Saturday, 24 November 2012

China's hospital-centred health system impairs diabetes control

Diabetes screening, monitoring and follow up are best done through community care

China has a huge diabetes problem but its hospital-centered medical care system undermines effective intervention in the rapidly rising chronic disease, a top specialist says.
"In addition to funding, the government should greatly improve its primary care capacity to better care for the multitude of diabetes and other chronic disease patients," Ji Linong, president of the Chinese Diabetes Society, under the Chinese Medical Association, said in Beijing.
On Nov 16, members of the World Health Organization agreed for the first time to set global targets for the discovery and treatment of non-communicable diseases like diabetes.
According to the Ministry of Health, the Chinese mainland is estimated to have more than 92 million diabetics, or 6.8 percent of the population, the highest proportion in the world. Sixty percent of Chinese diabetics remain undiagnosed, owing to low public awareness and limited medical resources, especially at grassroots level.
Without efficient intervention, the mainland will have 40 million more patients by 2030, according to the International Diabetes Federation.
"That would further burden the already strained medical system in the country, multiplying the medical costs and affecting public health and the nation's development," said Ji, who is also vice-president of the federation.
The Chinese medical system has long been better at dealing with acute serious diseases like infectious outbreaks, but it remains at a fledgling stage of chronic disease care, which requires long-term surveillance, early screening programs and follow-up services outside hospitals, he said.
"That can't be handled by large hospitals alone."
Experts say people with chronic diseases, such as diabetes, receive treatment mostly in their homes, so community medical institutions should play a greater role in disease intervention.
According to the Chinese Diabetes Society, less than 50 percent of diabetics being treated in China have their blood-sugar levels under control, and more than 60 percent develop various complications, such as foot and eye problems, a far higher rate than the international average.
"That greatly impairs their quality of life and increases the economic burden," Ji said, adding that about 80 percent of diabetes treatment costs in China are caused by complications.
Despite ample drug supplies and improved insurance coverage, "we need a quality system and primary care providers supplementing large hospitals to support sustainable diabetes care", he said.
In most developed countries, family doctors provide diabetes care.
"China is making efforts toward that, but right now most of the grassroots medical workers are not competent enough," he said.
He urged the government to introduce more doctor-training programs amid efforts to construct networks for diabetes prevention and treatment.
"That will also help with early detection," he said.
Most diabetes cases are discovered during routine physical examinations, and rural residents have a higher risk of late diagnosis and treatment, he said.
To address that, the Ministry of Health has integrated basic diabetes care and early screening into the national package of public health services, particularly in rural areas.
"But we need a long-term plan for government diabetes intervention, which will help ensure sustained investment and doctor training," Ji said.
Read more: Xinhua

1 comment:

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