Health Care Reform and China

A few weeks ago in class, I shared my ideas for health care reform. Currently, we have many for-profit payers and leave the sickest and most costly patients to burden our government. Instead, we could instead have a single payer, non-profit, that would be the government. They single payer would have to be the government as it is non-profit. By having a single payer, the risk would be spread among a larger pool of people, including the young and health. We could keep our current private providers, however, and encourage them through payment methods such as a patient centered medical home. According to the Patient Centered Primary Care Collaborative (2012), a patient centered medical home is a payment method where the team of health care providers is paid based on “patient outcomes and health system efficiencies” (p. 2).  This would encourage healthcare quality by reducing the amount of unnecessary tests and treatments and increase the amount of preventative measures used by the health care team.  

After class, I went home to talk to my roommate, Ting, about what we discussed in class. Ting is a pharmacy student in my class from China. I told her about my ideas for health care payment reform. She said that it sounded exactly like the current health system in China. Everyone has access to health care there, but the rich still seek special privileges. They will pay a doctor more for the same services at the same quality level because the doctor’s office is well decorated. It provides them a better experience for which they are willing to pay. This goes even further when it comes to life-saving surgeries. A rich patient will bribe a doctor to do everything in their power to ensure they survive. The best doctors, therefore, end up treating the rich more than they do the poor. Ting says that no matter how much you try to reduce disparities, the rich will always feel entitled to have more than the poor. Ting feels that the healthcare system in China is great for anyone with a common illness that is simple to treat. She says that once the new system was implemented, people were very happy. On the other hand, she feels that she would be better off in the United States if she had an illness which required surgery or some sort of specialty doctor.

I decided to research China’s health system further. Here are some interesting points from the World Health Organization Representative Office in China (2014):

• China’s total health expenditure in 2010 was 199.80 billion RMB (about US$29.51 billion). It accounted for 5.1% of GDP, lower than the average for all middle-income countries (6.6%). Per capita health expenditure is 1490 RMB (about US$220).

•  Noncommunicable diseases (NCDs) (cardiovascular diseases, cancer, diabetes mellitus and chronic lung diseases) are the main cause of mortality in China. More than 85% of mortality in China is attributed to NCDs.

• China has a population of more than 1.3 billion people, with approximately 7 million added annually. Almost half of the population lives in rural areas (48.73%).

• At the end of 2011, China had a total of 877,727 medical institutions and 3.5 medical institution beds per thousand residents. However, there is a marked difference between urban and rural areas, with 6.24 hospital and health centre beds per thousand people in urban areas, and only 2.80 in rural areas.

• In 2008 there were 5.58 health technical personnel per thousand in urban areas, more than twice the number for rural areas.

Even though China made health care more accessible to its citizens and has decreased the amount of non-communicable diseases, they do not pay that much for health care compared to other countries. Also, while there is a better method of payment in place, there is still a lack of health care professionals and facilities in rural areas. This highlights the need for infrastructure and to reduce “brain drain.” Even though they may be able to pay for care, they still do not have access to it. This is a great example of structural violence. If there were more facilities in rural areas, those patients might have access to treatment and not have to suffer from their diseases.

References: 

1.     Patient Centered Primary Care Collaborative. (2012). Benefits of implementing the primary care patient-centered medical home: a review of cost and quality results. Washington, DC: Nielson, M., Langner, B., Zema, C., Hacker, T., & Grundy, P.

2.     World Health Organization Representative Office in China. (2014). Health Sector Reform in China. Retrieved from http://www.wpro.who.int/china/mediacentre/factsheets/health_sector_reform/en/.