Towards strengthened primary care in China: an early evaluative study of the government’s role between 2003 and 2015

© 2019 Xiao TanSince the early 2000s, the Chinese government has significantly increased its subsidies for health care and made new promises. Among different reform areas, primary care has been prioritised. This thesis evaluates the Chinese government’s role in strengthening primary care between 2003 and 2015. Two main research questions are addressed: 1. What has the Chinese government done to strengthen primary care? and 2. What were the outcomes of these efforts? In order to answer these research questions, data were drawn from both secondary research and fieldwork conducted in China between October 2016 and March 2017. More specifically, data were collected from the China Health Yearbook and China Health Statistical Yearbook, relevant policy documents and academic publications. During my fieldwork, primary data were obtained from semi-structured interviews and observations. These data were analysed using a framework developed from the existing literature. The strengthening of primary care was considered both as a goal in itself and as a means to improve the Chinese health care system. When considered as a goal in itself, the strength of primary care was broken down into structures and processes, which were then further divided into eight dimensions/features. Under each dimension/feature, the Chinese government’s intentions were described, followed by what the government did and intervention outcomes. The major findings of this study can be summarised as follows. To strengthen primary care, the Chinese government has relied heavily on increasing requirements for public primary care facilities and injecting more subsidies. The government has been successful in increasing the inputs of primary care facilities and meeting its own quantitative targets. Primary care facilities have become more spacious, better equipped and staffed by more people. They have delivered a large quantity of essential public health services free of charge, offered essential medicines at wholesaling prices and provided many medical services at below-cost prices. However, problems also exist. The quantitative targets set by the government are not always well justified. The effectiveness of various government efforts has been compromised by a mismatch between targets and funds, weak monitoring and a poor data foundation, compounded by the fragmented administrative structure. The strengthening of primary care facilities has been further complicated by their competitive relationship with hospitals. In the past 15 years, hospitals expanded rapidly, and the relative market share of primary care facilities dropped. The government has realised that diverting patients from hospitals to primary care facilities requires a more comprehensive approach. More recently, the government has further stepped up its efforts to strengthen primary care. Some promising initiatives have been initiated. However, the problems identified in this study have not yet been fully addressed, and these may continue to pose challenges for the government to achieving its intended goals