1. Teach the Teachers in Primary Care of Universal Health Care System in China
Karen W. R. Lin, MD, MS
Assistant Dean, Global Health
Associate Professor, Family Medicine and Community Health
Rutgers Robert Wood Johnson Medical School

2. Activity Disclaimer ACTIVITY DISCLAIMER
It is the policy of the AAFP that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflicts of interest (COI), and if identified, conflicts are resolved prior to confirmation of participation. Only those participants who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity.
[list all presenters and authors ] have indicated they have no relevant financial relationships to disclose.

3. Goals and Objectives The participants will be able to:
Review the history and politics of medical reforms in past 60 years in China
Examine the attitudes and obstacles of leaders of institutions towards 2014 Reform
Identify the opportunities of “Teach the Teachers” in the 12th five-year implantation plan

4. Opportunities Government commitments Institutional commitments
Individual commitments
International MOUs
Funding steering the priorities
Perception and acceptance range widely
Collaboration with WONCA, WHO and other programs in US.
Government’s policy
Institutional commitment
Individual commitment
Ranking is important to universities in China
Help their ranking by how many international MOU signed, international studies
Harvard, JH, Mass General, Mayo Clinic

5. Training primary care physicians
300,000 primary care physicians by 2020
60 physicians are trained in each center
600 physicians in 10 years per center
300,000 physicians in 500 basic training centers/10 yrs.
RMB$ 1,000,000 per basic training center
RMB$ 3,500, 000 per clinical training center
Total of RMB$180,000,000 investment
12th 5-year Plan- started in April 2015
2020年, 30 萬合格全科醫師,
500 clinical training centers for 10 years, will train 600 physicians. 臨床培訓基地, 10年培養 600 名, basic training centers
600x 500 = 300,000 名
3 basic training centers with one clinical training center
3 x500 = 1500 社區衞生服務員中心, 鄉鎮衞生院和疾病控制中心
基層實踐基地基本建設 100萬元, 臨床培訓基地基本建設3500萬元, 總共 180 億投資

6. Healthcare Reforms
1948
Government provided basic services, barefoot doctors
1980
Town clinic, contract responsibility system
1990
Medical marketing, specialty care / wards
1999
General practitioner training
2000
Healthcare Reform
醫改大事記
1948 醫療政府制, 人人享有初級醫療服務, 赤腳醫生
1980鄕鎮衛生所 - 承包責任制
1990醫療市場化, 以工助醫, 以副補主, 點名手術, 特殊護理, 特殊病房
1999鄉鎮民 7% 有保險, 醫院, 醫生, 護士以營利為主,
病人對醫生有了疏離感
衞生部:全科醫師規範化培訓試行辨法
2000國企改革: 宿遷醫改, 海城醫改

7. Healthcare Reforms 2002 State Council:
New rural cooperative medical care system
2003
SARS – severe deficit was recognized
2006
New Reform
12 General Practitioners standardized training bases identified
2007
WHO contact
政府派 vs. 市場派
2002 國務院召開全國農村衛生工作会議 , 國務院: 主導建立新型農村合作醫療制度和醫療救助制度
2003SARS - 中國醫療衞生體系有重大缺陷
6598 億元, GDP 5.6%
2005 市場化非医改的方向, 國務院報告: 中國醫改從總體上講是不成功的 –
2006
新一輪 醫改: 成立 醫改協調小組
衛生部: 全科醫師規範化培訓試點基地 (12 )
2007 委託北京大學,世界衞生組織等機構提交方案
2008 委託北京大學,世界衞生組織等機構提交方案

8. Health Care Reforms 2009 Healthcare reform 2010
Ministry of Health:16 public hospitals for reform
2011
State Council:
proposed 2 GP /10,000 people = 300,000 GPs
2012
State Council: Healthcare Reform
GP Standardized Training
Access problem – expensive public hospitals
2014
Identified one city per province for public hospital reform
2009 政府主草導, 市場微觀主體發揮空間
2010衞生部: 16 個公立医院改革試奌城市
2011國務院 : 村衛生室納入基本藥物制度範疇
“建立全科醫生制度的指導意見”, 2 /10,000 人民 = 30 萬 全科醫生
2012國務院: [十二五]期間深化医药衛生體制改革規劃及實施方案, 99% have insurance coverage, still in tertiary hospital
2013 國務院: 醫改四大主要工作仼務
2014國務院總理: 推動医改向縱深發展
2014
Identified one city per province for public hospital reform
Keep balance between medical care, health insurance and medications.
Allow private practices, bring physicians to community, referral systems

