There are three major models of primary care providers (Community Health Centers, CHCs) in China, i.e., government managed, hospital managed and privately owned CHCs. We performed a systematic review of structures and health care delivery patterns of the three models of CHCs.
Studies from relevant English and Chinese databases for the period of 1997–2011 were searched. Two independent researchers extracted data from the eligible studies using a standardized abstraction form. Methodological quality of included articles was assessed with the Mixed Methods Appraisal Tool (MMAT).
A total of 13 studies was included in the final analysis. Compared with the other two models, private CHCs had a smaller health workforce and lower share of government funding in their total revenues. Private CHCs also had fewer training opportunities, were less recognized by health insurance schemes and tended to provide primary care services of poor quality. Hospital managed CHCs attracted patients through their higher quality of clinical care, while private CHCs attracted users through convenience and medical equipment.
Our study suggested that government and hospital managed CHCs were more competent and provided better primary care than privately owned CHCs. Further studies are warranted to comprehensively compare performances among different models of CHCs.
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Their Similarities and Differences:
- Oceanic/Oceanic Convergent Boundaries
Where different oceanic plates run into each other, the older – and therefore cooler and denser – one dives beneath the other; in other words, it subducts. Such a convergent boundary includes a seafloor trench marking the earthquake-rattled subduction zone as well as an island arc: a line of volcanoes created by rock-melt in the mantle associated with subduction. Other features of an oceanic/oceanic convergent boundary are the forearc basin between the trench and the island arc and the backarc basin on the opposite side of the arc.
An example of an oceanic/oceanic convergent boundary is that between the Pacific and Mariana plates, which includes the Mariana Islands arc and a subduction zone encompassing the Mariana Trench, the deepest part of the World Ocean. The World Ocean is the name for the collective group of oceans on the planet.
Oceanic/Continental Convergent Boundaries
Where oceanic and continental plates collide, the former subducts beneath the latter because ocean crust – rich in iron and magnesium – is denser than continental rock. Here again a subduction zone occurs, as does a volcanic arc that develops on the continental side of the boundary; in between, sediments sloughed up against the continental margin form an accretionary wedge.
The western coast of the Americas – part of the Pacific Ring of Fire, named for the Pacific basin’s energetic volcanic and seismic turmoil – hosts this type of tectonic convergence. Along the Pacific Northwest coast, for example, oceanic plates subducting beneath the North American Plate create the Cascadia Subduction Zone, fueling the Cascade Range volcanoes; the Nazca (and, to a lesser extent, Antarctic) plate subducting under the South American Plate, meanwhile, uplifted the Andes and peppered that towering range with volcanoes. Both regions are vulnerable to severe earthquakes associated with this intense plate collision.
Continental/Continental Convergent Boundaries
Convergent boundaries between continental plates are a bit different than oceanic/oceanic and oceanic/continental mashups. Continental lithosphere is too buoyant to subduct deeply, so rather than a subduction zone and trench these boundaries encompass a thick mess of folded, piled-up crust. This compression results in massive mountain belts rather than the volcanic arcs powered by subduction-zone magma in the other two cases.
The classic example of a continental/continental convergent boundary is the rumpled overlap where the Indian Plate drives into the Eurasian Plate, a tectonic collision that has thrown up the greatest mountains in the world – the Himalayas – as well as the vast, high Tibetan Plateau. To the west, the Alps grew in similar fashion via the collision of the African and Eurasian plates.
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