Assessing the viability of general practice in China

Thesis

Background: China has had a well-known tradition of primary care, particularly its barefoot doctors in the 1960s and 1970s, and it contributed to the Declaration of Alma-Ata. In 2011 China formally launched a new, ambitious plan of establishing a system of general practitioner (GP) care by 2020; and aims to train 300,000 GPs. My thesis assesses whether this new strategy for general practice is viable.

Methods: I used a systematic approach with a rigorous pre-set protocol to review the government documents at national level in relation to GPs. I undertook a policy implementation study, in Henan Province, using a mixed methods approach. The qualitative element was a thematic analysis of focus group discussions (FGDs) and semi-structured interviews. The quantitative element comprised structured questionnaires. Two rounds of fieldwork generated eight FGDs, seven semistructured interviews, and 1,887 quantitative questionnaires covering medical students, grassroots doctors and GP residents (together called the policy implementation targets [PITs]).

Main findings: The document analysis shows that the Chinese government has made great efforts in GP capacity building. However, the government definition of GPs, based on an idealistic primary care framework, is too broad to be a practical guide to the training and work of GPs. The PITs have some intuitive awareness of the attributes of general practice (comprehensiveness, first contact, continuity and coordination), but often misinterpret what GPs actually do, or base their understanding on their knowledge of the existing hospital-dominated system. Eight factors (such as low income) are identified as deterrents to medical students opting to be GPs. Understandings of what being a GP entails is more likely than the deterrents to influence the students’ decision to become a GP.

Conclusions: China is unlikely to have a GP system by 2020. Pursuing the quantity of GPs on its own is meaningless, as the number depends on how to define GPs. Top priority is to establish clarity about the GP role, which requires rigorously regulating China’s medical pluralism, reversing the dominance of hospital and specialist practice model, and reforming the wider political and social environment in respect of health care.

Authors: Zhu, J

• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: University of Oxford