Fang shan: the urban rural

26 07 2011

By Lily Zeng

Beijing is a sprawling metropolitan, but it has several rural districts. Fang Shan is one of those districts. Located on the southwest side of Beijing, it as a population of close to one million. I went on field visit there to look at how rural health care might be different than urban Beijing. Although I was told that Fang shan is still a district of Beijing, I was not expecting the rural area to be quite so urban. It looked much like downtown Beijing only with fewer cars and tall glass buildings.

We visited the community health center and a community health post. The facilities were impeccable, but there were hardly any patients. This was in stark contrast to the sea of people I see in the hospitals around the Peking University Health Science Center campus and even the community health centers that we visited. The facilities in this center were much better than the ones in Beijing, but the facilities were very underutilized.

I think this points to one of the universal trends in health care utilization: people will always try to access the highest level of care they can afford. So, people in rural areas might go to hospitals instead of community health centers, people who go to hospitals want to see specialists instead of general care practitioners. This is true all over the world, regardless of urban or rural.

One reason that people may not want to use the rural community health centers is because the doctors are often not trained at the most prestigious institutions and may not have all the qualifications as doctors in the large hospitals in Beijing. Often times the doctors working at the centers and the lower level community health posts went to technical school and received medical training through a government training program. Because rural posts are not very prestigious, doctors don’t want to go to the rural areas so there is a lack of human resources despite the shiny facilities. The village doctors may not have medical degrees from the best universities do receive rigorous training in both western and traditional medicine through government programs and are evaluated twice a year. They are perfectly qualified to deal with most of the primary care issues, which is what the community health centers are supposed to be dealing with. However, an ethical issue then arises. Is it ok to give the rural population a lower level of care? But if the village doctors are not allowed, then is it possible to find ways to attract the best doctors to these rural health centers? Access to health facilities is no longer a major issue in many rural areas, especially in the richer provinces. Now the issue is quality.

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