Wed, 08/25/2010 - 17:33
GUEST COLUMN: China's smaller cities are not yet ready for community health centers
by Wang Lixin, translated from the original Chinese by Maisie Shen
The community health center (CHC) model was introduced to China more than a decade ago. Government authorities and the state media have praised the system as improving access to health care and reducing the costs. But from a doctor's perspective, the model is unlikely to work well in China, especially in small- and medium-sized cities.
CHCs are supposed to focus primarily on disease prevention and treating minor illnesses, while hospitals should mainly concentrate on the treatment of serious conditions. Given their fundamental role, CHCs must have strong financial support from the government if they are going to survive and provide affordable medical services.
However, China's CHCs are far from being adequately funded. According to government policy, in China's central and western regions CHCs are subsidized only RMB 3 for every person in their catchment area, while subsidies for such institutions in the rest of the country are just slightly higher, ranging from RMB 5 to around RMB 10 per person on average. As a result, most of China's CHCs have to devote medical resources to treating major diseases, or even over-prescribe drugs, in order to generate enough income to survive.
Another serious problem haunting China's CHCs is a serious lack of qualified doctors and nurses, especially general practitioners (GP). Altogether, China has 27,000 CHCs staffed by less than 10,000 GPs. However, authorities state the ideal doctor-patient ratio in these institutions ranges from one doctor per 2,000 people to one doctor per 4,000 people. By this reckoning, China's CHCs lack at least 500,000 GPs, and it will take the country at least a decade to meet such a shortage.
Furthermore, community doctors are not as well paid as their counterparts in hospitals. This makes it even more challenging for CHCs to recruit medical school graduates and retain doctors.
In addition to funding and staffing problems, some CHCs must also suffer the unreasonable demands of health authorities. Their requirement that community doctors keep computerized medical records for each patient turns out to be a most infeasible and wishful policy. Community GPs must create medical records which contain a swathe of information from patients, ranging from name, age, profession and marital status to diet and recreational habits. And GPs must visit patients to keep the records up-to-date four times a year.
For example, take a CHC with 16 GPs and 10 nurses serving 30,000 residents. A doctor needs at least fifteen minutes to create medical records for one patient. Each doctor can create records for no more than 20 patients a day, meaning the process will take about half a year in all. As a result, the few doctors that are working in CHCs are performing the role of administrators instead, further squandering the limited medical resources available at grassroots level.
All in all, unless CHCs are given better funding and the means to attract qualified doctors like their counterparts in major cities such as Beijing and Shanghai, it seems too early to set up so many in small- and medium-sized cities.
Wang Lixin is a physician in Heilongjiang Province and author of a popular Sina.com blog on China's ongoing health care reform.
The above is a personal opinion piece by the author. Its publication in no way implies that Interfax shares the views expressed in the article.
