Mhc 720 Jh01 Health Care Systems Health Care In China 121307

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  • Mhc 720 Jh01 Health Care Systems Health Care In China 121307

    1. 1. Health Care In China MHC 720 Health Care Systems
    2. 2. The Irony <ul><li>While ruled by one of the most authoritarian regimes of the century and while being one of the poorest countries in the world China saw tremendous health improvements…. </li></ul><ul><li>… As it has become freer, some of the advances in health have been reversed. </li></ul>(Hesketh & Zhu)
    3. 3. Rural Cooperative Medical System (RCMS) 1950s to the 1970s <ul><li>1 st Large Nation to develop rural health insurance system </li></ul><ul><li>Priority was prevention </li></ul><ul><li>Financing relied on pre-payment </li></ul><ul><li>Universal access to health care </li></ul>http://www.nature.com/nature/journal/v441/n7092/images/441392a-i1.0.jpg
    4. 4. Rural Cooperative Medical System (RCMS) 1950s to the 1970s <ul><li>Life expectancy jumped from 35 to 65 </li></ul><ul><li>Brothels and opium dens closed </li></ul><ul><li>Elimination of flies, mosquitoes, rats, and sparrows </li></ul><ul><li>Sexually transmitted diseases, schistosomiasis, and leprosy virtually eradicated </li></ul><ul><li>Declines in recorded cases of tuberculosis & hepatitis B </li></ul><ul><li>Training of a million “barefoot doctors” </li></ul>http://www.destination360.com/asia/china/forbidden-city.php
    5. 5. Barefoot Doctors <ul><li>An army of paramedics trained in western disease control & traditional Taoist medicine </li></ul><ul><li>Hygiene and infectious disease control educators </li></ul><ul><li>Focus on the poor, rural peasant </li></ul>
    6. 6. Late 1970’s – Early 1980’s <ul><li>Urban living standards improved </li></ul><ul><li>Rural-urban disparity in health care emerged </li></ul><ul><li>Fee-for-service replaced barefoot docs </li></ul>http://www.frbatlanta.org/publica/econ_south/2005/q2/images/china-one.jpg
    7. 7. Late 1970’s – Early 1980’s <ul><li>Rural cooperatives abolished </li></ul><ul><li>Doctors and health authorities were encouraged to find private sources of income </li></ul><ul><li>In 25 years, the share of medical spending individuals jumped from 20% to 60% </li></ul><ul><li>Disproportionate investment in cities and high-tech equipment. </li></ul>
    8. 8. Late 1970’s – Early 1980’s <ul><li>State Council Controlled 30 Provinces </li></ul><ul><ul><li>71 Counties </li></ul></ul><ul><ul><ul><li>25 Townships </li></ul></ul></ul><ul><ul><ul><ul><li>14 Villages </li></ul></ul></ul></ul>http://www.jephc.com/ewebeditpro3/upload/china_map.jpg
    9. 9. 1980’s – 1990’s <ul><li>Chinese with access to state health facilities </li></ul><ul><ul><li>71% in 1981 </li></ul></ul><ul><ul><li>21% in 1993 </li></ul></ul><ul><li>1978-99: Central govt.’s share of health spending fell 32 to 15% </li></ul><ul><li>1999-China ranked # 144 out of 191 WHO member countries </li></ul>
    10. 10. Rise in Government Health Care Spending 1998 - 3.7 trillion yuan <ul><li>($ 499 billion U.S. dollars) </li></ul>2004 - 7.5 trillion yuan ( 1 trillion U.S. dollars)
    11. 11. Chinese Government's Share of National Health Care Spending, as % of Total Health Care Expenditures.
