The Performance of Primary Healthcare in China: The Need for a Systematic Design for Improvement; Comment on “Quality and Performance Measurement in Primary Diabetes Care: A Qualitative Study in Urban China”

Document Type : Commentary

Authors

Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China

Abstract

In the paper “Quality and Performance Measurement in Primary Diabetes Care: A Qualitative Study in Urban China,” Rasooly and colleagues provide an in-depth analysis of the ways in which Shanghai manages the quality and performance of the primary healthcare (PHC). The present commentary extends the analytical perspective offered in this paper from the city of Shanghai to the entire Chinese Mainland. In so doing, it points out certain systemic shortcomings in the capabilities of family doctors, the unreasonable competition between primary, secondary, and tertiary forms of healthcare, and the negative incentives in the salary system for PHC providers that must be overcome to improve performance. This commentary also proposes strategies and other recommendations for overcoming the bottlenecks identified in the paper as a means of systematically enhancing PHC performance across Mainland China.

Keywords


  1. Rasooly A, Pan Y, Tang Z, et al. Quality and Performance Measurement in Primary Diabetes Care: A Qualitative Study in Urban China. Int J Health Policy Manag. 2022;11(12):3019-3031. doi:34172/ijhpm.2022.6372
  2. Li X, Krumholz HM, Yip W, et al. Quality of primary health care in China: challenges and recommendations. Lancet. 2020;395(10239):1802-1812. doi:1016/s0140-6736(20)30122-7
  3. Yip W, Fu H, Chen AT, et al. 10 years of health-care reform in China: progress and gaps in universal health coverage. Lancet. 2019;394(10204):1192-1204. doi:1016/s0140-6736(19)32136-1
  4. National Health Commission of PRC. China Health Statistical Yearbook. http://www.nhc.gov.cn/mohwsbwstjxxzx/tjzxtjsj/tjsj_list.shtml.
  5. Chen S, Fu H, Jian W. Trends in avoidable hospitalizations in a developed City in eastern China: 2015 to 2018. BMC Health Serv Res. 2022;22(1):856. doi:1186/s12913-022-08275-w
  6. Liu HR, Chen SY, Zhang LY, Fu HQ, Jian WY. Expanding outpatient benefits package can reduce diabetes-related avoidable hospitalizations. Front Public Health. 2023;11:964789. doi:3389/fpubh.2023.964789
  7. Rendell N, Rosewell A, Lokuge K, Field E. Common features of selection processes of health system performance indicators in primary healthcare: a systematic review. Int J Health Policy Manag. 2022;11(12):2805-2815. doi:34172/ijhpm.2022.6239
  8. Tang L, Yang H, Mao Z, Li Q, Li S. The negative factors influencing the career intention of general practice trainees in eastern China: a qualitative study. BMC Med Educ. 2022;22(1):393. doi:1186/s12909-022-03456-x
  9. Chen S, Sam XH, Soong A, Car LT, Lian S, Smith HE. Recruitment of general practitioners in China: a scoping review of strategies and challenges. BMC Prim Care. 2022;23(1):249. doi:1186/s12875-022-01854-0
  10. Wang A, Tang C, Zhou L, et al. How surface acting affects turnover intention among family doctors in rural China: the mediating role of emotional exhaustion and the moderating role of occupational commitment. Hum Resour Health. 2023;21(1):3. doi:1186/s12960-023-00791-y
  11. Cheng Y, Wang F, Zhang L, et al. Effects of organisational and patient factors on doctors' burnout: a national survey in China. BMJ Open. 2019;9(7):e024531. doi:1136/bmjopen-2018-024531
  12. Zonneveld N, Driessen N, Stüssgen RAJ, Minkman MMN. Values of integrated care: a systematic review. Int J Integr Care. 2018;18(4):9. doi:5334/ijic.4172
  13. Su M, Zhou Z, Si Y, Fan X. The association between patient-centered communication and primary care quality in urban China: evidence from a standardized patient study. Front Public Health. 2021;9:779293. doi:3389/fpubh.2021.779293
  14. Sun XF, Chen MJ, Ni Y, et al. Cognitive analysis on residents' acknowledgements of general practitioner system reforms of community health service in Shanghai. Chin Gen Pract. 2015;13(12):1907-1909. doi:16766/j.cnki.issn.1674-4152.2015.12.001
  15. Stokes J, Struckmann V, Kristensen SR, et al. Towards incentivising integration: a typology of payments for integrated care. Health Policy. 2018;122(9):963-969. doi:1016/j.healthpol.2018.07.003
  16. Sun M, Rasooly A, Fan X, Jian W. Assessing the quality of primary healthcare for diabetes in China: multivariate analysis using the China Health and Retirement Longitudinal Study (CHARLS) Database. BMJ Open. 2020;10(12):e035192. doi:1136/bmjopen-2019-035192