Health and health system impacts of China's comprehensive primary health care reforms

Detalhes bibliográficos
Autor(a) principal: Cai, Chang
Data de Publicação: 2023
Outros Autores: Xiong, Shangzhi, Millett, Christopher, Xu, Jin, Tian, Maoyi, Hone, Thomas
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10362/157643
Resumo: © The Author(s) 2023. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.
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spelling Health and health system impacts of China's comprehensive primary health care reformsa systematic reviewSDG 3 - Good Health and Well-being© The Author(s) 2023. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.China's comprehensive primary health care (PHC) reforms since 2009 aimed to deliver accessible, efficient, equitable and high-quality health care services. However, knowledge on the system-wide effectiveness of these reforms is limited. This systematic review synthesizes evidence on the reforms' health and health system impacts. In August 2022, 13 international databases and three Chinese databases were searched for randomised controlled trials, quasi-experimental studies and controlled before-after studies. Included studies assessed large-scale PHC policies since 2009; had a temporal comparator and a control group; and assessed impacts on expenditures, utilisation, care quality, and health outcomes. Study quality was assessed using ROBINS-I and results were synthesized narratively. From 49,174 identified records, 42 studies were included - all with quasi-experimental designs, except for one randomised control trial. Nine studies assessed as at low risk of bias. Only five low to moderate quality studies assessed the comprehensive reforms as a whole and found associated increases in health service utilisation, whilst the other 37 studies examined single-component policies. The National Essential Medicine Policy (N=15) and financing reforms (N=11) were the most studied policies, whilst policies on primary care provision (i.e., family physician policy and the National Essential Public Health Services) were poorly evaluated. The PHC reforms were associated with increased primary care utilisation (N=17) and improved health outcomes in people with non-communicable diseases (N=8). Evidence on healthcare costs was unclear and impacts on patients' financial burden and care quality were understudied. Some studies showed disadvantaged regions and groups accrued greater benefits (N=8). China's comprehensive PHC reforms have made some progress in achieving their policy objectives including increasing primary care utilisation, improving some health outcomes, and reducing health inequalities. However, China's health system remains largely hospital-centric and further PHC strengthening is needed to advance Universal Health Coverage.Centro de Investigação em Saúde Pública (CISP/PHRC)Comprehensive Health Research Centre (CHRC) - Pólo ENSPEscola Nacional de Saúde Pública (ENSP)RUNCai, ChangXiong, ShangzhiMillett, ChristopherXu, JinTian, MaoyiHone, Thomas2023-09-11T22:15:02Z2023-07-282023-07-28T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10362/157643eng0268-1080PURE: 71366144https://doi.org/10.1093/heapol/czad058info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2024-03-11T05:39:56Zoai:run.unl.pt:10362/157643Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T03:56:48.108807Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Health and health system impacts of China's comprehensive primary health care reforms
a systematic review
title Health and health system impacts of China's comprehensive primary health care reforms
spellingShingle Health and health system impacts of China's comprehensive primary health care reforms
Cai, Chang
SDG 3 - Good Health and Well-being
title_short Health and health system impacts of China's comprehensive primary health care reforms
title_full Health and health system impacts of China's comprehensive primary health care reforms
title_fullStr Health and health system impacts of China's comprehensive primary health care reforms
title_full_unstemmed Health and health system impacts of China's comprehensive primary health care reforms
title_sort Health and health system impacts of China's comprehensive primary health care reforms
author Cai, Chang
author_facet Cai, Chang
Xiong, Shangzhi
Millett, Christopher
Xu, Jin
Tian, Maoyi
Hone, Thomas
author_role author
author2 Xiong, Shangzhi
Millett, Christopher
Xu, Jin
Tian, Maoyi
Hone, Thomas
author2_role author
author
author
author
author
dc.contributor.none.fl_str_mv Centro de Investigação em Saúde Pública (CISP/PHRC)
Comprehensive Health Research Centre (CHRC) - Pólo ENSP
Escola Nacional de Saúde Pública (ENSP)
RUN
dc.contributor.author.fl_str_mv Cai, Chang
Xiong, Shangzhi
Millett, Christopher
Xu, Jin
Tian, Maoyi
Hone, Thomas
dc.subject.por.fl_str_mv SDG 3 - Good Health and Well-being
topic SDG 3 - Good Health and Well-being
description © The Author(s) 2023. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.
publishDate 2023
dc.date.none.fl_str_mv 2023-09-11T22:15:02Z
2023-07-28
2023-07-28T00:00:00Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
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status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/10362/157643
url http://hdl.handle.net/10362/157643
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv 0268-1080
PURE: 71366144
https://doi.org/10.1093/heapol/czad058
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