Thursday, 3 January 2013

Community clinics could reduce Beijing hospital overload

80% of patients don't need to be seen in hospital
Zhang Changrong's favorite treatment in a community clinic in Beijing's southern suburb involves soaking her feet in hot water that contains traditional Chinese herbal medicines.
It takes the 59-year-old woman, who has had a rapid heart beat for years, just five minutes to walk from her home to the clinic for the treatment, which is believed to help improve blood circulation.
Compared to big, crowded hospitals, "seeking service here is much easier and sometimes enjoyable," said Zhang, a long-time resident of the Guiyuan Residential Community in Daxing District.
"We don't need to queue up for hours to see doctors. Doctors here know us well and the communication process is nice," she said.
The clinic, which covers some 250 square meters, offers basic medical services such as injections, medical examinations, massage and acupuncture. Patients can get prescriptions for about 300 of the most frequently used medicines for less than what a big hospital would charge.
In China, strain on the doctor-patient relationship has continued to worsen, as many patients are dissatisfied with their poor access to treatment.
People have to wait overnight in long queues for a registration ticket to see a renowned doctor in some popular public hospitals. However, the diagnostic process is always too brief to allow for further consultation.
China's urban doctor-patient ratio was 2.8 doctors per 1,000 people in 2011, according to statistics released by the Ministry of Health.
Meanwhile, doctors are overworked and underpaid. Many work more than 10 hours a day and might examine more than 100 patients per shift, according to a study by Peking University.
Experts say 80 percent of outpatients in the country's big hospitals don't need to have their first diagnosis in big hospitals.
Fang Laiying, head of the Beijing Health Bureau, said people should seek medical treatment from lower-level hospitals and community clinics before swarming into larger hospitals.
"Expanding grassroots medical service institutions is the key to tackling the chronic imbalance in supply and demand," said Liu Jun, professor at the Central University of Finance and Economics.
The grassroots healthcare system began to take shape after the People's Republic of China was founded in 1949. However, following China's transformation from planned economy to market economy, medical resources gradually poured into public hospitals, which saw an excessive number of patients but left lower-level hospitals with insufficient business, according to Liu.
Huang Jiefu, vice minister of health, said the uneven distribution of medical investment, resources and talent causes patients to crowd into larger hospitals.
The Chinese government initiated the reform of medical and healthcare systems in the 1980s. The reform was sped up in 2003 after the country won the fight against SARS, and in March 2009, a new round of reform was launched.
Statistics from the Beijing Health Bureau show that by the end of 2011, there were 9,699 grassroots medical institutions in the city of 12.77 million permanent residents, including 1,744 community-based clinics.
Daxing District has developed a three-tier medical service system comprising a number of prominent public hospitals, 19 community-based medical service centers and 129 subordinate clinics, according to Li Jianguo, vice director of Daxing's community healthcare office, which is affiliated with the health bureau of Daxing District.
"Getting fundamental health services and receiving medical treatment for minor illness at grassroots clinics could effectively alleviate big hospitals' workloads and lead to the improvement of patient satisfaction," said Li.
In addition to meeting residents' basic needs, lower-level medical institutions also offer a helping hand during emergencies.
Doctors with the Yizhuang community healthcare service center in Daxing saved a woman and her twins who were prematurely delivered on the way to the hospital two years ago, according to Zheng Jinjing, vice president of the center.
Doctors quickly set up a makeshift maternity ward in the woman's car, cut the first infant's umbilical cord and then helped with the early delivery of the second baby.
"The mother was unprepared and the situation was critical. A few minutes' delay could have led to unfavorable results," said Zheng.
In addition to regular services, the center has established health archives for contracted residents and provides family-doctor consultation assistance. It has also set up a referral system along with some higher-level hospitals, helping patients with various health conditions find appropriate treatment.
There were about 918,000 grassroots medical service institutions across China by the end of 2011, including 26,000 community-based health centers, 38,000 township-level hospitals and 663,000 village clinics, according to a white paper on the country's medical and health services released on Dec. 26, 2012.
The disparity between urban and rural medical resources has been narrowed in recent years, as the three-tier rural medical service network that covers counties, townships and villages has expanded farmers' access to medical treatment.
The white paper says more than 80.8 percent of rural residents can reach medical institutions within 15 minutes.
However, it is still difficult for farmers in some remote mountainous areas to see a doctor.
In Wumeng Mountain of southwest China's Yunnan Province, villagers have to walk for hours to get to a village-level clinic due to the area's underdeveloped traffic system.
But Chen Jinzheng, a rural doctor, has managed to cut the distance by walking along rough mountain paths to see patients over the past 12 years.
The 42-year-old doctor has treated about 2,100 patients and walked more than 10,000 km of rugged roads, wearing out 50 pairs of shoes.
Many rural doctors like Chen are working hard to address the loopholes in China's rural medical service network, and more farmers have joined a new rural insurance mechanism.
The system, which took shape in the 1990s, was put into pilot operation in selected regions in 2003 to ensure farmers' access to affordable medical treatment and reduce disease-triggered poverty.
By 2011, more than 1.3 billion Chinese people had joined the three basic medical insurance schemes that cover both urban and rural residents, meaning that China has built the world's largest basic medical security network, according to Zhang Mao, vice minister of health.
The Chinese government has announced that it will establish a sound basic medical and health system covering both urban and rural residents by 2020, in order to ensure that everyone can enjoy access to basic medical and health services.
Source: Xinhua

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