Legal reflections on the evolving role of general practitioners in China's primary care: an assessment of regulatory strategies.

Ziyu Liu,Martin Buijsen

doi:10.1017/s1463423618000555

Abstract

AimTo assess the regulation of the Chinese healthcare system in assisting a nationwide implementation of general practitioner (GP) services. BACKGROUND: Along with the perennial problems of unaffordable and inequitable healthcare, a rapidly ageing population and the increasing burden of non-communicable diseases pose challenges to the Chinese healthcare system. Recognising these challenges and to satisfy people's demands for more and better healthcare, China has initiated a plan, named 'Healthy China 2030', based on the findings from a two-year joint study by the World Health Organization (WHO) and the World Bank Group (WBG) in collaboration with Chinese agencies. The Chinese healthcare plan, officially approved in 2016, is an attempt to use the people-centred, integrated care (PCIC) model recommended by the WHO and WBG to shape the Chinese healthcare system. In accordance with PCIC, China began the implementation of gatekeeping primary care by introducing GP services to local communities. METHODS: A comparative analysis was employed to point out the importance of introducing GP services. A systematic assessment was carried out to evaluate the regulatory sector of the Chinese healthcare system, including a critical review of related legal norms and a theoretical exploration of external impediments (eg, cultural attitudes, government capacity and interest groups).FindingsResults demonstrate that the current regulatory sector of the Chinese healthcare system needs to be improved in order to assist the nationwide implementation of GP services and to strengthen its gatekeeping role. Major deficiencies include the problematic relationship between legal norms and health policies, the lack of effective and consistent new legislation, the low rate of social acceptance, and lack of support from agencies. To address those challenges, this paper recommends that preliminary efforts be devoted, in part, to two changes in the legal structure: enacting a specific law, and creating an independent regulatory oversight body.

Highlights

Along with the perennial problems of unaffordable and less equitable healthcare, a rapidly ageing population and the increasing burden of non-communicable diseases pose challenges to the Chinese healthcare system (Anonymous, 2011; Huang, 2011; Tang et al, 2013; Xiao et al, 2014)
Results show that major deficiencies in the regulatory sector include the problematic relationship between legal norms and health policies, the lack of effective and consistent new legislation, the low rate of social acceptance of general practitioner (GP) services, and the lack of support for GPs from government agencies
Recognising that the regulatory sector is unprepared for the challenge of implementing the new healthcare system, we propose two ways to improve internal structure and address external factors, respectively

Summary

Introduction

Along with the perennial problems of unaffordable and less equitable healthcare, a rapidly ageing population and the increasing burden of non-communicable diseases pose challenges to the Chinese healthcare system (Anonymous, 2011; Huang, 2011; Tang et al, 2013; Xiao et al, 2014). Recognising these challenges, China initiated a healthcare reform plan in 2016 named ‘Healthy China 2030’ (The World Bank Group et al, 2016). Major reform efforts are devoted towards providing a GP for every household in China and establishing electronic personal health records for each Chinese citizen before 2020 (National Health and Family Planning Commission, 2015)

Objectives

Findings

Conclusion