Academic journal article Australian Health Review

Job Satisfaction of Village Doctors during the New Healthcare Reforms in China

Academic journal article Australian Health Review

Job Satisfaction of Village Doctors during the New Healthcare Reforms in China

Article excerpt

Introduction

China is the largest agricultural country in the world.1 Up until 2014, there were 618.66 million people living in rural areas, accounting for 45.2% of the total population. It is therefore critical for the Chinese government to promote rural health services. Since the 1950s, a three-tiered healthcare system in rural areas has been in place, consisting of village clinics, township health centres and county hospitals.2 Initially, village clinics were supported by the village collective economy and village doctors were registered as farmers, who were often barefoot working in the paddy field, rather than public employees. 3 This is why village doctors in China were initially called 'barefoot doctors'. These barefoot doctors provided basic curative and preventive services for villagers and enabled the system to be low cost but high yield.4,5

However, the barefoot doctor system was dismantled as a result of the collapse of the collective economy following China's economic reform in the 1980s. Instead, a user-pays healthcare system was introduced and doctors had to support major village clinics themselves. Doctors became private forprofit practitioners and made their income primarily through the selling of drugs.6 As a result of focusing on economic benefits, disease prevention and public health efforts were continuously ignored because these were considered low-profit activities. Village clinics had insufficient financial support from the village committees and the government to develop and improve clinic services. With low medical skills in the village clinics, the satisfaction of rural residents with the medical services provided fell.1 To tackle these problems, the government decided to improve the medical service at the bottom tier and emphasise the value of village doctors. In the National Health Service System Plan (2015-20, http://www.gov.cn/zhengce/content/ 2015-03/30/content_9560.htm; accessed 11 November 2015.), village doctors were described as the gatekeepers of rural health service systems. According to the 4th China Health Service Survey (http://www.nhfpc.gov.cn/mohbgt/s3582/200902/392 01.shtml; accesed 7 November 2015), 57.3% of rural patients are first diagnosed and treated by village doctors in village health centres. In 2014, there were 1.08 million village doctors working in 648 619 village clinics that accounted for 11.04% of China's total workforce; these clinics serviced 2.01 billion out-patients visits, or 27.51% of the total out-patient visits across the country.7

In 2009, China launched a landmark healthcare reform with the goal of providing affordable and equitable basic health care for all by 2020.8 Faced with growing inequalities between urban and rural areas, the government implemented a series of policies to improve medical services at the village level, which included: (1) funding of 10 000 RMB per clinic for infrastructure and up to 3000 RMB per clinic for new equipment in order to establish a standard clinic in each village; (2) adopting integrated management of villages and towns to strengthen the regulation and guidance for village clinics; (3) implementing the Essential Drugs List (http://www.moh.gov.cn/mohywzc/s3580/201303/f0 1fcc9623284509953620abc2ab189e.shtml;accessed10November 2015) in all village clinics to remove financial incentives to overprescribing; (4) prioritising public health services and providing a public health subsidy to village doctors; (5) implementing a unified charging standard; and (6) improving the training of village doctors. These reform initiatives were centred on controlling fast-growing medical costs and improving the quality of services. Several of these new reform policies affected village doctors' income, training, workload and duties.9

Human force drives health system performance.10,11 Healthcare providers with higher job satisfaction have a more positive attitude within the workplace and have better performance, greater patient satisfaction and improved patient outcomes. …

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