The healthcare systems of the United States and China are compared in the document. Both countries spend a significant amount on healthcare, but the United States spends more as a percentage of GDP. The United States does not have universal healthcare, while China has three systems that provide coverage to over 90% of its population. General health issues are also similar between the two high-income countries, with heart disease and cancer among the leading causes of death. Suggestions to improve both systems include increasing access and affordability in the United States and addressing inequalities between rural and urban areas in China.

1. Running head: China 1
Research Paper: China
Alexandria Amici
HCS 400.3OL: Healthcare Systems and Policy
Professor Lewis
2/17/17

2. China 2
The health care systems in the United States and China have different aspects that bring
the system together and make it what it is today. The costs, accessibility and policies differ
among the two countries. The amount of money spent on the health care services vary between
the two countries. The general health issues of the countries prove to be similar to one another
as they are both high income countries. There are similarities and differences between the two
systems. There are strengths and weaknesses to each system as well. The healthcare systems of
the United States and China both have improvements that can be made and issues that need to be
addressed.
There are different aspects of the United States Healthcare system that summarize exactly
what it is and how it works. Health care spending in the United States is much higher than other
high income countries such as China. “Even though the U.S. is the only country without a
publicly financed universal health system, it still spends more public dollars on health care than
all but two of the other countries”(Brotherton 2014). Americans have less hospital admissions
than most of the world and have less overall doctor’s appointments. Even with this in mind, the
United States still spends a larger amount of money on various technologies than other countries.
Examples of the different expensive technologies physicians in America use are MRIs, CAT
scans, and X-Rays. Even pricing for different health care needs is relatively expensive in the
United States. “Data from the OECD show that the U.S. spent 17.1 percent of its gross domestic
product (GDP) on health care in 2013. This was almost 50 percent more than the next-highest
spender (France, 11.6% of GDP) and almost double what was spent in the U.K. (8.8%)”
(Brotherton 2014). The United States also has huge issues when it comes to accessibility in
health care.

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There are barriers to accessing health care in America certain communities, especially
ones of low socioeconomic status. Different discrepancies within health care systems have a big
impact on the health of those in the public. Quality of healthcare also affects an individual’s
ability to lead a healthy life style. If the quality and accessibility of health care is difficult, then
individuals find trouble doing daily life activities and they cannot be their best self. “Barriers to
services include lack of availability, high cost, and lack of insurance coverage. These barriers to
accessing health services lead to unmet health needs, delays in receiving appropriate care,
inability to get preventive services, and hospitalizations that could have been prevented”(Squires
2017). The United States also has several health care policies set in place to try to achieve the
best overall amount of health care coverage in the country. An example of a good policy includes
the pre existing conditions initiative. This policy states that an individual cannot be turned away
due to a pre existing condition. This is one success factor in our health care system. The Chinese
health care system does not have direct policies, but a healthcare system organized into three
different systems.
The amount of money China spends on healthcare is relatively high, but not as much as
the United States. “Health care spending in China is increasing rapidly. According to a Deloitte
report released in 2015, the country’s annual expenditure is projected to grow at an average rate
of 11.8 percent a year in 2014-2018, reaching $892 billion by 2018” (Health care for 1.3 billion.
An overview of China’s health system 2012). Spending is increasing due to the increasing
income of citizens in China. China has two different types of citizens. The systems are based and
developed off of these two different groups of citizens in China. In the 1970s, the health care
system did fail and leave a large amount of the population uninsured. The Chinese government
has created three systems for both the urban and rural areas, which give coverage to more than

