Monday, 28 April 2014

Why are GP community clinics unpopular in China?

by Michael Woodhead
A recent article about medical services in Shanghai noted that hospital clinics were severely overworked, with patients facing hours in the waiting room to see a doctor for just a few minutes. In contrast, the nearby community clinic was very quiet, with doctors there underemployed. Now an article has been published claiming that community clinics are underused because they are inefficient and the doctors there lack the expertise of hospital medical staff. According to columnist Xin Ya, community clinics need competition from private clinics to lift their game. The writer says the old state service model on which community clinics are based means they provide only the most basic medical facilities and the service levels are poor - due to the unmotivated 'iron rice bowl' mentality of the staff.
Public community clinics in China are characterised as 'gatekeepers' but the writer says the offer little benefit to patients as they stock only the most basic drugs (due to their non-profit model) and they lack investment in equipment. The doctors are unmotivated because they are on a fixed salary and get paid the same regardless of results, with no performance targets or bonuses.
According to the columnist, a recent visit to the gatekeeper provide frustrating because they did not even have the basic equipment such as needles and sample test tubes to collect blood, and so a prson requiring tests had to go to the hospital to get a full examination.
The author say the government should remove the restrictions on private clinics setting up in competition to the current network of community clinics. In this way, 'the survival of the fittest' will occur as privately-invested clinics will have a motive to offer better services and better facilities to win patients. The government also needs to remove restrictions on doctor's employment contracts to allow hospital doctors to provide community clinic services and earn larger salaries there.
"In the future, private clinics should be as free as the restaurant competition ... and let the market decide who can survive," the article says.
"For community clinics, public sector and private medical institutions are like 'the lion and the antelope' - the establishment of a competitive community "gatekeepers" system, will improve the overall quality of medical care for residents, and allow them to enjoy affordable and quality services."

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