Shanghai unveils medical reforms

PUBLISHED : Thursday, 17 March, 2011, 12:00am
UPDATED : Thursday, 17 March, 2011, 12:00am

The Shanghai government has unveiled sweeping reforms of the city's medical system, with the ambitious target of covering 90 per cent of urban and rural residents by the end of next year.

It plans to establish an integrated network linking community health centres with long-term hospital treatment and specialist wards, with a view to reducing the pressure on emergency wards from dealing with minor ailments. The nearest emergency ward is the first port of call for most Shanghai residents - for anything from a cold to a heart attack - making it difficult for health professionals and the authorities to maintain individuals' medical records and consistency in treatment.

A survey by the municipal health bureau found that more than half of the people seeking outpatient treatment at the city's top hospitals had relatively simple conditions, including the common cold or a cough, or were having follow-up treatment for a pre-existing problem, such as high blood pressure.

Under the new plans, 10 of the city's districts are to experiment with registering local residents at community health centres where teams of family doctors - similar to the British system of general practitioners - will be responsible for individual patients' primary health care. Patients would require a reference from their family doctor in order to see a hospital-based specialist.

Three districts - Pudong, Changning and Xuhui - have already introduced pilot schemes for the community-based health network, and the proposals call for it to be extended over the next four to five years.

However, the new system faces an uphill battle against public perceptions. A survey of 3,000 local residents, published in the Shanghai Morning Post yesterday, found just under 60 per cent of respondents avoided community health centres because they felt they provided lower quality health care.

Questions have also been raised about the city's ability to find enough qualified family doctors - each of whom would be responsible for 2,000 to 3,000 patients.

Liu Bao, professor of public health at Fudan University, said the Shanghai reforms could help provide a model for improvements to the national public health system, which was suffering from high medical costs and poor access to medical resources. He said the authorities had been encouraging local residents for several years to visit community health centres when they fell ill but there had been little impact on public attitudes.

'People are not convinced,' Liu said. 'I think the authorities should spend more effort in providing more qualified general practitioners as well as providing a system to ensure patients can be transferred to high-level hospitals smoothly or receive treatment from more senior doctors.'

Liu doubted the city could recruit and train the number of family doctors required for the new system in the time allotted.