The Shanghai case: A qualitative evaluation of community health reform in response to the challenge of population ageing.
Shanghai's health care system is facing a serious challenge of an ageing population, as 14% of its 17 million residents are 65 or older. In 2000, a community health reform was implemented to provide comprehensive and continuous primary care to community residents with a focus on seniors. The study employed the theoretical framework of examining primary care in terms of the constellation of its four unique elements (first contact, comprehensiveness, longitudinality and coordination) and three healthcare components (structure, process and outcome). The study aimed to evaluate the extent to which the reform has achieved its process goals and how the organizational context influenced the level of implementation. In-depth interviews with 25 health providers, 15 seniors and four community leaders were carried out. The study found that the Shanghai community health reform has improved the structure and process of primary care regarding first contact, comprehensiveness and longitunality. However, the reform is constrained by structural barriers on seniors' financial access to resources and the capacity of primary care providers. The previous organization system also constrains the reform in CHCs financing and administration. The Shanghai case illustrates that a broad societal view has to be taken when analysing health reforms, which requires the involvement of multiple sectors including the government, health providers and health consumers.