Do you find it overwhelming to see a doctor in China? If so, that’s quite normal. Standing in long lines in crowded hospital lobbies; feeling uncomfortable sharing your health concerns with a doctor while other patients hover over you; feeling uncertain about a physician’s quick diagnosis and treatment plan. It’s also easy to get confused with payment and reimbursement from your insurance.
At least that was my memory of navigating the Chinese health system years ago. However, this year when I came back to Shenzhen, while taking care of my father, I discovered a shining gem in the emerging Chinese community health system.
If you live in Shenzhen and need low cost (or free) and convenient care for chronic diseases such as high blood pressure, diabetes, or need an annual physical exam, pre- and postnatal care, vaccination, routine testing, wound care, or an IV infusion, you are in luck! You may sign up for a family doctor for free.
Based on Shenzhen Family Physician Service Regulations (Trial) published on November 7, 2017, family doctors are primary care physicians who provide comprehensive, continuous, coordinated and individualized care to the community. This is team-based care provided by a team of physicians and nurses. The care team may include public health providers, specialists, pharmacists, mental health providers, nutritionists, physiatrists, volunteers, and community health professionals. When a patient establishes care with a family physician and signs a contract, the following extensive menu of care is completely free – subsidized by the government. There are now over 600 community health centers in Shenzhen and the goal of the network is for each resident to access a community health center within 5 kilometers of their residence. Since 2014, the Shenzhen government has invested over RMB1 billion in building the network of community health centers 社区健康服务中心 (CHC).
Inside a CHC. Image via Xiaoyan Huang
Thrilled to learn about this development, I signed my father up with a family doctor. For elderly or disabled patients who have trouble getting to the clinic, one can even pay RMB100 to sign up for a ‘hospital at home’ service for six months. One can then pay a nominal fee for a home-visiting nurse to deliver home care. Additional services at select CHC also include specialty clinics.
CHC often contracts with local tertiary hospitals to have visiting specialists run cardiology or diabetes clinic, in order to attract patients to their centers. As an American cardiologist interested in population management and health policy, I spent a couple of afternoons at various CHCs, following a couple of specialists to observe clinic operations. Further, I wanted to try out our neighborhood CHC and experience the care first hand. Because I am not a resident, I was not eligible to sign up for a family physician. Still, I was able to see a doctor at the CHC just steps from my father’s apartment for RMB10 for a routine visit without an appointment. I paid RMB18 for three prescriptions and achieved a complete cure for my minor ailment. I also requested some lab tests done and for RMB130, I had blood drawn and several tests ran. Everything went very smoothly with minimal wait, no advanced scheduling needed. During COVID times, these CHC also provide COVID testing for a fee and have started giving vaccinations to high-risk populations.
You may wonder why the Chinese government would invest so many resources in building the CHC network? With urbanization and an aging population, cardiovascular disease has become the leading cause of death in China. In an effort to shift the focus from delivering expensive treatment after the disease has occurred to providing health to the population, the Chinese government clearly has recognized the importance of prevention, risk reduction and chronic disease management.
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To take advantage of the services provided by your neighborhood CHC, bring your ID card (or passport) and try it out! For urgent care issues, one will still need to call an ambulance by dialing 120 or go to the closest emergency room in a hospital.
Free services covered at community health centers:
Establish Health Records
Target population: Permanent residents or long-term visitors with over six months’ stay
Services provided: Establish and manage health records
Free Birth Control
For foreigners, as long as you have a local phone number, you can scan a QR code at the CHC and pay RMB10 to access this service.
Provide Health Education
Target population: Permanent residents
Services provided: Health education, public health counseling, health information workshop, individualized health education
Vaccination
Target population: Children up to six years old and other targeted population
Services provided: Vaccination and management of potential complications
Pediatric Care
Target population: Resident children up to six years old
Services provided: Newborn home visit, care for newborns during the first month, neonatal and pre-school health management
Obstetrics Care
Target population: Resident pregnant women
Services provided: First, second and third-trimester perinatal care, post-partum home visit, 42-day post-partum exam
Geriatric Care
Target population: Resident 65 years old and above
Services provided: Lifestyle and health assessment, annual physical exam, routine testing, health counseling
Chronic Disease Management
Hypertension:
Target population: Resident 35 years old or above with primary hypertension
Services provided: Screening, diagnosis, follow-up and intervention, routine physical exam
Type II diabetes:
Target population: Resident 35 years old or above with type II diabetes
Services provided: Screening, diagnosis, follow-up and intervention, routine physical exam
Mental Health Management
Target population: Residents with severe mental health conditions
Services provided: Patient information management, follow-up and intervention, routine physical exam
Tuberculosis Management
Target population: Residents with tuberculosis
Services provided: Screening and referral, first home visit, medication compliance management, treatment completion assessment
Chinese Traditional Medicine Services
Target population: Residents 65 years old and above and children up to 36 months old
Services provided: Elder care, pediatric care
Infectious Disease and Epidemic Management
Target population: Residents
Services provided: Infectious disease and epidemic risk management, case discovery and registration, information reporting and disease management
Public Health Management
Target population: Residents
Services provided: Food-related illness, drinking water safety, school public health services, illegal health practice and illegal blood management, family planning management
Public Health Education
Rural health advancement, public health education, smoking cessation, health counseling hotline, targeted disease, area and population health education
Dr. Xiaoyan Huang is an American cardiologist and medical director of general cardiology at Providence Heart Institute in Portland, Oregon. Dr. Huang graduated from Yale College and Stanford Medical School and holds a Master’s degree in Health Care Management from the Harvard T. H. Chan School of Public Health.
[Cover image via Xiaoyan Huang]
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