    12. 12. Current Crisis http://www.bbc.co.uk/worldservice/specials/1543_ruling_china/index.shtml
    13. 13. Causes of Current Crisis <ul><li>Decreased government support </li></ul><ul><li>Government imposed price regulation </li></ul><ul><li>Government privatized agriculture </li></ul><ul><li>Decentralization of public health system </li></ul>http://www.bbc.co.uk/worldservice/specials/1543_ruling_china/page2.shtml
    14. 14. Urban Health Care <ul><li>Escalated health care costs </li></ul><ul><ul><li>15 percent increase a year </li></ul></ul><ul><ul><li>Urban care consumes 80% medical resources </li></ul></ul><ul><li>Average length of stay increase </li></ul><ul><li>Hospital-based spending </li></ul><ul><ul><li>75 percent of health spending goes to hospital-based care </li></ul></ul><ul><ul><li>60 percent goes to pharmaceuticals </li></ul></ul>http://www.bbc.co.uk/worldservice/specials/1543_ruling_china/page6.shtml
    15. 15. Urban Health Care <ul><li>Most urban hospitals receive only about 10% of operational funds from the state </li></ul><ul><li>Remainder is generated by own revenues </li></ul><ul><ul><li>Drug sales </li></ul></ul><ul><ul><ul><li>Cost and willful over-prescription is biggest grievance of patients </li></ul></ul></ul><ul><ul><li>Medical Testing / Technology </li></ul></ul>
    16. 16. Rural Health Care <ul><li>Rural hospitals are in worse financial shape. </li></ul><ul><li>Most basic hospitals are run by governments at the township level </li></ul><ul><li>Source of funding </li></ul><ul><ul><li>Higher level of government funding </li></ul></ul><ul><ul><li>Taxes </li></ul></ul><ul><ul><li>Fees paid by farmers and businessmen. </li></ul></ul>http://www.economist.com/research/backgrounders/displaystory.cfm?story_id=3104423
    17. 17. Rural Health Care <ul><li>“ A peasant saying has it that a pig must be taken to market every time an ambulance siren wails, a year's work is ruined as soon as you sleep in a hospital bed, and if you are struck with a serious disease, 10 years of savings go up in smoke.” (Watts 5-07) </li></ul>http://iftf.typepad.com/photos/uncategorized/homeless_1.jpg
    18. 18. Rural Conditions <ul><li>Surmang is among poorest of rural China </li></ul><ul><li>No running water, electricity or roads </li></ul><ul><li>30% infant mortality rate </li></ul><ul><li>Estimated maternal mortality rate is 3000/100,000 live births </li></ul><ul><li>All births are unattended </li></ul><ul><li>Women give birth alone with animals </li></ul><ul><li>Umbilical cords are severed with an old rusty knife </li></ul><ul><li>Newborns are bathed in powdered yak dung </li></ul><ul><li>Illiteracy rate is nearly 100% </li></ul>http://www.ratnafoundation.org/images/surmang/Gary's%20Surmang%20photos%20for%20Ratna%20011.jpg http://www.surmang.org/intro.php
    19. 19. Rural Health Care <ul><li>Preventive medicine relies on fees </li></ul><ul><li>China is the only country in the Western Pacific region which relies on patients to finance childhood immunizations (World Health Organization) </li></ul>http://www.chinaembassy.org.ro/rom/xw/W020070829607486880149.jpg
    20. 20. Urban/Rural Disparity <ul><li>Guizhou's 37 million people - most of whom are peasants - can expect to live 13 years less than Beijing counterparts </li></ul><ul><li>Mothers have a 10 times greater risk of dying during childbirth </li></ul><ul><li>Infants are 5 times more likely to perish before the age of five </li></ul>http://cache.viewimages.com/xc/52255392.jpg?v=1&c=ViewImages&k=2&d=17A4AD9FDB9CF193CC300C081D9F47003ABB457FB89A6DA009EE3D65BCA33BAFA55A1E4F32AD3138
    21. 21. Urban/Rural Disparity <ul><li>Despite having only 35% of the population cities currently enjoy 80% of health resources </li></ul><ul><li>More than half of China's 1.3 billion population live in the countryside. </li></ul>http://www.bbc.co.uk/worldservice/specials/1543_ruling_china/page8.shtml
