Healthcare in China consists of both public and private medical institutions and insurance programs. About 95% of the population has at least basic health insurance coverage. Despite this, public health insurance generally only covers about half of medical costs, with the proportion lower for serious or chronic illnesses. Under the "Healthy China 2020" initiative, China is currently undertaking an effort to cut healthcare costs, and the government requires that insurance will cover 70% of costs by 2017.[1][2][2] The Chinese government is working on providing affordable basic healthcare to all residents by 2020.[3]
China has also become a major market for health-related multinational companies. Companies such as AstraZeneca, GlaxoSmithKline, Eli Lilly, and Merck entered the Chinese market and have experienced explosive growth. China has also become a growing hub for health care research and development.[4]
The above applies to Mainland China. Taiwan and the Special Administrative Regions of Hong Kong and Macau maintain their own separate universal healthcare systems.
Traditional Chinese Medicine (TCM) has been practiced for years, and served as the basis for health care in China for much of its history. Western-inspired evidence-based medicine made its way to China beginning in the 19th Century. When the Communist Party took over in 1949, health care was nationalized, a national "patriotic health campaign" attempted to address basic health and hygiene education, and basic primary care was dispatched to rural areas through barefoot doctors and other state-sponsored programs. Urban health care was also streamlined. However, beginning with economic reforms in 1978, health standards in China began to diverge significantly between urban and rural areas, and also between coastal and interior provinces. Much of the health sector became privatized. As state-owned enterprises shut down and the vast majority of urban residents were no longer employed by the state, they also lost much of the social security and health benefits. As a result, the majority of urban residents paid almost all health costs out-of-pocket beginning in the 1990s, and most rural residents simply could not afford to pay for health care in urban hospitalities.
All major cities have hospitals specializing in different fields, and are equipped with some modern facilities. Residents of urban areas are not provided with free healthcare, and must either pay for treatment or purchase health insurance. The quality of hospitals varies. The best medical care in China is available in foreign-run or joint venture Western-style medical facilities with international staff available in Beijing, Shanghai, Guangzhou and a few other large cities. They are highly expensive; treatment there can often cost up to ten times more than a public hospital.[6] Public hospitals and clinics are available in all Chinese cities. Their quality varies by location; the best treatment can usually be found in public city-level hospitals, followed by smaller district-level clinics. Many public hospitals in major cities have so-called V.I.P. wards or gaogan bingfang. These feature reasonably up-to-date medical technology and skilled staff. Most V.I.P. wards also provide medical services to foreigners and have English-speaking doctors and nurses. V.I.P. wards typically charge higher prices than other hospital facilities, but are still often cheap by Western standards. In addition to medical facilities providing modern care, traditional Chinese medicine is also widely used, and there are Chinese medicine hospitals and treatment facilities located throughout the country. Dental care, cosmetic surgery, and other health-related services at Western standards are widely available in urban areas, though costs vary.
Historically, in rural areas, most healthcare was available in clinics providing rudimentary care, with poorly trained medical personnel and little medical equipment or medications, though certain rural areas had far higher-quality medical care than others. However, the quality of rural health services has improved dramatically since 2009. In an increasing trend, healthcare for residents of rural areas unable to travel long distances to reach an urban hospital is provided by family doctors who travel to the homes of patients, which is covered by the government.[7][8][9][10][11]
Reform of the health delivery system in urban areas of China has prompted concerns about the demand and utilization of Community Health Services Centres (CHC); a recent study, however, found that insured patients are less likely to use private clinics and more likely to use CHC.[12]
Despite the introduction of western style medical facilities and the implementation of a National Essential Drug Policy,[13] the PRC has several emerging public health problems, which include problems as a result of pollution, a progressing HIV-AIDS epidemic, hundreds of millions of cigarette smokers,[14][15] and the increase in obesity among the population.[16][17] The HIV epidemic, in addition to the usual routes of infection, was exacerbated in the past by unsanitary practices used in the collection of blood in rural areas.[18] The problem with tobacco is complicated by the concentration of most cigarette sales in a government controlled monopoly.[15] The government, dependent on tobacco revenue, seems hesitant in its response and may even encourage it as seen from government websites.[19] Hepatitis B infection is widespread in mainland China, with about 10% of the population contracting the disease.[20] Some hepatitis researchers link hepatitis infections to a lower ratio of female births. If this link is confirmed, this would partially explain China's gender imbalance.[21] A program initiated in 2002 will attempt over the next 5 years to vaccinate all newborns in mainland China.[22]
Strains of avian flu outbreaks in recent years among local poultry and birds, along with a number of its citizens, have caused great concern for China and other countries. While the virus is currently mainly animal-human transmissible (with only two well documented cases of human-human have been to the present known of to scientists), experts expect an avian flu pandemic that would affect the region should the virus morph to be human-human transmissible.[23]
A more recent outbreak is the pig-human transmission of the Streptococcus suis bacteria in 2005, which has led to 38 deaths in and around Sichuan province, an unusually high number. Although the bacteria exists in other pig rearing countries, the pig-human transmission has only been reported in China.[24]
As of 2004, in more undeveloped areas it is advised to only drink bottled water as cholera, among other diseases, is spread through the water supply. As of 2012, food and water safety remains an issue.
