The Performance of Primary Healthcare in China: The Need for a Systematic Design for Improvement Comment on "Quality and Performance Measurement in Primary Diabetes Care: A Qualitative Study in Urban China".

In the paper "Quality and Performance Measurement in Primary Diabetes Care: A Qualitative Study in Urban China," Rasooly and colleagues provide an in-depth analysis of the ways in which Shanghai manages the quality and performance of the primary healthcare (PHC). The present commentary extends the analytical perspective offered in this paper from the city of Shanghai to the entire Chinese Mainland. In so doing, it points out certain systemic shortcomings in the capabilities of family doctors, the unreasonable competition between primary, secondary, and tertiary forms of healthcare, and the negative incentives in the salary system for PHC providers that must be overcome to improve performance. This commentary also proposes strategies and other recommendations for overcoming the bottlenecks identified in the paper as a means of systematically enhancing PHC performance across Mainland China.