Intended for healthcare professionals


Training sufficient and adequate general practitioners for universal health coverage in China

BMJ 2018; 362 doi: (Published 26 July 2018) Cite this as: BMJ 2018;362:k3128
  1. Yat-Hung Tam, clinical assistant professor,
  2. June Y Y Leung, clinical assistant professor,
  3. Michael Y Ni, clinical assistant professor,
  4. Dennis K M Ip, clinical associate professor,
  5. Gabriel M Leung, chair professor of public health medicine
  1. School of Public Health, University of Hong Kong, Hong Kong SAR, China
  1. Correspondence to: J Y Y Leung leungjy{at}

As China moves to expand primary healthcare services as part of its efforts to achieve universal health coverage, June Leung and colleagues discuss the challenges in recruiting, training, and keeping general practitioners

China introduced national health system reforms in 2009 with the aim of achieving universal health coverage by 2020, and to address growing inequalities in access to healthcare across urban and rural areas.12 Strengthening primary healthcare is considered essential for universal health coverage, which is a key target of sustainable development goal 3 (SDG3) as it provides financial protection against catastrophic healthcare expenses and ensures accessibility to necessary health services.3

The reforms have achieved substantial progress in service delivery, including nearly universal insurance coverage.2 However, China now faces rapidly rising health needs associated with population ageing, with chronic diseases already accounting for over 80% of all deaths.4 China’s health system also remains hospital centric, resulting in spiralling health expenditure.4Figure 1 summarises how a shift to primary healthcare could help achieve universal coverage and meet health needs, specifically by emphasising disease prevention and a person centred approach.5 Through gatekeeping, primary healthcare also has the potential to achieve long term health savings equivalent to 3% of gross domestic product.4

Fig 1

How strengthening primary healthcare can help meet China’s health needs

Growing the primary care workforce

China is the world’s largest producer of medical graduates yet faces a critical shortage of qualified general practitioners (GPs), particularly in rural areas.67 In cities, primary care is mostly provided by licensed doctors at community health centres and hospitals; in rural areas, many practitioners at township or village clinics resemble “barefoot doctors” with less formal training.6

Higher education reforms in the 1990s boosted the quality of schools and increased student enrolment.6 Nevertheless, the medical education system has since developed …

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