| Title:
|
Basic public health services delivered in an urban community: a qualitative study |
| Abstract:
|
OBJECTIVES: To understand the advancements in and barriers to the implementation of measures to improve basic public health services in an urban Chinese community. STUDY DESIGN: A qualitative study based on semi-structured interviews. Interviews were audio-taped transcribed and analysed using thematic content analysis. METHODS: In-depth interviews were undertaken with the directors of the management centres for community health services in 15 of the 18 districts in Beijing from December 2008 to February 2009. Content analysis of the data was completed in May 2009. RESULTS: Fifteen types of free basic public health services had been delivered in Beijing. Some were supplied at a low level. An average of 2.38 per person per year was provided for inhabitants since 2008 but demand for funding far exceeded monies available. Teams consisting of general practitioners community nurses and public health specialists delivered these services. The number of practitioners and their low levels of skill were insufficient to provide adequate services for community residents. Respondents gave recommendations of how to resolve the above problems. CONCLUSIONS: In order to improve the delivery of basic public health services it is necessary for Beijing Municipal Government to supply clear and detailed protocols increase funding and increase the number of skilled practitioners in the community health services. |
| Published:
|
2010-12-08 |
| Journal:
|
Public Health |
| DOI:
|
10.1016/j.puhe.2010.09.003 |
| DOI_URL:
|
http://doi.org/10.1016/j.puhe.2010.09.003 |
| Author Name:
|
Zhao Y |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/zhao_y |
| Author Name:
|
Cui S |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/cui_s |
| Author Name:
|
Yang J |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/yang_j |
| Author Name:
|
Wang W |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/wang_w |
| Author Name:
|
Guo A |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/guo_a |
| Author Name:
|
Liu Y |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/liu_y |
| Author Name:
|
Liang W |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/liang_w |
| sha:
|
f4357d296b78d6c3681a1cf5a8896755fa5e381b |
| license:
|
no-cc |
| license_url:
|
[no creative commons license associated] |
| source_x:
|
Elsevier; Medline; PMC |
| source_x_url:
|
https://www.elsevier.com/https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/ |
| pubmed_id:
|
21145087 |
| pubmed_id_url:
|
https://www.ncbi.nlm.nih.gov/pubmed/21145087 |
| pmcid:
|
PMC7118740 |
| pmcid_url:
|
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118740 |
| url:
|
https://www.sciencedirect.com/science/article/pii/S0033350610003185
https://doi.org/10.1016/j.puhe.2010.09.003
https://api.elsevier.com/content/article/pii/S0033350610003185
https://www.ncbi.nlm.nih.gov/pubmed/21145087/ |
| has_full_text:
|
TRUE |
| Keywords Extracted from Text Content:
|
£
u m m
directors
bodies
heart
CHS
People
18À20
people
women
migrants
breast cancer
CDCs
CHS organizations
locales
oral
24,740
residents
funds
persons
centre
Fengtai
MCCHS
CHS centre
alcohol
cervical cancer
directors
tobacco
patients
p u b l i c h e a l t h 1 2 5
participants
£
patient
£4
34,35
£1
body
Chaoyang,
line
children
CHS centres
O. Daniel Smith
r e f e r e n c e
directors
Wang
her |
| Extracted Text Content in Record:
|
First 5000 Characters:China s u m m a r y Objectives: To understand the advancements in and barriers to the implementation of measures to improve basic public health services in an urban Chinese community.
Study design: A qualitative study based on semi-structured interviews. Interviews were audio-taped, transcribed and analysed using thematic content analysis.
Methods: In-depth interviews were undertaken with the directors of the management centres for community health services in 15 of the 18 districts in Beijing
Results: Fifteen types of free basic public health services had been delivered in Beijing.
Some were supplied at a low level. An average of £2.38 per person per year was provided for inhabitants since 2008, but demand for funding far exceeded monies available. Teams consisting of general practitioners, community nurses and public health specialists delivered these services. The number of practitioners and their low levels of skill were insufficient to provide adequate services for community residents. Respondents gave recommendations of how to resolve the above problems.
Conclusions: In order to improve the delivery of basic public health services, it is necessary for Beijing Municipal Government to supply clear and detailed protocols, increase funding and increase the number of skilled practitioners in the community health services.
Supplying free basic public health services (individual-based clinical preventive services and population-based public health services) in community settings is of great significance in improving quality of life and promoting social harmony. Since 2005, the Chinese Government has promulgated a series of documents for developing basic public health services. 1e3 These reports mandated that basic public health services would be funded at all levels of governments and be delivered by the nationwide community health services (CHS) organizations. 4 On 10 April 2009, the Chinese Government released a policy statement which enhanced the reforms of the medical and health systems, and which re-emphasized that governmental bodies will offer equitable access to basic public health services for both urban and rural residents. 3 As the centre of politics, economy and culture of China, Beijing Municipal Government attaches extreme importance to and promotes advances in the development of basic public health services delivered in the community.