    22. 22. Urban/Rural Disparities <ul><li>Funds are disproportionately invested in the cities and on hi-tech equipment </li></ul>http: /www.guardian.co.uk/china/story/0,,2168522,00.html http: /www.guardian.co.uk/china/story/0,,2168522,00.html
    23. 23. Who Pays? <ul><li>Government healthcare spending doubled between 1998 -2004 </li></ul><ul><li>Health Insurance Covers </li></ul><ul><ul><li>Government employees </li></ul></ul><ul><ul><li>College communities </li></ul></ul><ul><ul><li>State enterprises with > 100 employees </li></ul></ul><ul><li>“ 56 % of the nation's health care costs are paid directly by patients…” </li></ul>http://english.people.com.cn/200703/02/images/yuan.jpg
    24. 24. Insurance Coverage <ul><li>Gongfei yiliao </li></ul><ul><ul><li>Government Employee Health Insurance </li></ul></ul><ul><li>Laobao yiliao </li></ul><ul><ul><li>Labor Health Insurance </li></ul></ul><ul><ul><li>Self paying </li></ul></ul><ul><li>Uncovered </li></ul><ul><ul><li>Unemployed </li></ul></ul>
    25. 25. Consequences <ul><li>90% of rural population is uninsured </li></ul><ul><li>Nearly 60% of urban population have no coverage </li></ul><ul><li>Some 60% of rural residents avoid hospitals altogether because of the expense </li></ul><ul><li>Out-of-pocket spending on health care is soaring. </li></ul>
    26. 26. Consequences <ul><li>Lack of Health Coverage </li></ul><ul><ul><li>Elderly </li></ul></ul><ul><ul><li>Rural Dwellers </li></ul></ul><ul><li>Over 1/3 who fall ill do not seek care due to inability to pay </li></ul><ul><li>TB, syphilis and rabies on the rise again </li></ul><ul><li>Hong Bao </li></ul><ul><ul><li>“ Red Packets” </li></ul></ul>
    27. 27. Current Conditions <ul><li>Doctors and nurses poorly paid </li></ul><ul><li>Level of training varies greatly </li></ul><ul><li>Specialists well-trained </li></ul><ul><ul><li>No national standardization body to assess competency such as American Boards or a Royal College </li></ul></ul><ul><li>Hospital director earns about the same as a company sales representative </li></ul>http://www.jokes.org.au/useimages/user756_1179386167.jpg www.gac-china.com
    28. 28. Current Conditions <ul><li>17,000 major hospitals in China </li></ul><ul><li>48,000 smaller &quot;township&quot; hospitals </li></ul><ul><li>3.6 million hospital beds nationwide 170 medical schools and educational institutions </li></ul><ul><li>120 biomedical research institutions </li></ul><ul><li>Variety of national organizations representing hospitals and physicians </li></ul>http://english.people.com.cn/200501/06/images/0105_C91.jpg
    29. 29. Hospital Conditions <ul><li>1/2 babies born in China are delivered by caesarean section, partly because doctors make more money that way. </li></ul><ul><li>China is one of the few countries in the world with more doctors than nurses, despite research suggesting nurses provide more cost-efficient services. </li></ul>http://www.guardian.co.uk/china/story/0,,2168522,00.html
    30. 30. Guiyang city, Guizhou province: A woman extracts a client's tooth at her stand offering dentistry services on a pedestrian overpass in Guizhou's capital. Dental health is not a high priority to many low-income Chinese people, who are not covered by medical insurance http://www.guardian.co.uk/news/gallery/2007/jul/10/internationalnews?picture=330175082 Care for the Uninsured
    31. 31. Prescription Drug Sales http://www.guardian.co.uk/news/gallery/2007/jul/10/internationalnews?picture=330166411 Barefoot Doctor Hua Wanxiang recently shut his clinic and opened a shop selling groceries alongside medicines The sale of medication now accounts for half of hospital incomes, which has led to suspicions of over prescribing http://www.guardian.co.uk/news/gallery/2007/jul/10/internationalnews?picture=330166435
    32. 32. Prescription Drug Sales <ul><li>Privatized medicine is blamed for rampant over-prescription </li></ul><ul><li>New strains of TB and other diseases that are resistant to antibiotics </li></ul><ul><li>&quot;I prescribe penicillin more than any other drug,&quot; says Hua, who charges 2 yuan for each injection. </li></ul><ul><ul><li>“ I mostly recommend it for rheumatoid arthritis. A lot of villagers suffer from that.&quot; </li></ul></ul>http://www.patentdocs.us/photos/uncategorized/2007/08/13/prescription_drugs.jpg
