sian griffiths presentation part 2 wspcr 2010
TRANSCRIPT
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