Low salaries and high patient numbers are causing physicians to shy away from the program, as Wang Xiaodong reports.
Parents bring their children to see their general practitioners at Xiluoyuan Community Health Service Center in Fengtai district, Beijing. (WANG ZHUANGFEI / CHINA DAILY)
Despite recent improvements to the medical cover provided by general practitioners in China, the family doctor service is still in its infancy and will require regular improvements to meet expectations, the top health authority has said.
By the end of last month, GPs had signed treatment contracts with more than 500 million people, accounting for more than 35 percent of the population, according to Liu Liqun, an official for grassroots health at the National Health and Family Planning Commission, speaking at a conference in Beijing on Dec 17.
"However, we need to continue to make efforts to promote the service because the coverage provided by GPs has not received the recognition it deserves, and services lag far behind those in developed countries," he said.
We need to continue to make efforts to promote the service because the coverage provided by GPs has not received the recognition it deserves, and services lag far behind those in developed countries
In the days following the announcement, the figure was met with disbelief by many members of the public, who said they were not aware of family doctor services in their areas.
In response, the commission said family doctors are not private practitioners who provide services to individual patients. Instead, they work in partnership with other medical professionals to provide services to entire communities.
A shortage of GPs means they have to focus on providing services to key groups, including seniors, pregnant women, children and people with disabilities or chronic illnesses.
Speaking at a media briefing on Friday, Song Shuli, a commission spokeswoman, said most GPs work at the grassroots, such as community clinics and hospitals, and village health centers. Some are retired physicians from large hospitals. They act as "health gatekeepers" and primarily treat residents who have signed contracts with them.
"They are obliged to begin providing services as soon as the contract has been signed," she said.
Many areas have taken steps to promote the family doctor service, including providing subsidies to grassroots medical institutions based on the number of people who have signed service contracts with local GPs.
However, one GP, who asked not to be identified, told China Daily that in some areas a shortage of family doctors means many people who have signed up for the service do not have access to a GP, and also claimed that some regional health authorities have exaggerated the number of people who have signed contracts as a means of receiving more subsidies and funding.
In recent years, China has promoted GP services, and in 2010, Beijing was one of the first cities to launch a pilot. The program is expected to help solve problems such as the soaring medical expenditure caused by the rising incidence of chronic illnesses and the imbalance in the distribution of medical resources, which are usually concentrated in big hospitals.
A patient at the center uses a health monitor which is provided free of charge.
According to a guideline released by six central government departments last year, the contracted family doctor service is expected to cover the entire population and provide long-term, stable services, including basic care, public health provision and health management advice.
People can attend community health centers to register and sign yearly service contracts with a GP group, which usually consists of at least one general practitioner and a nurse. All members of a family are encouraged to sign contracts with the same GP group.
Those who sign up for the service enjoy advantages such as being eligible to receive a larger number of drugs on each prescription, priority referral to tertiary hospitals, higher medical bill reimbursement and home visits by GPs.
Patients pay a set fee every year after signing their contract. The fee, which varies according to their home area, is never more than a few hundred yuan, and is usually partially or fully offset by a government subsidy. In Beijing, the subsidy covers the full annual cost.
Liu Dan, a GP at the Xiluoyuan Community Health Service Center in Beijing's Fengtai district, said family doctors offer residents many advantages compared with specialist physicians at large hospitals.
"We know almost all the patients we receive and are familiar with their conditions, which helps us to provide continuous health management," she said. "We place greater focus on the entire family rather than individuals."
One of Liu's patients is a 70-something woman who, despite diabetes and difficulty moving, always attends the surgery on her own. When Liu asked why, the patient said her husband has had a stroke and is unable to move.
At Liu's suggestion, the patient registered her husband with a home-based senior healthcare program in the community. The program provides basic services, such as checkups and nursing care, at home.
According to Wu Haitao, the center's director, the service, which is unique in Beijing, is aimed at seniors with special difficulties, such as the partially disabled and people living on their own, who have signed up for GP services to ensure regular health management and medical care.
By Monday, 155 seniors in the community were covered by the service, which is provided by more than 50 medical professionals from the center, he said.
About 19,000 people in Xiluoyuan, which has a population of 86,000, had signed GP contracts by the same date, he added.
"Most of them are age 60 or older and they have chronic illnesses," he said.
Liu, the GP, said the family doctor service has become increasingly popular in recent years, with about 500 patients visiting the center every day, compared with about 30 in 2010.
"After being reimbursed by the basic medical insurance program, the consultation fee is just 1 yuan (15 cents) per visit, which is far cheaper than in tertiary hospitals, but it is free for people age 60 and older," she said.
In addition, as a result of medical reform in Beijing which started in April, community hospitals can now purchase and prescribe almost every medication available in large hospitals.
That has brought greater convenience and raised the popularity of community hospitals and health centers, she said.
Chen Baofeng, a 55-year-old resident of Xiguan community in Beijing's suburban Changping district, has high blood pressure.
She said the doctors at the community health center pay great attention to patients and, unlike specialist physicians at large urban hospitals, they are willing to spend time talking with them.
"I would have to drive to a big hospital, and the complex prescription procedures mean it would take at least three hours to collect my medication," she said. "But I can collect the drugs in just 10 minutes at the local health center."
Chen is also able to collect medication for her 87-year-old mother-in-law, who has diabetes and a chronic heart condition, sparing the elderly lady the need to leave home.
"My doctor knows my mother-in-law, and I can also ask him to visit our house and provide treatment or infusions for her," she said.
Patients wait to see family doctors at the center.
According to Wu, from Xiluoyuan Community Health Service Center, the biggest challenge to promoting family doctor services is a lack of GPs at the grassroots.
The community of 86,000 is served by just 28 family doctors, which means it is impossible to provide care for every resident, he said, adding that more government investment is required to effectively promote and improve the service.
"Our pharmacy is too small to store enough types of drugs, which results in chronic shortages of medication," he said. "We are considering cooperating with logistics companies so they can deliver drugs in the quantities we need."
In addition, policy restrictions mean the salaries of community doctors are usually fixed and much lower than those of practitioners in large hospitals, and they are not related to workload, which has resulted in a constant drain of talent, he said.
"I've heard that general doctors at Beijing's tertiary hospitals receive an average annual salary of 250,000 yuan, but at our health center it's only about 100,000 yuan, even though our doctors have the same qualifications as those in big hospitals," Wu said.
Liu Zhiwen, director of Xiguan Community Health Center, said the clinic has just four doctors to treat a population of 22,000.
"In addition, half of our patients come from other communities, so our doctors are constantly busy every day. It's difficult to provide an adequate service," he said.
As the promotion of family doctor services is expected to result in more patients attending community medical centers, the shortage of talent will become more severe in the coming years, he added.
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