New design for Chinese 'family doctors'

Are “Family Doctors” Coming?—A Study on the Relationship of Contractual Service between Community Doctors and Residents in Rural Areas

Are “Family Doctors” Coming?—A Study on the Relationship of Contractual Service between Community Doctors and Residents in Rural Areas,written by Zhang Kuili, an associate professor from the School of Public Administration at Central China Normal University, tries to propose a new type of contractual relationship with Chinese characteristics that targets China’s medical problems.

The book starts by giving a comprehensive account of the contractual relationship between family doctors and community residents in typical countries. Then the book examines the practice of contractual service relationships between community doctors and residents in China’s pilot areas, revealing the “low signing rate” and the root cause behind “signing yet without appointments.”

The “new” type of contractual relationship is first manifested as de-administration, where community residents voluntarily participate. Community doctors and residents jointly participate and establish bilateral interactions. Residents no longer passively accept the contractual service relationship, but turn proactive and participatory. In the process of system construction, they can voice their desires and demands. In the process of system practice, they can choose freely.

De-administration does not mean the government neglecting its responsibilities, but re-regulation with new ideas and new methods. The new regulation method is no longer an administrative order, but based on the concept of social governance. This will not only allow the government to lead, but also encourage social organizations, community doctors, and community residents to participate.

Under the new type of contractual relationship, community residents’ signing behaviors will change from “I am asked to sign” to “I want to sign,” thereby addressing the problem of low signing rates. In doing so, the contract will no longer be a formality, but a real, effective one.

This new type of contractual relationship spans various links such as prevention, diagnosis and treatment, and rehabilitation, covering the entire life cycle from birth to death. This will constitute a long-term relationship and repetitive strategic interactions between doctors and patients, bringing hope for curbing the moral hazard of medical providers and building a harmonious doctor-patient relationship.

Zhang adopts a research paradigm with a “top-down” and “bottom-up” combination to match system design and residents’ desires. Considering wide differences between Western theories and the practice of Chinese community governance, the author introduces the theory of community consultative governance, thereby enriching both the theory of primary health care and the theory of community governance.

Lyu Guoying is a professor from the School of Public Administration at Zhongnan University of Economics and Law.