The Quality of Primary Care in Rural China

Collaborators: Zhou Huan, Zhou Chengchao, Xue Hao, Jishnu Das, Madhukar Pai, Scott Rozelle, Hongmei Yi

In recent years, China has set about wide-raning reforms of the health system. The goal of this project is to provide evidence on the nature of primary care in rural areas to inform this effort.

Key findings:

• The quality of primary care available in rural areas is poor, particulalry in lower-level village clinics

• These quality deficits are due both to low leveles of medical knowledge among rural clinicians and the relatively weak incentives they face to provide high-quality care.

• Rural clinicians also face distorted incentives to provide unecessary care, such as antibiotics for viral infections

• Rural clinicians have low demand for in-service training

• Classroom-based training sessions have only small effects on clinician knowledge of approraite diagnostic and therapeutic procedures, and have no effect on actual practice in treating patients

• In public health facilities, physicians employed as permanent employees (civil servants) vastly underperform those hired on fixed-term contracts