Healthcare System in China and Policy Implication - Assignment Example

Healthcare System in China and Policy Implication China’s healthcare system has become a leading example for the developing countries around the globe. It has developed one of the largest national health care institutions’ systems and one of the reasons will be the large workforce it has. Its achievement in health care can serve as a model for economically less advanced nations in the world. The health care network in China is composed of three schemes; the well-established Government Insurance Scheme, the Labor Insurance Scheme, urban collective medical care schemes and rural collective medical care schemes (Dong, 2001). Also there are many “barefoot doctors" that are working for the health care of citizens. All these policies that are being implemented in China are in accordance to the Mao’s initial ‘prevention first’ health policy. During Mao’s era the healthcare was taken as an utmost priority (W & Sidel, 1977 ). China did a surveillance to check for any social inequities in the healthcare system (W & Sidel, 1977 ). Few inequities were found as a result of the surveillance and these inequities seemed difficult to resolve. But the authorities figured out that the health care responds directly to the demonstrated needs of citizens. The surveillance also helped China in activation of political will and community participation among the public because it provided realistic information for local, district and national decision-makers (W & Sidel, 1977 ). This activation of community participation was done through the famous Model County Project. This model showed how an efficiently organized system can be extended to test procedures in experimental areas and adapt them for wide-ranging achievement of specific goals. This project shows how ideological commitment to impartiality and objectiveness can improve health care. Between the early 1960s and late 1970s, China used barefoot doctors to monitor the health of locals and also to give health care to people nearby. Local health cooperatives and the barefoot doctors together, spread knowledge related to healthcare. The activities from the implementation of Model County Project showed a considerable decline of infant mortality which was 275 to 250 (CE, 1992). The general economic reform occurred in China in 1980. China shifted to privatization which reversed the earlier priority of equity. This has caused Chinese rural health care system to go through a rapid transformation. According to some researches, the modernization of China has caused its once viable model of health care system to fall apart. While several new arrangements have come out of the old health care system, yet it has failed to achieve the results that were being achieved by previous system (Blumenthal & Hsiao, 2005). The healthcare service delivery in China has been structured around a three-tier system. This three-tier system was made of street clinics, district hospitals, and city hospitals in urban areas and in rural areas it consisted of village clinics, ownership health centers (THCs), and county hospitals (Eggleston, Ling, Qingyue, & Lindelow, 2008). Advanced referral care is offered by the provincial and central hospitals to the patients. The local Bureau of Health handled most of these provider organizations, but other enterprises like the army and other sectors have also been involved in delivery services. Other services related to health care are usually supplied by maternal and child health centers and family planning centers at the rural level (Eggleston, Ling, Qingyue, & Lindelow, 2008). The government of China set the prices of medical and health care at a low level. This was done in order to ensure that practically Chinese public had access to medical care. To cover the difference between costs and revenues, the health care providers received direct financial support from the government. Public health services were mostly financed by government and were provided at different levels (Eggleston, Ling, Qingyue, & Lindelow, 2008). The basic features of this health care system can still be seen but the economic and administrative reforms that have been put into practice since the early 1980s and it has since then very prominently impacted the service delivery. But this has caused a decline in effective health insurance coverage for the public. The new system introduced in China has both positive and negative points. This New Rural Cooperative Medical System (NRCMS) was implemented in 2003 and since then a significant development can be seen in Chinas rural health sector (Lan, 2007). However, the health sector still had many complexities, such as lack of professional workers, specialized doctors and nurses, technological equipment and lack of suitable services, mostly lying in the mid-west, south-west and north-west regions of the country (Du X & Du H, 1999). Many areas from different regions and districts were deprived by lack in the primary rural health care. There was very less medical insurance coverage and also difficult reimbursement procedures which affected the farmers to experience high medical costs and poor access to medical care (Xilong, DibH, Xiaohang, & Hong, 2006). The New Rural Cooperative Medical System provides household farmers only with clinics and rural hospitals and services and treatments for small