The overall objective is to establish a basic health care system covering both rural and urban people, as well as to provide safe, effective, convenient and affordable health services to all people.

Phase 3 :Healthy China

1november 3 2010

Why ?

• Politics of change • Costs escalating • SARS showed the deficiencies in the

public health system• Increasing affluence spread unevenly

across the country >potential for social unrest

november 3 2010 2

3

New health system reform plan: one building, four girders and eight pillars

Collecting extensively people’s comments and suggestions on deepening medical and health

reform

Overall objective

Establishing a basic health system covering both urban and rural people, promoting health for all.

Public health service system

Medical service system

Medical insurance system

Drug production and supply system

Man

agem

ent system

Op

eration

system

Inp

ut system

Price fo

rmin

g system

Mo

nito

ring

system

Hu

man

resou

rces

Info

rmatio

n system

legislatio

n

november 3 2010

4 systems for establishing a basic universal healthcare system:

§ Public health services including primary care

§ Medical services including primary care

§ Health insurance to cover primary care

§ Medicine supply system to cover primary care

4november 3 2010

Primary care in China

• CHS first announced as the future direction for urban healthcare reform in 19971

– borrowed much from the UK. • Primary care is provided by community health

service (CHS) via community health centres (CHCs)

• Public Health and primary care integrated

1. “Decision on Development of Urban Health Care System”. CCP Central Committee and State Council. Jan 15, 1997.Accessed on http://www.moh.gov.cn/publicfiles/business/htmlfiles/wsb/pM30115/200804/18540.htm.

2. “? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ”. Establishing community health services in the urban areas of China. Division of Primary and Women’s Health, Ministry of Health. MOH. No.467 document. Dec 29, 2000. Accessed on http://www.moh.gov.cn/publicfiles/business/htmlfiles/mohfybjysqwss/pfybj/200804/18182.htm.

TCM physic

iansGPs

PHDs

Multi-skilled nurses

Allied healthcar

e personnel

5november 3 2010

• Basis of urban public health system & basic medical services

Community Health Services (CHS)

1. Division of Primary and Women’s Health, Ministry of Health – “Opinions on Development of Community Health Services in the Cities”. MOH .No.326 document. Jul 16, 1999. Accessed on http://www.moh.gov.cn/publicfiles/business/htmlfiles/mohfybjysqwss/pfybj/200804/18183.htm.

Six-in-one comprehensive care package1

Prevention

Treatment& Referral

Health Maintenance

Health Education

Family Planning

Rehab

6november 3 2010

77

november 3 2010

Strengthening the establishment of the public health service system:§ build up sound public health networks of §disease prevention,§health education, §maternal and child health care, §mental health,§first aid, §blood collection and supply,§ health supervision, §family planning.

§

Public Health Reforms

8november 3 2010

Observation

• Language is confusing • Much of what is labeled public health can

be regarded as primary care • Those providing primary care have public

health responsibilities • Therefore Van Weels terminology /concept

is more helpful to achieve healthcare reform ; community-oriented primary care approach

9november 3 2010

Hong Kong

10november 3 2010

11

Market based Primary care in Hong Kong

• Fragmented

• Uncoordinated

• Mainly out of pocket

• No clear clinical standards

• Doctor shopping

• Generalist /specialist issues

• No register of primary care practitioners

• No comprehensive data system

november 3 2010

12

Hong Kong Primary Care :the reform challenge

• Participants who did not currently have a family doctor and were mainly of lower socioeconomic status than those with a family doctor saw a family doctor as something of a ‘luxury item’ for the wealthy and not within the financial reach of the bulk of the population in Hong Kong.

• There is a need to make primary care acceptable, accessible, and affordable to all, especially those in need.

(Source: Mercer et al., BMC Public Health 2010)

november 3 2010

Way forward: enhance primary care

• New funding mechanisms

• Promote the family doctor concept which emphasizes continuity of care, holistic care and preventive care.– register

• Put greater emphasis on prevention of diseases and illnesses through public education and through family doctors.-guidelines

• Encourage and facilitate medical professionals to collaborate with other professionals to provide coordinated services.- new models of care

13november 3 2010

CUHK response

• Build on SARS report • Increase the profile and capacity of public

health • Increase the profile and capacity of

primary care • Create an integrated approach –combining

public health and primary care :SPHPC

14november 3 2010

15

School of Public Health and Primary CareThe Chinese University of Hong Kong

november 3 2010

16

The challenges of public health education with a particularreference to China

S.M. Griffiths L.M. Li , J.L. Tang , X. Ma, Y.H. Hu, Q.Y. Meng H. Fu

in many countries,traditional public health methods targeted atindividuals, such as vaccination and child and maternal care,have been successfully relocated into the clinical sector, most often primary care or general practice. Such individual public health approaches to prevention are too important to be

neglected.Although, in essence an individual approach, primary careis where much of clinical medicine and many public healthpractices meet, and recognition of this interface is extremely importantfor building a seamless framework for improving the health of the

population.november 3 2010

• The future of primary care, and health care in general, will depend on how effectively primary practices achieve this community-oriented primary care approach and contribute to equity and social cohesion

» Van weel et al Lancet 200817november 3 2010

18november 3 2010