Looking Forward to a Renewed Primary Health Care System in China

In 1978, China began extensive market-oriented health reforms, effectively abandoning its equitable and efficient approach to primary health care (PHC) the year it was celebrated in the Alma Ata declaration. Thirty years later, how is China renewing its PHC system? This article analyzes China’s potential to become a high performing system by examining its: 1) accessibility and equity of health care, 2) PHC workforce, 3) efficiency in care delivery, and 4) quality of care through literature review, government reports, and case studies. China’s primary care system is performing poorly on many dimensions. Access to primary care is limited by low rates of insurance coverage, especially for the poor. The PHC workforce consists of doctors and nurses low levels of training. Drug sales can make up 60% of a community health centre’s revenue, which creates incentives for overprescription and limits efficiency. Urban community health centres are underutilized, with low patient trust and satisfaction with services. Demonstration projects showed viable community-based models which increased access to care and were acceptable to patients, but coordination with tertiary services remained problematic. Proposed reforms aim to achieve universal health care, but focus on major illness rather than PHC services, and do not address models of care and coordination. After three decades of focus on economic development, the growing political will and financial resources committed to PHC indicate a renewed role for the state, and the hope that China can once again create a primary care system that is a model for the world.