When I first arrived in China, I was constantly worried for my Chinese friends whenever they would tell me they were sick and “going to the hospital”. Where I’m from, going to the hospital is serious – usually involving a serious or life-threatening emergency or a pre-booked specialist service like surgery. Generally people prefer to go to a local doctor. While I wish for everyone to be healthy always, I want to hear from my Chinese friends if they are sick not that they are going to the hospital, but that they are “going to see the doctor” instead.
This weekend the National Health Conference is taking place to discuss the next steps for a Healthy China. China’s health care reforms aim to provide basic health services to the entire population, and reduce impoverishment caused by health care costs. At the heart of this project is the creation of a tiered health care delivery system – based on General Practitioners (GPs) and community health centres as the first point of contact with the health system.
As China’s health challenges – increasing rates of cancer and cardiovascular disease linked to lifestyle factors like smoking – continue to mount, with an ageing population, so too will the demands on the country’s health system, along with the costs. It is simply not sustainable to meet these challenges in a health system that relies on hospitals. Hospitals, of course, are needed – to provide acute care to people who are seriously ill, and specialized services like surgery or radiotherapy. But hospitals are expensive to run. And frankly, they’re not especially pleasant or convenient for patients.
Just think about the current system in China: online and telephone booking systems are not always reliable, so the sick (or their family members) must queue at the hospital either late the night before or early the following morning to secure an appointment (“gua hao”), then sit in a cramped waiting room until their name is called. When the doctor is finally ready to see the patient, the consultation is likely to last only a few minutes – a symptom of the enormous patient load and pressure which doctors in China face every day. But this is not how things should be in a well-functioning health system.
There is strong international evidence that health systems centred around community health services staffed by well-trained GPs and primary care professionals, close to where people live, is the most effective and efficient way to provide good quality health care to the whole population. In this model people develop a long term relationship with a GP, who gets to know them and their health care needs. Trust is developed. In the majority of cases the care that is needed can be provided there and then – in the community clinic. If not, the staff can help refer patients to the specialist care they need.
China is already taking steps in this direction. I have visited many community health centres around the country and I’m encouraged by what I’ve seen. However, achieving such a massive transformation will not happen overnight. GPs need a decent salary to make it an attractive profession. GPs and nurses must be specially trained. And we need to change the mindsets of the sick who automatically go to hospitals, when they would be better off seeing a GP.
Premier Li Keiqang has said that health is at the root of happiness. The GP is at the root of a well-functioning health system – delivering health for everybody. During her recent visit to Beijing, WHO Director General Margaret Chan discussed her Chinese Dream with President Xi Jinping: when she retires back to China, she will have close to her home a well-trained GP who will help her to manage her own health, look after her health care needs, and navigate her way through hospital care – only if it is needed.
Achieving the vision of a Healthy China – where all people can access the health care that they need, close to home, when they need it, at an affordable cost – will not be easy. But with the same pragmatism and determination with which China has faced so many health challenges in the past, I know it is possible. And it will set China on a path to a healthier and more prosperous future.