Health system reform in rural China: Voices of healthworkers and service-users

Underuse of Primary Care in China: The Scale, Causes, and Solutions

“…In addition, because the salary is guaranteed and seeing more patients does not necessarily increase the income, some PCPs lose the motivation to see more patients and shuffle patients to higherlevel facilities. If they are insured and affected by the unavailability of certain drugs, 49 patients may be more likely to bypass primary care to hospitals.…”

Have health human resources become more equal between rural and urban areas after the new reform?

“…However, in China, the basic health facilities are only allowed to use the essential drugs, thus results in the inconsistency of drugs available between tertiary, secondary hospitals and primary health institutions (basic health facilities) because the tertiary and secondary hospitals which are usually located in urban areas are allowed to use essential drugs and also other drugs, further reduces the clinical capacity in the basic health facilities, makes patients move to a big hospital. It also leads to a fall in physician's income (10). Physicians rely on patients to hone their skills, especially for those who have a dream of future career development, thus the essential drugs program has deteriorated the stability of health human resources in basic health facilities.…”

“…This change has also made a negative contribution on clinical services because the total payment budget in a facility cannot be broken and the size of bonus is small, people worked more cannot get more pay. Thus, no one wants to work hard, resulting in a lazy (10). This kind of reform further makes clinician switch to hospitals where they can earn more by better performance.…”

http://www.omicsonline.com/open-access/child-pornography-users--child-contact-offenders-applications-for-law-enforcement-prosecution-and-forensic-mental-health-1522-4821-1000283.php?aid=63682

“…By the end of 2011, medical and healthcare institutions around the country totaled 954,000; licensed doctors (assistants) reached 2,466,000; registered nurses totaled 2,244,000; and the number of hospital beds reached 5160,000 (Information Office of the State Council, 2012). Nevertheless, patient access to healthcare has not increased, and the county-level hospital has become even more crowded (Zhou, Li & Hesketh, 2014). It is believed that the speed of hospital admission in urban cities cannot keep up with the flood of patients from rural areas.…”

“…Moreover, although the organ of authority has transferred from the Ministry of Health to the National Development and Reform Commission, the strongest power group related to Chinese health reform is always the central government. Health workers, especially in rural areas, have little power in the healthcare reforms (Zhou, Li & Hesketh, 2014). Even a benevolent policy may fail.…”