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90% of the population (Health care for 1.3 billion. An overview of China’s health system
2012). The systems do however give more assistance to the individuals in urban areas. “In 1998
was set the Urban Employees’ Basic Medical Insurance System. This was the first step in
re‐ establishing the health insurance system in urban areas. The Urban Employees Basic Medical
Insurance (UEBMI) is compulsory based on employment” (Health care for 1.3 billion. An
overview of China’s health system 2012). This policy helps employees in the urban areas receive
healthcare coverage that provides for basic medical needs. The deductibles, copayments, and
reimbursement payments are based on the average income of the employees in that said area. “In
2007, the State Council issued guidelines to launch the Urban Residents Basic Medical Insurance
(URBMI). According to the guidelines, the URBMI covers primary and secondary school
students who are not covered by the UEBMI (including students in professional senior high
schools, vocational middle schools, and technical schools), young children, and other
unemployed urban residents on a voluntary basis”(Nofri 2015). These guidelines provide
coverage for urban citizens who do not have a permanent place of employment. Rural health
coverage was rare because the citizens in that area had low socioeconomic status. Due to this, the
New Rural Cooperative Medical Insurance was developed. NRCM was developed for those
living in these areas. “In 2010, the NRCM covered more than 90% of all rural residents. The
NRCM was funded by premiums from both the insured and by subsidies from the local and
central governments” (Nofri 2015). This was the first example of the Chinese government using
its money to help pay for a healthcare policy. There are however very little comparisons between
the health care systems in China and The United States.
The healthcare systems of the United States and China have very little comparison to one
another. Both are high income countries with high spending on healthcare. Heart disease is

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among the list leading causes of death in both countries. It is the first leading cause of death in
the United States and the second leading cause of death in China. China is beginning to have
more modern health problems similar to high income countries such as United States. “China is
now facing similar health issues to higher income countries including the UK and US, according
to new global health figures”(Nofri 2015). Health problems such as smoking and high blood
pressure are becoming a more frequent issue. It is said that over half of Chinese men smoke
which is one of the highest rates in the world (Nofri 2015). Unhealthy life styles and cancer are
of concern in China similar to that of the United States who has issues in obesity and healthy life
styles. Cancer is also extremely prevalent in the United States. Both countries do however
provide the majority of their populations with health coverage thanks to new reforms made by
the government.
The healthcare systems in the United States and China experience more contrasting
aspects than comparisons. “China has now achieved universal coverage, since 1.295 out of
1.3397 billion people — fully 95% of the population — have health insurance, and out-of-pocket
spending is 35.5% of total expenditure on health”(). The United States does not have universal
health care. China spends much less money on healthcare than the United States, even if they do
have high spending. The United States is one of the worst in the world. Even though the U.S. is
the only country without a publicly financed universal health system, it still spends more public
dollars on health care than all but two of the other countries().China has three systems for its
health care coverage in specifically rural and urban areas. The United States has one overall
health care system with many different policies involved. As stated in the summary of United
States health care, the United States spends large amounts of money on high technologies in the
medical field. In contrast to China, the United States dedicates a small part of its economy to

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social services, such as housing assistance, employment programs, disability benefits, and food
security().Even though the United States has high spending in health care, it still has the worst
outcomes when it comes to the treatment of illnesses and a low life expectancy. Mortality rates
from cancer are low and have fallen more quickly in the United States than in other countries.
This being said, the United States health care system had strengths and weaknesses along with
China’s health care system.
There are various strengths and weaknesses in the healthcare system of the United States.
The health care reform allows for everyone to have health care coverage. However, the costs of
health care in the United States are outrageous. Also, there are weaknesses to the high spending
the government uses on the United States health care system. “High health care spending has far-
reaching consequences in the U.S. economy, contributing to wage stagnation, personal
bankruptcy, and budget deficits, and creating a competitive disadvantage relative to other
nations”().The healthcare system in China has its own strengths and weaknesses like the United
States. Strengths are that China has achieved universal healthcare coverage. Still, there are health
inequalities between rural and urban areas. Another weakness is that china has a huge health care
coverage gap due to aging population, growing urbanization, proliferating lifestyle diseases,
rapidly increasing consumer wealth, and the advancement of universal health care insurance().A
strength is that the Chinese government gives strong support to its healthcare system and
provides it with heavy investment. There is a registration system in china that makes the
distribution of health care uneven and sometimes unfair. The system separates rural and urban
residents thanks to this household registration, which is called hukou (). It can be assessed that
the rural residents are not taken care of as much as urban residents due to their poor
socioeconomic statuses. Therefore, the financing systems are different for each household of