health problems. The treatment of severe and chronic diseases is only done in hospitals that are above rural level because the advance medical equipment is not present in the rural hospitals. Also, these hospitals lack the wide range of medicines that are usually available in higher level hospitals. At the same time these above rural level hospitals are also costly as they have higher reimbursement ratio. Thus the farmers that suffer from major illnesses experience heavy medical cost. China has one of the highest shares of pharmaceutical and total health spending compared to the average 15% around the world. Researches show that China has allotted around 4.7% of its GDP to health care, out of which 44% of the spending was on pharmaceuticals (Paris, 2004). Patients in China are treated in a very costly manner, and in most of the scenarios, it is evident that the additional cost is not warranted from a medical perspective. Excessive usage of medicines in the Chinese hospitals is a common problem in China. The reason of this over usage of medicine is that Chinese doctors’ bonus payment is directly linked with the revenues generated from pharmaceutical sales (Zhan S & al, 1998). In short, the more medicines doctors prescribe, the more profits they can make for themselves. Monetary incentive like these creates enormous concerns of quality and cost of health care. China’s Health Care system: A comparison Health care expenses are growing in China as compared to some countries but it is still less when compared to United States. Annual per capita spending on individual health services in China was amplified from 11 to 442 Yuan, from 1978 to 2002 (Blumenthal & Hsiao, 2005). Overall, national expenditure on health care of all kinds, including the public health, increased from 3.0 percent to nearly 5.5 percent of the GDP (Blumenthal & Hsiao, 2005). Chinese spend half of their health budget on drugs whereas United states it is only 10%. Also the efficiency of the health care system has declined majorly in China as compared to that of United States. The declining financial access and the increasing cost are adding up to the inefficiency of this system (Blumenthal & Hsiao, 2005). There is also an increase in the average expenditure on visits of patients and the average expenditure on the services given to them as compared to the capita per income. This increase in costs is because of the fact that the technology and drugs used in the treatment of patients is very expensive and also because the unit cost of health service has increased over time (Blumenthal & Hsiao, 2005). Barriers in the Provision of Healthcare in China Quality The quality of healthcare can be improved. It has got the tools and equipments but what they lack is good staff, doctors and nurses. Researches also show that the health quality in China is lower than the best practice standards that are usually followed. Costs and efficiency The studies show that China’s healthcare sector exhibits a low level of efficiency. Different indicators point towards low productivity of health staff. The number of patients treated per provider per day has also decreased in rural areas. Affordability, disparities and access As discussed earlier the rural public cannot afford the treatment for chronic diseases. Also there has been an increase in the health budget. Health spending has gone up between 1990 and 2002. It has increased much faster than per capita income and prices resulting in an increase in nominal per capita health spending. We can say that China shows a significant gap between affordability in rural and urban areas and income groups. References Blumenthal, D., & Hsiao, W. (2005). Privatization and Its Discontents — The Evolving Chinese Health Care System. The new England Journal of Medicine. CE, T. (1992). Surveillance for equity in primary health care: policy implications from international experience. International Journal of Epidemiol, 1043-9. Dong, W. (2001). Health care Reform in Urban China. Lupina Research Associate. Du X, W., & Du H, Y. (1999). Mechanism for adjusting health services prices. Chinese Health Economics, 50–1. Eggleston, K., Ling, L., Qingyue, M., & Lindelow, M. (2008). HEALTH SERVICE DELIVERY IN CHINA: A LITERATURE REVIEW. HEALTH ECONOMICS, 149–165. Hsiao, W. C. (1984). Transformation of Health Care in China. Harvard School of Public Health, 932-936. J, G., S, T., R, T., & K, R. (2001). Changing access to health services in urban China: implications for equity. Health Policy and Planning, 302 -312. Lan, L. Y. (2007). Guangdong province health affairs meetings report. . Abgerufen am 10. July 2012 von http://www.gdwst.gov.cn/html/wsjb/200703202115.html Paris, J. S. (2004). Pharmaceutical policies in OECD countries: Reconciling social and industrial goals. Labour Market and Social Policy, S. Occasional Papers No. 40. W, S. V., & Sidel, R. (1977 ). Primary Health care in Relation to Social Political Structure. Social Sciences and Medicine Vol. 11. Xilong, P., DibH, H., Xiaohang, W., & Hong, Z. (2006). Analysis of Service Utilization in Community Health Centers Compared with the Local Hospitals in China: a comparative analysis. BMC Health Services Research Journal, 1186/1472-6963-6-9. Zhan S, T. S., & al, e. (1998). Drug prescribing in rural health facilities in China: Implication for service quality and cost. Tropical Doctor, 42 -48. Read More