• Xi Li, Harlan M Krumholz, Winnie Yip, Kar Keung Cheng, Jan De Maeseneer, Qingyue Meng, Elias Mossialos, Chuang Li, Jiapeng Lu, Meng Su, Qiuli Zhang, Dong Roman Xu, Liming Li, NormandSharon-Lise TSTDepartment of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA; Institute of Applied Health Research, University of Birmingham, Birmingham, UK., Richard Peto, Jing Li, Zengwu Wang, Hongbing Yan, Runlin Gao, Somsak Chunharas, Xin Gao, Raniero Guerra, Huijie Ji, Yang Ke, Zhigang Pan, Xianping Wu, Shuiyuan Xiao, Xinying Xie, Yujuan Zhang, Jun Zhu, Shanzhu Zhu, and Shengshou Hu.
• National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China.
• Lancet. 2020 Jun 6; 395 (10239): 180218121802-1812.

AbstractChina has substantially increased financial investment and introduced favourable policies for strengthening its primary health care system with core responsibilities in preventing and managing chronic diseases such as hypertension and emerging infectious diseases such as coronavirus disease 2019 (COVID-19). However, widespread gaps in the quality of primary health care still exist. In this Review, we aim to identify the causes for this poor quality, and provide policy recommendations. System challenges include: the suboptimal education and training of primary health-care practitioners, a fee-for-service payment system that incentivises testing and treatments over prevention, fragmentation of clinical care and public health service, and insufficient continuity of care throughout the entire health-care system. The following recommendations merit consideration: (1) enhancement of the quality of training for primary health-care physicians, (2) establishment of performance accountability to incentivise high-quality and high-value care; (3) integration of clinical care with the basic public health services, and (4) strengthening of the coordination between primary health-care institutions and hospitals. Additionally, China should consider modernising its primary health-care system through the establishment of a learning health system built on digital data and innovative technologies.Copyright © 2020 Elsevier Ltd. All rights reserved.

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