Over the past two decades, China has been undergoing a process of economic reform and has been relatively successful. The healthcare system, which had been reformed to suit the market economy, 5 faced multiple challenges: limited financial support from governments; high rates of catastrophic out-of-pocket spending and impoverishment through health expenses; inequalities in health and healthcare utilization; and limited financial protection even among those with insurance (a small minority of the population). 6 Due to the above challenges, the old 'three-tiered' hospital system, which involved local neighbourhood hospitals, district-wide secondary hospitals and city-wide tertiary hospitals, was forced to rely on the sales of new drugs and technologies to boost income, which resulted in expensive and inefficient care and strained patientedoctor relationships. 7 The old public health system was the responsibility of dozens of disparate institutes, centres, agencies, bureaus and departments, which resulted in overlapping and sometimes conflicting mission statements and agency mandates. 8 With an increase in life expectancy, increased burden due to chronic diseases, and the challenges of emerging infectious diseases (e.g. severe acute respiratory syndrome in 2003), the Chinese Government re-examined the public health infrastructure and saw the need for a new public health system to address the many health issues associated with these changes. 5 To minimize overlapping of functions and to increase efficiency, the Chinese Government consolidated existing institutions into a new agency: the Centres for Disease Control and Prevention (CDC). The goal of the CDC is to provide a central public health organization with responsibility for both community and individual health needs. The development of the CDC strengthened the Government's role in public health. 5 As public health and primary care share the common goal of improving the overall health of specific populations, it was decided to integrate the two systems by strengthening public health functions in primary healthcare settings. This approach could improve local public health surveillance and reinforce disease prevention and health promotion. 9 In order to resolve the problems of the increasing burden of healthcare expenses and limited access to health services, the Chinese Government initiated its CHS programme in 1997. 4 The 'threetiered' hospital system was replaced by the current 'twotiered' CHS centre system. The new system consists of ambulatory care in CHS centres and inpatient care in referral hospitals. 7 The |
| Keywords Extracted from PMC Text:
|
cases:"However
persons
bodies
reimbursement.31
doctors.16
people
directors
body
items:"Few
statement,3
skills4
CHS centre
residents
£
MCCHS
countries.16
women
24,740
hospitals.4
Fengtai
protocols18
children's
funds
migrants
elsewhere.23
alcohol
locales
communities:"Certainly
£4
care.21
women's
CHS centres
patients
heart
China.4
transferability.32
's
oral
patient's
CHS
centre
providers.10
district.12
improvements.24
breast cancer
diseases.30
"
line
regimen).30 People
CDCs
participants
...
health care,27
referral:"Childhood
patient
bureaus.10
promotion.9
tobacco
communities.4
£1
approach3
cervical cancer |
| Extracted PMC Text Content in Record:
|
First 5000 Characters:Supplying free basic public health services (individual-based clinical preventive services and population-based public health services) in community settings is of great significance in improving quality of life and promoting social harmony. Since 2005, the Chinese Government has promulgated a series of documents for developing basic public health services.1, 2, 3 These reports mandated that basic public health services would be funded at all levels of governments and be delivered by the nationwide community health services (CHS) organizations.4 On 10 April 2009, the Chinese Government released a policy statement which enhanced the reforms of the medical and health systems, and which re-emphasized that governmental bodies will offer equitable access to basic public health services for both urban and rural residents.3 As the centre of politics, economy and culture of China, Beijing Municipal Government attaches extreme importance to and promotes advances in the development of basic public health services delivered in the community.
Over the past two decades, China has been undergoing a process of economic reform and has been relatively successful. The healthcare system, which had been reformed to suit the market economy,5 faced multiple challenges: limited financial support from governments; high rates of catastrophic out-of-pocket spending and impoverishment through health expenses; inequalities in health and healthcare utilization; and limited financial protection even among those with insurance (a small minority of the population).6 Due to the above challenges, the old 'three-tiered' hospital system, which involved local neighbourhood hospitals, district-wide secondary hospitals and city-wide tertiary hospitals, was forced to rely on the sales of new drugs and technologies to boost income, which resulted in expensive and inefficient care and strained patient–doctor relationships.7 The old public health system was the responsibility of dozens of disparate institutes, centres, agencies, bureaus and departments, which resulted in overlapping and sometimes conflicting mission statements and agency mandates.8 With an increase in life expectancy, increased burden due to chronic diseases, and the challenges of emerging infectious diseases (e.g. severe acute respiratory syndrome in 2003), the Chinese Government re-examined the public health infrastructure and saw the need for a new public health system to address the many health issues associated with these changes.5 To minimize overlapping of functions and to increase efficiency, the Chinese Government consolidated existing institutions into a new agency: the Centres for Disease Control and Prevention (CDC). The goal of the CDC is to provide a central public health organization with responsibility for both community and individual health needs. The development of the CDC strengthened the Government's role in public health.5 As public health and primary care share the common goal of improving the overall health of specific populations, it was decided to integrate the two systems by strengthening public health functions in primary healthcare settings. This approach could improve local public health surveillance and reinforce disease prevention and health promotion.9 In order to resolve the problems of the increasing burden of healthcare expenses and limited access to health services, the Chinese Government initiated its CHS programme in 1997.4 The 'three-tiered' hospital system was replaced by the current 'two-tiered' CHS centre system. The new system consists of ambulatory care in CHS centres and inpatient care in referral hospitals.7 The main roles of the CHS centres are to provide high-quality, affordable, accessible primary health care and public health services to community residents.
The scope of services of the CHS centres is described symbolically by the Chinese Government as 'one body, six aspects'. The body is the CHS centre. The six aspects consist of basic clinical services, prevention, health education, women and children's care, elderly care, immunizations and physical rehabilitation.7 The centres integrate Western and traditional Chinese medicine. In the population-based public health services, there is collaboration between the community health centres and the local CDC.7 Local governments are the main sources of funding for the local CDC and CHS centres. The core providers in the CHS centres are general practitioners (family doctors),10, 11 public health specialists and community nurses. These practitioners are responsible for the provision of basic clinical services and for maintaining the wellness of the residents, of all ages, in their communities.4
In China, a general practitioner is a medical practitioner with recognized general training, experience and skills, who provides and co-ordinates comprehensive medical care for individuals, families and communities.10, 11 Two models are currently being used to train general practitioners in China. |
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