Primary care in China

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Talking with my host, Dr. Meng, and the other faculty at the 2nd Hospital of Hebei Medical University in Shijiazhuang City and the Airbnb hosts I'm staying with in Beijing, a big realization about healthcare in China emerged: Primary care is nearly non-existent. Most people seek medical attention, even for relatively minor concerns such as colds and scrapes, at hospitals instead of seeing a community provider. As you can imagine, this can drastically overload hospital capacity quickly and makes care access and delivery inefficient.

Medical access being primarily hospital-based also creates the problem of misappropriation of resources. Patients often self-diagnose in order to book an appointment at a hospital clinic with a specialist in a specific department, such as cardiology or endocrinology, only to find that they misdiagnosed their problem, visiting the wrong kind of specialist, and must either be referred on to rebook with somebody else. This system is inefficient for patients and providers, as patients do not receive timely and appropriate care, and providers end up seeing a many patients outside their scope of practice that they must refer elsewhere.

Lack of primary care presents longer-term challenges as well for patients with chronic or complex diseases. These patients have nowhere to turn for ongoing management of conditions such as hypertension, diabetes, or even regular screenings for progression or prevention of disease. The difficulties are even greater in rural communities that may not have nearby access to hospitals or specialists and must spend inordinate amount of time or resources traveling to find the appropriate hospital and specialist for their care on a temporary or recurrent basis. Telehealth cannot reach China soon enough to support expanded services to both rural and urban communities beyond the 4 walls of a hospital setting.

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