title: Underuse of Primary Care in China: The Scale, Causes, and Solutions.
abstract: Strengthening the primary care system and promoting utilization of primary care are the major targets of China's ambitious health reforms to meet its people's escalating health care needs. However, the changing trend of primary care utilization 4 years before and after 2009, when the health reforms started, is against the government's stated goal. The percentage of outpatient visits in primary care significantly declined from 63% in 2005 to 59% in 2013 (P = .002). In Western China it went down from 66% in 2010 to 62% in 2013 (P = .017) and slightly dropped in Eastern and Central China. Causes are multiple and include major historic and institutional factors such as severe maldistribution of human resources and lack of primary care practitioners (PCPs), lack of a functional gate-keeping mechanism, the low educational attainment of PCPs, and the detrimental elements of health reforms. Immediate measures need to be taken to improve the situation. These include taking irrational hospital expansion under strict control through enhancing the government's accountability for health care industry regulation, strategies to recruit and retain a quality primary care workforce, empowering PCPs as gatekeepers in the system, timely evaluation of the impact of health reforms on primary care, and modifying damaging policies.
authors.affiliation: From the Department of Family Medicine and Primary Care, Faculty of Medicine, The University of Hong Kong, Hong Kong.
authors.forename: Dan
authors.initials: D
authors.lastname: Wu
authors.affiliation: From the Department of Family Medicine and Primary Care, Faculty of Medicine, The University of Hong Kong, Hong Kong. tplam@hku.hk.
authors.forename: Tai Pong
authors.initials: TP
authors.lastname: Lam
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data; D002681:China; D018166:Health Care Reform; D006291:Health Policy / Q000639:trends*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006801:Humans; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D000078329:Workforce
keywords: Access to Health Care; China; Health Care Reform; Primary Health Care