9. Non- Infectious Chronic Diseases 非傳染的慢性病
WHO gave 2014 updates
3,000,000 Chinese died of early death, younger than 70 y.o.
Heart disease, Lung disease, Stroke, Cancer, Diabetes
Recommendations: decrease smoking, drinking, unhealthy diet, lack exercise
Need neighborhood primary care service
3/19/15 WHO gave update of 2014 statistics
WHO 2014 updates 世界衞生組織
300萬中國人在70歲前過早死亡,
3,000,000 Chinese died of early death younger than 70 y.o,.
心臟病, 肺病, 腦中風, 癌症, 醣尿病
Heart disease, Lung disease, Stroke, Cancer, Diabetes
建議全民: 少吸煙, 少喝酒, 少飲食, 多運動
Decrease: Smoking, drinking, unhealthy diet, lack exercise
提倡 靠近居所的初級保健服務
neighborhood primary care service

10. National Health Service System
3/19/2015 passed by central government
Assure easy access to inexpensive, safe, basic medical services in villages.
One rural doctor per 1000 population
Community centers – built by government and managed by people
Needs clinics and equipment in village
全國醫療衞生服務體系規劃綱要, National Health Service System
Establish public hospitals 分級設置公立醫院
County –
general hospital, 縣綜合醫院
Chinese medicine hospitals, 縣中醫醫院
Municipality-
general hospital 市級綜合性醫院
Province –
general hospital 省級綜合性醫院

11. Institutions visited
Shanghai Medical School of Fudan University and General Practice Society of Shanghai Medical Association
The First Xiangya Hospital of Central South University
The Second Xiangya Hospital of Central Sough University
Health and Family Planning Commission of Dalian Municipality and the First Affiliated Hospital of Dalian Medical University

13. Shanghai Fudan University Hospital – General Medicine
Dr. Sunfang Jiang
Vice chairwoman, General Practice Society of Shanghai Medical Association, Convener of General Practice Education Group
10 years of GP Structured Vocational Training Program (GPSVTP), trained 500 GPs, not enough for 23 million people in Shanghai
1700 beds in Zhongshan hospital
84,000 inpatient
3,111,000 outpt/ER

14. Shanghai Fudan University Hospital – General Medicine
1937, 112 beds in General Medicine of 1700 beds
1994 standardization of training, Prof. Binghui Yang
1995 became sister hospital with Robert Wood Johnson University Hospital in NJ, by Prof. Yang
2006 “An introduction of Family Medicine” Prof. Yang
2010 included assessment (OSCE, tests, essays), clinical training for residents, teaching management
2013 became the 1st regional general medicine faculty training site in China
2014, Dept. of Family Medicine became the 1st WONCA standard certification of GP training institution
The Primary Study of Methods in General Practitioner’s training,
復旦大学附屬中山医院培訓訓全科医師方法初探中國全科醫學 Chinese General Practice, 2001, vol 12
祝墡珠,張淵,潘志剛,楊秉輝 Zhu ShanZhu, Zhang Yuan, Pan ZhigangZhongshan Hospital, Fudan University, Shanghai
2011 Chinese Journal of General Practitioners, 2011, 10(2)
Jiang Sun-Fan, Shou Juan, Zhang Xiang-Jie, Pan Zhi-gang, Peng Ming-Hui, Zhang Yuan, Zhu Shan-Zhu
The teaching and assessment of general practice training program in Shangahi-Practice and experiences
上海市全科醫師規範化培訓的教學與考核 – 復旦大学附屬中山醫院的实踐与思考
上海復旦大學附屬醫院,
Shanghai City, Jiangsu Province
1995 teaching hospital became sister hospital with Robert Wood Johnson University Hospital in NJ
President Yang promote Family Medicine
Computers as gifts for radiology distance diagnoses remotely
Advancement in training family doctors