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residents. This is a weakness because it affects the general health of the public in the rural
household system.
General health issues of the people in the United States and China are starting to become
much similar. Life expectancy in the United States is 78.74 years. Life expectancy in China is
lower than that of the United States at 75.2 years. Most common health problems in the United
States includes Overweight and Obesity which causes its own problems of increasing your
chances of dying from hypertension, type 2 diabetes, coronary heart disease, stroke, gallbladder
disease, osteoarthritis, sleep apnea, respiratory problems, dyslipidemia and endometrial, breast,
prostate, and colon cancers (Top Ten Most Common Health Issues 2017).China’s health
problems involve Smoking because of the high amount of the population that smokes. Women’s
health care proves to be an issue in China as well including Sex education and contraception.
Other health problems include Hepatitis B, HIV, AIDS, Tuberculosis, Leprosy and Mental health
(Adetunji 2013). Unfortunately because China was more underdeveloped than the United States
tuberculosis and leprosy were still an issue, but not as much anymore thanks to China’s
modernization. Leading death causes in the United States is heart disease. China’s leading cause
of death is malignant neoplasm or tumor that spreads rapidly and destroys the body, while heart
disease is a close second (Adetunji 2013). This shows that the leading health causes in both
countries are relatively similar when it comes to general health. Even life expectancies are close
in age to one another.
Suggestions to improve the healthcare system in China include changes among the
government ideas of health care. “In April, 2009,the China Central Communist Party along with
the China State Council announced a comprehensive healthcare reform initiative and issued a
new healthcare reform plan named ‘Implementation Plan for Deepening Pharmaceutical and

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Health System Reform 2009-2011’”(Adetunji 2013). The government developed five key reform
priorities for the first three years of the reform: accelerating the expansion of the basic health
insurance system; establishing a national essential drug list system; improving primary health
care services through a renewed system of grassroots providers; promoting the equalization of
basic public health services; and facilitating pilot reform programs in public hospitals(). China’s
health reforms also recognize the need to improve innovations throughout the system. For
example, an important aspect of plans to strengthen primary care is improving the performance
appraisal system for health workers in government-owned primary care organizations.
Suggestions to improve the healthcare system in the United States involve trying to improve
the cost and providing better access. Increasing the quality of the health care systems needs to
assure patients of a usual and ongoing source of care for them. People who frequently check up
with a family doctor or care physician have better health outcomes and fewer costs on their
medical bills. Developing meaningful relationships with patients is important as well. Having a
family doctor is associated with positive aspects of greater patient trust in the provider, good
patient-provider communication, and increased likelihood that patients will receive appropriate
care. The access to health care services in the United States is thought of as unreliable. “The U.S.
health care system, which is already strained, will face an influx of patients in 2014, when 32
million Americans will have health insurance for the first time”(). All of these issues make the
development of new plans and models important. Specific issues that should be improved over
the years include increasing and measuring access to appropriate, safe, and effective care,
including clinical preventive services().Access to care for diverse populations, including racial
and ethnic minorities and older adults needs to be addressed also. These improvements can have
strategies developed and carried out over the next few years.

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In conclusion, I have found that both the health care systems in the United States and China
have positive and negative aspects to their foundation. They are both high income countries that
spent an increased amount of money on their health care services. They have similar problems
when it comes to general health issues. There are differences between the two systems also.
There are differences in the cost, accessibility, and various policies. The life expectancies,
leading death causes and general health of the public in these countries also greatly affects the
success of the health care system. There are many improvements that can be made to help these
two healthcare systems achieve better success.

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References
Adetunji, J. First world problems: China’s lifestyle contributes to ill health. The Conversation.
(7 June 2013)Retrieved March 4, 2017 from http://theconversation.com/first-world-
problems-chinas-lifestyle-contributes-to-ill-health-15041
Brotherton, SE. Access to Health Services. ODPHP.(2014). Retrieved March 4, 2017 from
https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services
Health care for 1.3 billion. An overview of China’s health system. Sante et Services sociaux
Quebec(2012). Retrieved March 4, 2017 from
http://www.msss.gouv.qc.ca/ministere/observatoiresss/index.php?health-care-for-13-
billion-an-overview-of-chinas-health-system
Nofri, E. The Chinese Health Care System: How it Works and Future Trends. (13 Nov 2015).
http://www.albertoforchielli.com/2015/11/13/the-chinese-healthcare-system-how-it-
works-and-future-trends/
Squires, D. U.S. Health Care from a Global Perspective. Common Wealth
Fund.(2017).http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-
health-care-from-a-global-perspective
Top Ten Most Common Health Issues. University of Rochester Medical Center.(2017).
Retrieved March 4, 2017 from https://www.urmc.rochester.edu/senior-health/common-
issues/top-ten.aspx

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