Building integrated primary health care: the role of the government in China and Thailand

While the importance of primary health care (PHC) as a foundation for a strong healthcare system is widely accepted, the policies needed to achieve it remain deeply controversial. Some proponents call for a greater role for market and user choice in expanding and strengthening PHC, whereas others recommend a greater role for the government in directing its development. The objective of this paper is to assess these arguments by comparing the experience of China and Thailand in strengthening PHC. We find that tight government steering of the healthcare system in Thailand has produced better integration and eventually outcomes than the more decentralized and competitive system in China. The Chinese government's massive administrative and fiscal efforts to strengthen PHC have been undermined by systemic barriers in the wider health system, notably fee-for-service and out-of-pocket financing that distort the incentives of healthcare providers. A key conclusion to emerge from the analysis is that central stewardship and steering accompanied by appropriate incentives to promote integration are critical to building effective primary health care.