16. The Road to Family Medicine
1994
Dept. of General Medicine established in hospital
2000
Ministry of Health – training guidance for GP
GP Structured Vocational Training Program (GPSVTP)
2002
State Council- new type of health care in villages
Established Department of General Medicine in Medical School
2012
State Council – Healthcare reform: included
GP standardized training
Established PhD in Clinical General Medicine
2014
Department of Family Medicine became the 1st WONCA standard certification of GP training institution
上海复旦大学（原上海医科大学）附属中山医院在院长杨秉辉的积极努力下，在上海医科大学附属中山医院建立了全科医学科，成为三甲医院全科医学的首位拓荒者，也是我国首次在临床医学领域建立全科医学科。
2000 衛生部 ministry of health: 《全科医师规范化培训大纲》与《全科医师岗位培训大纲》
首都医科大學第一個衛生部 直屬全科医學培訓中心
复旦大学附属中山医院“中国全科医学的发展”全科医生规范化培训
2002 國務院 state council : 主導建立新型農村合作醫療制度和醫療救助制度
复旦大学上海医学院建立首个临床医学专业中的全科医学系
2012 國務院: 醫改四大主要工作仼務
复旦大学全科医学系获得全科医学（临床）博士授予点
首批“四证合一”学员正式毕业，是规范化培养全科医生的“第一期”
2014
國務院總理: 推動医改向縱深發展
Another success story
- 首都醫科大學附屬北京安貞醫院
1062 beds, 1984 tertiary hospital
RMB $8,000,000 investment by Chaoyang district government
Datun Community Health Center 大屯社區服務中心
2007 standardized training base for general practitioners, service 260,000 population
2011 became Datun Community Capital Medical University Dept. of FM
2012 outpatient clinic, 500 daily visit, 月門診量 1000人以上
A rotation sites prior to promotion for physicians who are at primary site
Beijing Anzhen Hospital-Capital Medical University- Datun Community Health Center

17. Standardization of Training for General Practitioner
GP theory and professional quality courses 2 month
Rotations of 27 months in clinical departments of general hospital, one month elective
Training in primary care services for 7 months
2013，implementation of two days per month rotating in community center.
4. Graduation requirements
-written exam of （MCQ）Applied Knowledge (200 items)
-（OSCE）Clinical Skills Assessment
-thesis oral defense

19. 中南大学湘雅医院 Xiangya Hospital, Central South University
1906 Dr. HuMei, The Yale-in-China Association
2012, ranked the 4th among China’s public hospitals for contribution to the society.
Center for health care, medical education and medical research in China.
Direct supervision by the National Health and Family Planning Commission 国家卫生和计划生育委员会
3,500 beds,100,000 discharges/2,400,000 ER/yr
2013年在全国公立医院社会贡献度排名中居全国第四位。医院相继荣获全国卫生系统先进集体、全国百佳医院、全国科普工作先进集体、全国行风建设先进集体、全国卫生系统护理巾帼文明岗、全国百姓放心示范医院、全国最受欢迎三甲医院等多种荣誉称号。
是我国重要的医疗诊治、医学教育和医学研究中心。
#9 MBBS
Comprehensive and national key university under direct administration of the ministry of education , ranked top 20 on overall strength of all Chinese universities.

20. Xiangya Hospital Central South University
Dr. Sun Hong
2015 中美医院院长哈佛峰会
中國公立医院的管理改變革及其意义
麻省总院 Mass General Hospital
临床科研
高年资医師
科主任培訓合作意向
Houston Methodist Research Institute Hospital
Director of Central operations at Houston Methodist Research Institute (MRI) affiliated hospital
Tong Sun
八年制学生学习, 一對一個培訓导师
人員培訓
國際病人
10 Medical students
休斯顿衛卫理会医院

