Summary Cancer is one of the major non-communicable diseases posing a threat to world health. Unfortunately, improvements in socioeconomic conditions are usually associated with increased cancer incidence. In this Commission, we focus on China, India, and Russia, which share rapidly rising cancer incidence and have cancer mortality rates that are nearly twice as high as in the UK or the USA, vast geographies, growing economies, ageing populations, increasingly westernised lifestyles, relatively disenfranchised subpopulations, serious contamination of the environment, and uncontrolled cancer-causing communicable infections. We describe the overall state of health and cancer control in each country and additional specific issues for consideration: for China, access to care, contamination of the environment, and cancer fatalism and traditional medicine; for India, affordability of care, provision of adequate health personnel, and sociocultural barriers to cancer control; and for Russia, monitoring of the burden of cancer, societal attitudes towards cancer prevention, effects of inequitable treatment and access to medicine, and a need for improved international engagement.

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Challenges to effective cancer control in China, India, and Russia

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(14)61120-X.pdf

Harnessing the privatisation of China's fragmented health-care delivery

Objective Deteriorations in the patient-provider relationship in China have attracted increasing attention in the international community. This study aims to explore the role of trust in patient satisfaction with hospital inpatient care, and how patient-provider trust is shaped from the perspectives of both patients and providers. Methods We adopted a mixed methods approach comprising a multivariate logistic regression model using secondary data (1200 people with inpatient experiences over the past year) from the fifth National Health Service Survey (NHSS, 2013) in Heilongjiang Province to determine the associations between patient satisfaction and trust, financial burden and perceived quality of care, followed by in-depth interviews with 62 conveniently selected key informants (27 from health and 35 from non-health sectors). A thematic analysis established a conceptual framework to explain deteriorating patient-provider relationships. Findings About 24% of respondents reported being dissatisfied with hospital inpatient care. The logistic regression model indicated that patient satisfaction was positively associated with higher level of trust (OR = 14.995), lower levels of hospital medical expenditure (OR = 5.736-1.829 as compared with the highest quintile of hospital expenditure), good staff attitude (OR = 3.155) as well as good ward environment (OR = 2.361). But patient satisfaction was negatively associated with medical insurance for urban residents and other insurance status (OR = 0.215-0.357 as compared with medical insurance for urban employees). The qualitative analysis showed that patient trust-the most significant predictor of patient satisfaction-is shaped by perceived high quality of service delivery, empathic and caring interpersonal interactions, and a better designed medical insurance that provides stronger financial protection and enables more equitable access to health care. Conclusion At the core of high levels of patient dissatisfaction with hospital care is the lack of trust. The current health care system reform in China has yet to address the fundamental problems embedded in the system that caused distrust. A singular focus on doctor-patient inter-personal interactions will not offer a successful solution to the deteriorated patient-provider relationships unless a systems approach to accountability is put into place involving all stakeholders.

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Patient Satisfaction with Hospital Inpatient Care: Effects of Trust, Medical Insurance and Perceived Quality of Care.

Medical council of India.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)00582-1.pdf

Doctors in China: improving quality through modernisation of residency education

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(14)61307-6.pdf

Transformation of the education of health professionals in China: progress and challenges.

Status of clinical research in China

Medical education in China has undergone significant reforms in contemporary times. As the world's largest medical education system, it is important to understand the status of China's medical education in our interdependent world. This paper highlights the current landscape of medical education in China, particularly the progress that have been made in recent years. It also examines the current topics and challenges facing China's medical educators today, and proposed recommendations for improving medical education in China. The medical education in China will produce better qualified health professionals to meet the health needs of Chinese population according to the new requirements of the "Healthy China 2030" blueprint.

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Medical education in china: progress in the past 70 years and a vision for the future.

China faces major challenges in the distribution of health professionals with serious shortages in rural areas and in the development of Primary Care Providers (PCPs). This study investigates the career preferences of medical students in China and the impact of rural backgrounds on these preferences. Medical students in the final year of their program in 16 medical schools across China completed a 58-item survey that included questions regarding their demographic characteristics, attitudes toward practice in low resource areas, postgraduate planning, self-assessed competency, university facilities assessment, and financial situation. Descriptive calculation and Logit model were used for the analysis. Completed surveys from 3020 students were included in the analysis. Upon graduation, 48.5 % of the medical students preferred to work in urban public hospitals and this percentage rose to 73.6 % when students were asked to state their anticipated preference five years after graduation. Students’ top three ranked reasons for preferred careers were “good career prospects”, “living close to parents/families”, and “remuneration”. Those who preferred to work in rural areas upon graduation were more likely to be those who lived in rural areas when 1–15 years old (β = 2.05, p < 0.001), had high school in rural areas (β = 1.73, p < 0.001), or had parents’ place of current residence in rural areas (β = 2.12, p < 0.001). Similar results were found for those students who preferred to work in PCPs. To address the serious shortages of health professionals in rural areas and PCPs, medical schools should consider strategies to recruit more medical applicants with rural backgrounds and to orient students to rural and primary care interests.

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Career preferences of graduating medical students in China: a nationwide cross-sectional study.

Five countries in Asia including Bangladesh, China, India, Thailand and Vietnam formed a network called Asia-Pacific Network for Health Professional Education Reforms (ANHER). This network collectively conducted a survey at the national level and at the institutional level (for medical, nursing and public health education). We also undertook an assessment of final year graduates from these schools on their attitudes, competencies and willingness to work in rural areas. Pretested anonymous questionnaire comprised of four sections including demographic data, attitudes towards working in rural area, where to work after graduation and perception about competency of respondents was used. Descriptive and analytical statistics were used for data analyses. About 60 % of students from Bangladesh and Thailand had positive attitude towards working in rural area, 50 % in both China and India and only 33 % in Vietnam. Students’ positive attitudes towards their school in terms of preparing or inspiring them to work in rural areas were low across all five countries. Upon graduation and in the next five years, majority of students wanted to work in public sectors. Interestingly confidence about overall competency was quite low. Positive attitude towards working in rural areas varied significantly across five countries in Asia. Medical schools should improve the preparation and inspiration towards working in rural areas for their students. Medical schools should put more effort in improving students’ attitude towards working in rural areas.

https://link.springer.com/content/pdf/10.1186%2Fs12909-016-0719-9.pdf

Weimin Wang

Papers

Transformation of the education of health professionals in China: progress and challenges.

Status of clinical research in China

Medical education in china: progress in the past 70 years and a vision for the future.

Career preferences of graduating medical students in China: a nationwide cross-sectional study.

Attitude towards working in rural area and self-assessment of competencies in last year medical students: A survey of five countries in Asia.