Who will protect the health of rural residents in China if village doctors run out?
Le Yang A and Hongman Wang A BA The School of Health Humanities, Peking University, 38 Xueyuan Road, Haidian, Beijing 100191, China.
B Corresponding author. Email: cde@pku.edu.cn
Australian Journal of Primary Health 25(2) 99-103 https://doi.org/10.1071/PY18048
Submitted: 19 March 2018 Accepted: 14 January 2019 Published: 9 April 2019
Abstract
This paper discusses the current situation of Chinese village doctors and highlights the importance of increasing the number of village doctors for better health service and a stronger health system. This study reviewed relevant health policies and data from the Chinese Statistic Year Book 2016 to assess the current status of Chinese village doctors and clinics. The Chinese government has launched a set of healthcare reforms to strengthen primary health care (PHC), especially in rural areas. However, the recruitment and retention of village doctors has not been successful. The analysis of available data suggests that fewer doctors or graduated medical students want to work in village clinics and provide services for rural residents. It is widely recognised in China and other countries that a good PHC system protects the population’s health at low cost. To achieve a better health system, the Chinese government should strengthen PHC, expanding the village clinics’ coverage to improve access to PHC and basic public health, and introduce more sustainable policies to attract more PHC practitioners to Chinese villages.
Additional keywords: health policy, primary health care.
References
Australian Institute for Health and Welfare (2016) Medical practitioners workforce 2015. (AIHW: Canberra, ACT, Australia) Available at https://www.aihw.gov.au/reports/workforce/medical-practitioners-workforce-2015/contents/how-many-medical-practitioners-are-there [Verified 16 December 2018]Bhatia M, Rifkin S (2010) A renewed focus on primary health care: revitalize or reframe? Globalization and Health 6, 13
China Daily (2012a) Support for barefoot doctors urged. (China Daily: Beijing, China) Available at http://www.chinadaily.com.cn/china/2012npc/2012-03/10/content_14805434.htm [Verified 4 May 2018]
China Daily (2012b) Healthcare reform improves equal access: white paper. (China Daily: Beijing, China) Available at http://www.chinadaily.com.cn/xinhua/2012-12-26/content_7871954.html [Verified 4 May 2018]
Chinese Posters (1952) Patriotic Health Campaign. (Chinese Posters: Amsterdam, The Netherlands) Available at https://chineseposters.net/themes/patriotic-health-campaign.php [Verified 4 May 2018]
Chinese Village Doctor Training Center (2018) Policy interpretation of Opinions of the Improvement of the Cultivation and Incentive Mechanism of GP. (Chinese Village Doctor Training Center: Beijing, China) Available at http://202.118.40.32/cdtc/info/1008/1228.htm [Verified 4 May 2018]
Du J, Lu X, Wang Y, Cui S, Guo A, Coidand D, Wang W (2012) Mutual referral: a survey of GPs in Beijing. Family Practice 29, 441–447.
| Mutual referral: a survey of GPs in Beijing.Crossref | GoogleScholarGoogle Scholar | 22223744PubMed |
Frenk J, Sepúlveda J, Gómez-Dantés O, Knaul F (2003) Evidence-based health policy: three generations of reform in Mexico. Lancet 362, 1667–1671.
| Evidence-based health policy: three generations of reform in Mexico.Crossref | GoogleScholarGoogle Scholar | 14630451PubMed |
Fu H, He Q, Yu J, Gao H, Lei H, Liang W (2006) Review of literature on the different and expensive care. Chinese Journal of Hospital Administration 10, 701–704.
Ge Y, Gong S (2007) ‘Chinese Health Care Reform.’ (China Development Publishing: Beijing, China)
Gu D, Zhang Z, Zeng Y (2009) Access to healthcare services makes a difference in healthy longevity among older Chinese adults. Social Science & Medicine 68, 210–219.
| Access to healthcare services makes a difference in healthy longevity among older Chinese adults.Crossref | GoogleScholarGoogle Scholar |
Haggerty J, Burge F, Levesque JF, Gass D, Pineault R, Beaulieu MD, Santor D (2007) Operational definitions of attributes of primary health care: consensus among Canadian experts. Annals of Family Medicine 5, 336–344.
| Operational definitions of attributes of primary health care: consensus among Canadian experts.Crossref | GoogleScholarGoogle Scholar | 17664500PubMed |
Hongoro C, McPake B (2004) How to bridge the gap in human resources for health. Lancet 364, 1451–1456.
| How to bridge the gap in human resources for health.Crossref | GoogleScholarGoogle Scholar | 15488222PubMed |
Jones C, Parker T, Ahearn M, Mishra A, Variyam J (2009) Health status and health care access of farm and rural populations. Economic Information Bulletin, Number 57. United States Department of Agriculture, Economic Research Service, Washington, DC, USA.