21. Xiangya Hospital Central South University
Health Manager:
monitoring, evaluation, maintenance, and improvement of health
Emphasis transformed from treatment to prevention and health maintenance
Healthcare management-
safety, quality, standardization, efficiency
Patient Service Center
Micro-channel for registration appointment online
Patient centered care
4/8/15
Health Manager: monitor, evaluation, maintenance, improvement of health
From treatment of diseases to prevention, health maintenance, and improvement
Healthcare management
safety, quality, standardization, efficiency
健康管理師 湖南省实訓基地 – 雷副院長
健康监測, 健康评估, 健康維护, 健康促进
從医疗治疗型, 轉向疾病预防型, 保健型和健康促进型
医疗管理的核心 –医务部主任銭招昕
医疗安全, 医疗質量 ,医疗水平, 医疗效率
4/18/15 湘雅 Xianya Patient Service Center 医院病友服务中心主任袁叶 “湘雅医院非医疗服务提升医患者友好度”
Proactive preparation, service during hospitalization, follow up care, community service 院前准备, 院中服务, 院后工作 , 社会公益
24 hours answering center 小时呼叫中心院前准备中心
短信,电话, QQ,微信,微博,掌上湘雅 APP 六位一体的医患互动平台
网絡云平台
对病友双向轉诊
病友懇谈会, 健康讲座, 病房天使, 关愛老年糖尿病病友活动, 患者健康教育
出院后延伸服务
以患者为中心

22. The Second Xiangya Hospital Central South University

23. The Second Xiangya Hospital of Central South University
Changsha City, Hunan Province
1958, 3500 beds, 78,000 inpatients, 1,665,000 ER/opt
9 national clinical key disciplines: endocrinology and metabolism is one of them, received The National Science & Technology Advancement Award
Interest: send physicians for short-term fellowships research
The hospital has a medical institute and a number of well-established research
centers, including three National Key Discipline Research Centers , Nine National
Clinical Key Disciplines , Three Key Laboratories and four Provincial Key Disciplines.
Endocrinology and Metabolism is one of the nine National Clinical Key disciplines, which provide advanced research platforms in the field: diseased in metabolic bone diseases, diabetes autoimmunity and hereditary diseases in endocrine metabolism. The department is at the forefront in the study and received The National Science & Technology Advancement Award

24. Dalian City

25. Health and Family Planning Commission and Dalian Hospital
Dalian City, Liaoning province
Visions: love lives, maintain health, improve happiness
Village family doctors service
Strengthen primary services

26. The First Affiliated Hospital of Dalian Medical University
1930 established by Japanese, a tertiary hospital
3700 beds, 90,000 admissions, 2,160,000 ER visits per year
Eastern and Western Medicine
Clinical nursing, cardiovascular, nephrology, gastroenterology, orthopedics

27. The First Affiliated Hospital of Dalian Medical University
#30 Dalian Medical University >1000 international students fantastic environment, reasonable tuition, high quality education

29. Norman Bethune Health Science Center of Jilin University
Jilin University is the sister university with Rutgers University for 30 years
2015 signed MOU with Rutgers Biomedical and Health Sciences
Dean of NBHSC visited Rutgers in April 2015, vice chairs of Oral surgery. Public Health visited in July 2015
There is funding for physicians to obtain dual degrees in master and PhD programs
CUCAS- MBBS16 Jilin (JLU) is one of China’s finest and the largest-scale university in the country, high-quality course in
Medical education: 6 month special training program designed for USMLE, MBBS degree (Bachelor of Medicine and Bachelor of Surgery)
Automobile engineering
Law
Social sciences
Economics and management
Information science
Agriculture
The 1st affiliated Hospital (former First clinical college of Norman Bethune Medical University)
The second Affiliated Hospital (former second clinical college of Norman Bethune Medical University)
The Third Affiliated Hospital (China-Japan Union Hospital of Jilin University)

30. Opportunities Government commitments Institutional commitments
Individual commitments
International MOUs
Funding steering the priorities
Perception and acceptance range widely
Collaboration with WONCA, WHO and other programs in US.
Government’s policy
Institutional commitment
Individual commitment
Ranking is important to universities in China
Help their ranking by how many international MOU signed, international studies
Harvard, JH, Mass General, Mayo Clinic