Outpatient workload in China

Abstract

There is an increasing outpatient workload in large hospitals in China. It is not uncommon for a specialist to see around 100 patients daily in the outpatient department. The time spent with each patient is very limited—usually less than 3 min. Undoubtedly, this contributes to patients' dissatisfaction and the deterioration of doctor-patient relationships.1The LancetEnding violence against doctors in China.Lancet. 2012; 379: 1764Scopus (0) Google Scholar There is no general practitioner-based referral system in China. Patients are free to choose their health-care provider in virtually any public hospitals.2Xu J Wang W Li Y et al.Analysis of factors influencing the outpatient workload at Chinese health centres.BMC Health Serv Res. 2010; 10: 151Crossref PubMed Scopus (34) Google Scholar Tertiary medical centres are usually large-scale institutions well-equipped with advanced facilities and well-trained specialists. However, the primary health-care institutions do not have sufficient financial resources for equipment renewal and training of doctors. The outpatient consultation fee is almost the same between large tertiary teaching hospitals and community hospitals. Thus, a large number of patients with common diseases seek medical consultation in large tertiary institutions. Large tertiary hospitals are overwhelmed with heavy outpatient workloads, whereas the primary health-care institutions are underutilised.3Pan XL Hassan HD Wang XH Zhang H Service utilization in community health centers in China: a comparison analysis with local hospitals.BMC Health Serv Res. 2006; 6: 93Crossref PubMed Scopus (63) Google Scholar To avoid inefficiency, health-care reform in China should build up an efficient dual referral system between large tertiary hospitals and primary health-care services. The government should also increase financial and technical supports for the primary health-care institutions to meet patients' high expectations. We declare that we have no conflicts of interest. Effects of body size and hypertension treatments on cardiovascular event rates: subanalysis of the ACCOMPLISH randomised controlled trialHypertension in normal weight and obese patients might be mediated by different mechanisms. Thiazide-based treatment gives less cardiovascular protection in normal weight than obese patients, but amlodipine-based therapy is equally effective across BMI subgroups and thus offers superior cardiovascular protection in non-obese hypertension. Full-Text PDF