Elderly healthcare service at the community health centers in the Pearl River Delta region,China

Objective:The recent population census showed China had officially become a graying society.In the meantime,China also faces a growing burden of non-communicable diseases.Since 2009,a series of policies have been implemented to enhance primary care at the community level.This study describes the elderly care services provided in the differently organized community health centers(CHCs).Methods:It covered 13 CHCs of six cities located within the Pearl River Delta(PRD)region.In-depth interviews were conducted with a total of 59 health administrators,CHC managers,and CHC doctors regarding elderly care.Results:The study found that accessibility of healthcare for elders has been improved due to the development of health insurance schemes as well as preferential policy to encourage the CHC utilization by the elderly.All the CHCs provide health examinations and chronic disease management to the permanent elderly within their catchment district.However,some preventative care such as fall prevention,immunization and mental health management are not provided.Conclusion:Key barriers include low capacity of health service providers in the CHCs,and a lack of government investment in CHCs.Our report provides an empirical evidence for the health care reform in China.

Efficiency of community health centers in China during 2013-2015:A synchronic and diachronic study

Objective:We aimed to explore the efficiency of community health centers(CHCs)in China from 2013 to 2015,providing policy suggestions for optimizing the allocation of health resources.Methods:Data on the efficiency of CHCs in 30 provinces/autonomous regions/municipalities in China's Mainland(except Tibet)from 2013 to 2015 were collected from China’s Health and Family Planning Statistical Yearbook 2014,China’s Health and Family Planning Statistical Yearbook 2015,and China’s Health and Family Planning Statistical Yearbook 2016.Data envelopment analysis and Malmquist index analysis were performed to investigate the efficiency of sampled CHCs during this period at the national level and the regional level.The applied input indicators include the numbers of CHCs,community health workers,and beds,and the output indicators consist of the numbers of visits and inpatients,the occupancy rate of beds,and the average length of stay.Results:In 2015,the average annual overall technical efficiency,pure technical efficiency,and scale efficiency of CHCs in 30 regions at the national level were 0.715,0.705,and 0.972,respectively.Eight regions(Guangdong,Guizhou,Hainan,Ningxia,Qinghai,Shanghai,Zhejiang,and Chongqing,accounting for 26.7%of the total)had efficient CHCs with overall technical ef-ficiency of 1.000,and the other 22 regions had surpluses of 131 CHCs,5573 community health workers,and 2086 beds on average.In 2015,the average annual technical change index,pure technical efficiency change index,total factor productivity,technical efficiency change index,and scale efficiency change index of CHCs at the national level were 1.034,1.002,1.024,0.990,and 0.988,respectively.Compared with 2013,the former three increased by 3.4%,0.2%,and 2.4%,respectively,while the latter two decreased by 1.0%and 1.2%,respectively.Conclusion:On the whole,efficiency improvements of CHCs were achieved at the national level from 2013 to 2015,but with obvious interregional differences.In regions with inefficient CHCs identified by data envelopment analysis,there was a problem of coexistence of shortage and wastage of community health resources.In view of this,targeted measures should be taken to optimize the allocation of community health resources,and the management of CHCs should be strengthened to improve the efficiency of these institutions.

Integration of traditional Chinese medicine and Western medicine in a Chinese community health center

Objective:Although the literature is abundant on traditional Chinese medicine(TCM)in the West,there is limited information on how TCM is integrated with Western medicine(WM).We describe how one Chinese Community Health Service(CHS)system located in Beijing integrates WM and TCM.Methods:Our information is based on the authors’observations,interviews with center TCM practitioners,and discussions with center administrators.Results:We summarize our observations according to the following themes:selection of type of practitioner;frequent diagnoses of patients seen by TCM clinicians;types of TCM ser-vices provided;economic factors;challenges;and future directions.Patient age,nature of the problem,and cost may determine whether or not Chinese patients initially consult TCM or WM practitioners.Because of referral pathways between the WM and TCM practitioners,up to one-third of the patients receive integrated care.TCM physicians see more patients per day than do their WM counterparts;TCM physicians also earn higher salaries.Although there are clearly close collaborative relationships between the TCM and WM practitioners,a few TCM providers report that lack of respect between the two fields may be a barrier towards further integration.Conclusion:Given governmental policies and the cost differentials between WM and TCM,the future for the integration of the two medical traditions within the CHS system appears to be favorable;however,issues of mutual respect and workforce issues may challenge success-ful integration.Our impressions are limited by the fact that we observed practices in only one community in one district of Beijing.