in China, the commitment by the Chinese government to enhance primary care has been clear. This spells immense investment opportunities in China for the global healthcare industry, with loosening of restrictions in foreign investment – in 2019, subsectors of both the pharmaceutical and healthcare industries were added to the 2019 Foreign Investment National Encouraged Catalogue. With the renewed focus on the sector in the wake of COVID-19, China’s healthcare system looks set to continue its rapid growth trajectory in the coming years.
The growth of digital healthcare solutions such as telemedicine apps can help to drive efficiency while keeping costs affordable at primary care facilities. 5G applications can connect seasoned doctors from higher-tier hospitals with primary care clinics, to provide support and guidance. Doctors can also leverage on big data analytics to guide their diagnosis and clinical decision process.
The upcoming HMA China conference in August 2021 will gather hospital executives from China and around the world for sharing sessions and panel discussions, including on the topic of how primary care can play an important role in disease prevention and control, and disease management; as well as on how digitalisation can help to interconnect different systems, and drive continual care delivery across different medical institutions. Click here for more information on the HMA China event and find out how you can participate.