Kabene SM, Orchard C, Howard JM, Soriano MA, Leduc R (2006) The importance of human resources management in health care: a global context. Human Resources for Health 4, 20
| The importance of human resources management in health care: a global context.Crossref | GoogleScholarGoogle Scholar | 16872531PubMed |
Kruk ME, Porignon D, Rockers PC, Van Lerberghe W (2010) The contribution of primary care to health and health systems in low- and middle-income countries: a critical review of major primary care initiatives. Social Science & Medicine 70, 904–911.
| The contribution of primary care to health and health systems in low- and middle-income countries: a critical review of major primary care initiatives.Crossref | GoogleScholarGoogle Scholar |
Li J (2007) Reflection and countermeasures of “difficult and expensive to see a doctor”. Chongqing Medicine 1, 1–2.
Li Y, Zhao H, Zhang E (2008) Analysis on attitude toward employment of medical students in different grades. Journal of Liaoning Medical University (Social Science Edition) 4, 28–30.
Liu GG, Vortherms SA, Hong XZ (2017) China’s health reform update. Annual Review of Public Health 38, 431–448.
| China’s health reform update.Crossref | GoogleScholarGoogle Scholar | 28125384PubMed |
Long S (2013) Primary care health professionals in rural China: current status, influential factors, and countermeasures. The Journal of Medical Theory and Practice 7, 878–879.
National Bureau of Statistics of China (2017) China statistical yearbook 2016. (National Bureau of Statistics of China: Beijing, China) Available at http://www.stats.gov.cn/tjsj/ndsj/2016/indexeh.htm [Verified 4 May 2018]
National Health and Family Planning Commission of the People’s Republic of China (2017) ‘China Health Statistical Yearbook 2016.’ (Peking Union Medical College Press: Beijing, China)
Pan X, Dib HH, Zhu M, Zhang Y, Fan Y (2009) Absence of appropriate hospitalization cost control for patients with medical insurance: a comparative analysis study. Health Economics 18, 1146–1162.
| Absence of appropriate hospitalization cost control for patients with medical insurance: a comparative analysis study.Crossref | GoogleScholarGoogle Scholar | 18972328PubMed |
Regan S, Wong ST, Watson DE (2010) Public perspectives on health human resources in primary healthcare: context, choices and change. Healthcare Policy 5, e162–e172.
Starfield B, Shi L, Macinko J (2005) Contribution of primary care to health systems and health. The Milbank Quarterly 83, 457–502.
| Contribution of primary care to health systems and health.Crossref | GoogleScholarGoogle Scholar | 16202000PubMed |
The State Council (2017) The 13th Five-Year Hygiene and Health Plan. (The State Council: Beijing, China) Available at http://www.gov.cn/zhengce/content/2017-01/10/content_5158488.htm [Verified 4 May 2018] [In Chinese]
Wagstaff A, Lindelow M, Jun G, Ling X, Juncheng Q (2009) Extending health insurance to the rural population: an impact evaluation of China’s new cooperative medical scheme. Journal of Health Economics 28, 1–19.
| Extending health insurance to the rural population: an impact evaluation of China’s new cooperative medical scheme.Crossref | GoogleScholarGoogle Scholar | 19058865PubMed |
Wang H (2006) ‘On the Health of China.’ (Peking University Press: Beijing, China)
Wang W, Xing X, Zhang L, Chen G, Zhao H, Gao Y, Zhang C, Shang F, Guo J, Chen X (2007) Study on 841 medical students’ attitude toward future career. Soft Science of Health 3, 220–221.
World Health Organization (2010) ‘Increasing Access to Health Workers in Remote and Rural Locations Through Improved Retention: Global Policy Recommendations.’ (WHO Press: Geneva, Switzerland)
Yang L, Wang H (2017) Medical education: what about the barefoot doctors? Lancet 390, 1736
| Medical education: what about the barefoot doctors?Crossref | GoogleScholarGoogle Scholar | 29047444PubMed |
Zhan X, Zhang Z, Sun F, Liu Q, Peng W, Zhang H, Yan W (2017) Effects of improving primary health care workers’ knowledge about public health services in rural China: a comparative study of blended learning and pure E-learning. Journal of Medical Internet Research 19, e116.
| Effects of improving primary health care workers’ knowledge about public health services in rural China: a comparative study of blended learning and pure E-learning.Crossref | GoogleScholarGoogle Scholar | 28461286PubMed |
Zhang D, Unschuld PU (2008) China’s barefoot doctor: past, present, and future. Lancet 372, 1865–1867.
| China’s barefoot doctor: past, present, and future.Crossref | GoogleScholarGoogle Scholar | 18930539PubMed |