Primary care reform in China

Abstract

Between 1949 and the late 1970s, health care in China was organised on a three-tier system. Paramedics or ‘barefoot doctors’ provided basic primary care in neighbourhood clinics. They would refer patients with problems beyond their skill levels to district hospitals, and only the most complex problems would be managed at large municipal or regional centres. The ‘reform and opening-up’ policy since the late 1970s ushered in a market system that allowed private and foreign enterprise to act as catalysts for rapid economic growth. In the health sector, this market reform resulted in the development of large and well-equipped hospitals. The freedom to choose among the public meant that the majority opted to see hospital specialists, and this led to the gradual demise of primary care. Today, hospitals in China are overcrowded, consultations are short, and perverse financial incentives encourage over-investigation, over-medication, …