    33. 33. Disparities Causing Anger <ul><li>“ 5,500 medical workers were injured last year in assaults and protests” (Watts) </li></ul>
    34. 34. The Positive <ul><li>Response to SARS </li></ul><ul><li>Life expectancy continues to increase </li></ul>http://chinadigitaltimes.net/thumbnail/xin_50120327083115505441.jpg
    35. 35. Comparison With United States http://www.who.int/countries/chn/en/ $41,950 $6,600 Gross national income per capita 298,213,000 1,323,350,000 Total population Per capita total expenditure on health at international dollar rate Total expenditure on health as percentage of gross domestic product $6096.2 $276.7 15.4% 4.7% U.S. CHINA
    36. 36. Socialist Collectivist Privatized Decentralized
    37. 37. The Future
    38. 38. <ul><li>“ Americans have a huge stake in the wisdom and ingenuity with which China’s leaders approach their country’s health care challenges. In an age of terrorism, SARS, avian influenza, and HIV, no country is a health care island unto itself.” (Blumenthal and Shiao, p. 170) </li></ul>http://www.bbc.co.uk/worldservice/specials/1543_ruling_china/page4.shtml
    39. 39. Questions
    40. 40. Sources Blumenthal, David, M.C., M.P.O. and William Hsiao, Ph.D. (2005, September 15) The New England Journal of Medicine.Privatization and Its Discontents – The Evolving Chinese Health Care System. http://content.nejm.org/cgi/content/full/353/11/1165 The Economist. Where are the patients? (2004August 19) http://www.economist.com/research/ backgrounders/displaystory.cfm?story_id=3104423 Hesketh, Therese. & Zhu, Wei Xing. Effect of Restricted Freedom On Health in China. BMJ Publishing Group Ltd. (2004 December 18) http://www.bmj.com/cgi/content/full/329/7480/1427 Liu, Yuanli (2004) Development of the Rural Health Insurance System in China. Health Policy and Planning. http://www.heapol.oxfordjournals.org/cgi/reprint/19/3/159.pdf
    41. 41. <ul><li>Meng-Kin Lim, Hui Yang, Tuohong Zhang, Wen Feng and Zijun Zhou. Public Perceptions Of Private Health Care In Socialist China. Health Affairs, 23, no. 6 (2004): 222-234. http://content. Health affairs .org/cgi/content/abstract/23/6/222?ijkey=e0c45d2d9c36b85b7d bcd35f4f69bd9213bbcd8& keytype2=tf_ipsecsha </li></ul><ul><li>Moreton, MD Michael J Healthcare in China (retrieved December 1, 2007) http://www.med hunters.com /articles/healthcareInChina.html </li></ul><ul><li>Powell, Alvin. Vice minister Huang details advances, problems, reforms; Health care reform in China discussed. Harvard Gazette Harvard News Office (2005 September 15) http://www.hno.harvard.edu/ gazette/2005/09.15/09-china.html </li></ul><ul><li>Watts, Jonathan. Ailing system leaves sick to pay up or die (2007 September 14) Guardian Unlimited. http: //www.guardian.co.uk/china/story/0,,2168522,00.html </li></ul>Sources, 2
    42. 42. <ul><li>Watts, Jonathan. Chinese hospital staff face attacks amid high prices and dubious care . Guardian Unlimited (2007 May 12) http://www.guardian.co.uk /china/ story/ 0,,2078 004,00.html </li></ul><ul><li>Wong, B. & Gabriel S. The Influence of Economic Liberalization on Urban Health Care Access in the People’s Republic of China. (retrieved November 21, 2007) http://www.mtholyoke.edu /courses/ sgabriel/chinahealth.htm </li></ul><ul><li>World Bank Group, Curing China’s Ailing Health Care System. Beyond Transition. The Newsletter About Reforming Economies (2001)http://worldbank.org/html/prddr/trans/aprmayjun03/pg9.htm </li></ul><ul><li>Xingzhu Liu1, Yuanli Liu2 and Ningshan. The Chinese experience of hospital price regulation Chen Health Policy and Planning . Oxford University Press (2000 June15) http://heapol.oxfordjournals .org/cgi/content /abstract/15/2/ 157?ijkey =f1c8fea548077429a8e35288812b2943fb3aaa93&keytype2=tf_ipsecsha </li></ul>Sources, 3

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