Sian Griffiths presentation part 2 WSPCR 2010


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Sian Griffiths presentation part 2 WSPCR 2010

  1. 1. Phase 3 :Healthy ChinaThe overall objective is to establish a basichealth care system covering both rural andurban people, as well as to provide safe,effective, convenient and affordable healthservices to all people. november 3 2010 1
  2. 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. 3. New health system reform plan: one building, four girders and eight pillars Overall objectiveEstablishing 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. 4 systems for establishing a basic universal healthcaresystem:§ Public health services including primary care§ Medical services including primary care§ Health insurance to cover primary care§ Medicine supply system to cover primary care november 3 2010 4
  5. 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 “? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ”. 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 5
  6. 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 november 3 2010 6 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
  7. 7. november 3 2010 7 7
  8. 8. Public Health ReformsStrengthening the establishment of the public healthservice 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.§ november 3 2010 8
  9. 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 november 3 2010 9
  10. 10. Hong Kong november 3 2010 10
  11. 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 november 3 2010 11
  12. 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. 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 november 3 2010 13
  14. 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 november 3 2010 14
  15. 15. School of Public Health and Primary Care The Chinese University of Hong Kong november 3 2010 15
  16. 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. Fuin many countries,traditional public health methods targeted atindividuals, such as vaccination and child and maternal care, have been successfully relocated into the clinical sector,most often primary care or general practice. Such individualpublic health approaches to prevention are too important to be neglected.Although, in essence an individual approach, primary careis where much of clinical medicine and many public healthpractices meet, and recognition of this interface is extremely important for building a seamless framework for improving the health of the population. november 3 2010 16
  17. 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 november 3 2010 17
  18. 18. november 3 2010 18