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Lancet. 2017 Dec 9;390(10112):2584-2594. doi: 10.1016/S0140-6736(17)33109-4. Epub 2017 Dec 8.

The primary health-care system in China.

Author information

1
National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
2
Institute of Applied Health Research, University of Birmingham, Birmingham, UK; General Practice Development and Research Center, Peking University Health Science Center, Beijing, China.
3
Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium.
4
School of Public Health, Peking University Health Science Center, Beijing, China.
5
Department of Health Policy, London School of Economics and Political Science, London, UK.
6
Sun Yat-sen Global Health Institute, Sun Yat-sen University School of Public Health, Guangzhou, Guangdong, China.
7
Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
8
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA.
9
National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address: huss@fuwaihospital.org.

Abstract

China has made remarkable progress in strengthening its primary health-care system. Nevertheless, the system still faces challenges in structural characteristics, incentives and policies, and quality of care, all of which diminish its preparedness to care for a fifth of the world's population, which is ageing and which has a growing prevalence of chronic non-communicable disease. These challenges include inadequate education and qualifications of its workforce, ageing and turnover of village doctors, fragmented health information technology systems, a paucity of digital data on everyday clinical practice, financial subsidies and incentives that do not encourage cost savings and good performance, insurance policies that hamper the efficiency of care delivery, an insufficient quality measurement and improvement system, and poor performance in the control of risk factors (such as hypertension and diabetes). As China deepens its health-care reform, it has the opportunity to build an integrated, cooperative primary health-care system, generating knowledge from practice that can support improvements, and bolstered by evidence-based performance indicators and incentives.

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