Another major problem are the "black ambulances", or illegal, privately run, for-profit ambulance services. As there is a shortage of ambulances belonging to hospitals in major cities, many private businessmen are now operating fleets of unauthorized ambulances, often staffed by untrained personnel and with no medical equipment, and charging the patients. Despite a government crackdown, the number of private ambulances is growing.[25]
Unaffordable medications are another gaping hole in the Chinese safety net. This forces workers to save as much as possible in order to weather family medical emergencies, which acts to depress domestic consumption, leaving no alternative to the traditional unsustainable export and investment driven economic model.[26]
A cross-sectional study between 2003 and 2011 showed remarkable increases in health insurance coverage and inpatient reimbursement were accompanied by increased use and coverage. The increases in services use are particularly important in rural areas and at hospitals. Major advances have been made in achieving equal access to insurance coverage, inpatient reimbursement, and basic health services, most notably for hospital delivery, and use of outpatient and inpatient care.[27]
Nowadays, with substantial urbanisation, attention on health care has been changed. Urbanisation offers opportunities for improvements in population health in China (such as access to improved health care and basic infrastructure) and substantial health risks including air pollution, occupational and traffic hazards, and the risks conferred by changing diets and activity. Communicable infections should also be re-focused on.
China has also become a major market for health-related multinational companies. Companies such as AstraZeneca, GlaxoSmithKline, Eli Lilly, and Merck entered the Chinese market and have experienced explosive growth. China has also become a growing hub for health care research and development.[4]
The above applies to Mainland China. Taiwan and the Special Administrative Regions of Hong Kong and Macau maintain their own separate universal healthcare systems.
Traditional Chinese Medicine (TCM) has been practiced for years, and served as the basis for health care in China for much of its history. Western-inspired evidence-based medicine made its way to China beginning in the 19th Century. When the Communist Party took over in 1949, health care was nationalized, a national "patriotic health campaign" attempted to address basic health and hygiene education, and basic primary care was dispatched to rural areas through barefoot doctors and other state-sponsored programs. Urban health care was also streamlined. However, beginning with economic reforms in 1978, health standards in China began to diverge significantly between urban and rural areas, and also between coastal and interior provinces. Much of the health sector became privatized. As state-owned enterprises shut down and the vast majority of urban residents were no longer employed by the state, they also lost much of the social security and health benefits. As a result, the majority of urban residents paid almost all health costs out-of-pocket beginning in the 1990s, and most rural residents simply could not afford to pay for health care in urban hospitalities.
All major cities have hospitals specializing in different fields, and are equipped with some modern facilities. Residents of urban areas are not provided with free healthcare, and must either pay for treatment or purchase health insurance. The quality of hospitals varies. The best medical care in China is available in foreign-run or joint venture Western-style medical facilities with international staff available in Beijing, Shanghai, Guangzhou and a few other large cities. They are highly expensive; treatment there can often cost up to ten times more than a public hospital.[6] Public hospitals and clinics are available in all Chinese cities. Their quality varies by location; the best treatment can usually be found in public city-level hospitals, followed by smaller district-level clinics. Many public hospitals in major cities have so-called V.I.P. wards or gaogan bingfang. These feature reasonably up-to-date medical technology and skilled staff. Most V.I.P. wards also provide medical services to foreigners and have English-speaking doctors and nurses. V.I.P. wards typically charge higher prices than other hospital facilities, but are still often cheap by Western standards. In addition to medical facilities providing modern care, traditional Chinese medicine is also widely used, and there are Chinese medicine hospitals and treatment facilities located throughout the country. Dental care, cosmetic surgery, and other health-related services at Western standards are widely available in urban areas, though costs vary.
