1. Phase 3 :Healthy China
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.
november 3 2010 1

2. 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
Overall objective
Establishing a basic health system covering both urban and rural people, promoting health for all.
Public health Medical service Medical insurance Drug production and
service system system system supply system
Management system
Information system
Monitoring system
Operation system
Human resources
Price forming system
Input system
legislation
Collecting extensively people’s
comments and suggestions on
deepeningnovember 3 2010 and health
medical 3
reform

4. 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
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5. 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)
PHDs TCM
physic
• Public Health and primary care GPs
ians
integrated Multi- Allied
healthcar
skilled e
nurses personnel
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
november 3 2010
document. Dec 29, 2000. Accessed on http://www.moh.gov.cn/publicfiles/business/htmlfiles/mohfybjysqwss/pfybj/200804/18182.htm. 5

6. Community Health Services (CHS)
• Basis of urban public health system & basic medical
services
Treatment
& Referral Rehab
Health Six-in-one Health
Maintenance comprehensive Education
care package1
Family
Prevention
Planning
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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.

7. november 3 2010 7
7

8. Public Health Reforms
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.
§
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9. 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
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10. Hong Kong
november 3 2010 10

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
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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.
november 3 2010 12
(Source: Mercer et al., BMC Public Health 2010)

13. 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
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14. 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
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15. School of Public Health and Primary Care
The Chinese University of Hong Kong
november 3 2010 15

16. The challenges of public health education with a particular
reference 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 at
individuals, 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 care
is where much of clinical medicine and many public health
practices meet, and recognition of this interface is extremely important
for building a seamless framework for improving the health of the
population.
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17. • 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 2008
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18. november 3 2010 18