Primary Care

choi

(1) Health care  l  The Right Treatment; How developing countries should improve health care. Economist, Aug 26, 2017.

Quote:

"Primary health care is not flashy, but it works. It is the central nervous system of a country's medical services -- monitoring the general health of commun, treating chronic conditions and providing day-to-day relief. It can ensure that an infectious disease does not become an endemic.

"Government in many developing countries * * * have ploughed scare money into visible -- and expensive in big cities. Between 2002 and 2013 the number of large hospital in China nearly doubled, whereas the tally of primary-care providers [including persons who did not go to medical or nursing schools; see next posting] shrank by 6%. China now has more hospital beds than America.

"Some medical bodies would like to see care-providers without formal medical qualificatins banned, but the evidence is that even short training coursecan greatly improve their diagnoses.

Note:
(a) This article is a summary, called 'leader" in The Economist, of a longer, more in-depth, main article in the body of the magazine.
(b) There is no need to read the rest.
(c) The article carries a chart indicating in developing countries deaths from "infectious diseases" and "chronic conditions" (only two causes provided) have reserved, from 1990 (53: 47%), to 2000 (44: 56%), to 2020 (forecast: 30: 70%).
(d) Quotation 2 is the only mention of China in this "leader."
(e) Fast Facts on US Hospitals. American Hospital Association (AHA), "2017."
www.aha.org/research/rc/stat-studies/fast-facts.shtml
("Total Number of All US Registered* Hospitals: 5,564 * * * Total Staffed Beds in All US Registered* Hospitals 897,961 * * *    * Registered hospitals are those hospitals that meet AHA's criteria for registration as a hospital facility. Registered hospitals include AHA member hospitals as well as nonmember hospitals")

choi

(2) Primary health care  l  Diagnosing Doctors. In poor countries it is easier than ever to see a medica. But it is still hard to to find out who will make you better.
https://www.economist.com/news/i ... countries-it-easier

Quote:

"the mohalla (community) clinic opened in 2015 * * * Now, like thousands who attend the 158 such clinics that have opened over the past two years in Delhi, they [patients] receive free, comprehensive medical care, all under one prefab roof. [The article does not say where the funding comes from.]

"According to the World Bank, primary care—the generalist, front-line form of medicine * * *—can deal with 90% of health problems.

"Fully 86% of children [in the world] are now immunised against diphtheria, tetanus and pertussis (whooping cough) [common abbreviation: DPT].

"Primary care is 'not flashy,' says Dr Asaf Bitton of Ariadne Labs [based in Boston, Massachusetts -- though I have not heard of it], a research group, so it gets less attention.

Quality of health care from here on: "In India, for example, there are plenty of health-care providers and patients visit them often. Indians in rural areas visit a doctor on average six times a year. City-dwellers do so five times a year. For Americans, the annual average number of visits is just three. Nor do Indians have to travel far to find a clinic. In a survey of seven neighbourhoods in Delhi, Jishnu Das of the World Bank and Jeffrey Hammer of the University of Princeton found an average of 75 providers within a 15-minute walk. The Centre for Policy Research, a Delhi-based think-tank, estimates that there are about 4.4 providers per village.  But few of the visits are to doctors with modern training. In rural India 50-80% are to 'informal providers,' including traditional healers, drug dispensers and people who served apprenticeships with doctors but did not qualify. The picture is similar elsewhere * * * [in those situations:] Providers are typically paid directly by the patient.

in order to assess and compare health care: "a few researchers have used 'standardised patients'—people coached to describe symptoms of specific ailments, for example angina, or to say that they have a child at home with diarrhoea. Afterwards researchers quiz the mock patients and assess the quality of their treatment.  The results are startling. In India the average consultation lasted three minutes, a quarter as long as in OECD countries. A third lasted less than a minute and involved no examination and just one question from the clinician: 'What's wrong with you?'  The correct treatment was given in 30% of cases, and unnecessary or harmful treatment in 42%.   

"Patients fare little better in China.  * * * [research by Sean Sylvia, whose has no Chinese name, of Renmin University found:] Health workers spent an average of 96 seconds with patients. They gave a correct diagnosis in just 26% of cases, and an outright wrong one in 41%. Inept treatment is not because providers are too busy. * * * A better explanation starts with the fact that many clinicians have received little training and do not know what they are doing. * * * And a recent Kenyan study using standardised patients found that clinicians in Nairobi made 'significantly better' diagnoses than Indian and Chinese ones, who had less training.

"One reason Brazil and Costa Rica have better health-care systems than other countries of similar income is their dense networks of trained primary-care workers. In Costa Rica, local teams including a doctor and a nurse provide three-quarters of consultations. The country, which spends less than the global average on health care ($970 per person), has the third-highest life expectancy in the Americas, behind only Canada and Chile. Its rate of maternal mortality is lower than America's.  Costa Rica's health-care system is small and well-structured [unlike India's].

My comment:
(a) This is a thoughtful article. Please read. Incidentally, the verb diagnose is spelled the same in British and American English.
(b) "a recent Kenyan study * * * found that clinicians in Nairobi made 'significantly better' diagnoses than Indian and Chinese one"

Daniels B et al, Use of Standardised Patients to Assess Quality of Healthcare in Nairobi, Kenya: a Pilot, Cross-Sectional Study with International Comparisons. BMJ Global Health, _ : _ (online publication: June 10, 2017).
http://gh.bmj.com/content/2/2/e000333
("and in comparison with previously published results from urban India, rural India and rural China [that is, this team did not personally did studies in India or China]. * * * Kenyan outcomes compared favourably with India and China in all but the angina case. [The other 3 test cases were: diarrhoea, asthma and tuberculosis (TB)" )

(c) "Each mohalla clinic is equipped with a Swasthya Slate, a relatively cheap ($640) device that can perform 33 common medical tests, including measuring blood pressure and blood-sugar levels."

The "swasthya" is Hindi for "health." Swasthya Slate means "health tablet."