Historically, in rural areas, most healthcare was available in clinics providing rudimentary care, with poorly trained medical personnel and little medical equipment or medications, though certain rural areas had far higher-quality medical care than others. However, the quality of rural health services has improved dramatically since 2009. In an increasing trend, healthcare for residents of rural areas unable to travel long distances to reach an urban hospital is provided by family doctors who travel to the homes of patients, which is covered by the government.[7][8][9][10][11]
Reform of the health delivery system in urban areas of China has prompted concerns about the demand and utilization of Community Health Services Centres (CHC); a recent study, however, found that insured patients are less likely to use private clinics and more likely to use CHC.[12]
Despite the introduction of western style medical facilities and the implementation of a National Essential Drug Policy,[13] the PRC has several emerging public health problems, which include problems as a result of pollution, a progressing HIV-AIDS epidemic, hundreds of millions of cigarette smokers,[14][15] and the increase in obesity among the population.[16][17] The HIV epidemic, in addition to the usual routes of infection, was exacerbated in the past by unsanitary practices used in the collection of blood in rural areas.[18] The problem with tobacco is complicated by the concentration of most cigarette sales in a government controlled monopoly.[15] The government, dependent on tobacco revenue, seems hesitant in its response and may even encourage it as seen from government websites.[19] Hepatitis B infection is widespread in mainland China, with about 10% of the population contracting the disease.[20] Some hepatitis researchers link hepatitis infections to a lower ratio of female births. If this link is confirmed, this would partially explain China's gender imbalance.[21] A program initiated in 2002 will attempt over the next 5 years to vaccinate all newborns in mainland China.[22]
Strains of avian flu outbreaks in recent years among local poultry and birds, along with a number of its citizens, have caused great concern for China and other countries. While the virus is currently mainly animal-human transmissible (with only two well documented cases of human-human have been to the present known of to scientists), experts expect an avian flu pandemic that would affect the region should the virus morph to be human-human transmissible.[23]
A more recent outbreak is the pig-human transmission of the Streptococcus suis bacteria in 2005, which has led to 38 deaths in and around Sichuan province, an unusually high number. Although the bacteria exists in other pig rearing countries, the pig-human transmission has only been reported in China.[24]
As of 2004, in more undeveloped areas it is advised to only drink bottled water as cholera, among other diseases, is spread through the water supply. As of 2012, food and water safety remains an issue.
Another major problem are the "black ambulances", or illegal, privately run, for-profit ambulance services. As there is a shortage of ambulances belonging to hospitals in major cities, many private businessmen are now operating fleets of unauthorized ambulances, often staffed by untrained personnel and with no medical equipment, and charging the patients. Despite a government crackdown, the number of private ambulances is growing.[25]
Unaffordable medications are another gaping hole in the Chinese safety net. This forces workers to save as much as possible in order to weather family medical emergencies, which acts to depress domestic consumption, leaving no alternative to the traditional unsustainable export and investment driven economic model.[26]
A cross-sectional study between 2003 and 2011 showed remarkable increases in health insurance coverage and inpatient reimbursement were accompanied by increased use and coverage. The increases in services use are particularly important in rural areas and at hospitals. Major advances have been made in achieving equal access to insurance coverage, inpatient reimbursement, and basic health services, most notably for hospital delivery, and use of outpatient and inpatient care.[27]
Nowadays, with substantial urbanisation, attention on health care has been changed. Urbanisation offers opportunities for improvements in population health in China (such as access to improved health care and basic infrastructure) and substantial health risks including air pollution, occupational and traffic hazards, and the risks conferred by changing diets and activity. Communicable infections should also be re-focused on.
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