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An Introduction of Healthcare Market in China

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A research on healthcare market in China covering topics including an introduction of Public Hospital System, Chinese Physicians' Work Condition and Salaries, as well as Continued Medical Education system.

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An Introduction of Healthcare Market in China

  1. 1. Healthcare Market in China Ziqian WANG mail@ziqianwang.net
  2. 2. Introduction of Healthcare Market in China An overview of the healthcare market The hierarchy of the medical system Public hospitals Physicians’ work condition and salaries Outpatient patient consultation Medical Insurance System in China The development of the system Universal healthcare insurance Continued Medical Education for Physicians in China CEM policy and credit system Major issues of CME activities Accreditation criteria for national CME courses Table of Contents 2
  3. 3. An overview of the healthcare market in China1 • From 2004 to 2011, healthcare market in China increased by 18% annually • The public expense on healthcare in China is still quite low, accounting for only 5% of total GDP. This percentage could increase to 6,5 – 7% by 2020. • The market is largely monopolized by the public hospitals: 44% 18% 38% Government Other organisations Private The number of public hospitals accounts for 62% over the total number The total amount of service provided by private hospitals only accounts for 9% in 2011 Only 1% of the private – owned hospitals are the so called « Tier 3A hospitals » in China 3
  4. 4. The hierarchy of the medical system in China National Health and Family Planning Commission of the PRC1 Provincial Health Commission Municipal Health Commission Tier 1 hospitals - Responsible for assessing the Tier 1 hospitals - Managed by the Provincial Health Commission - Get financed from the regional government funding Tier 3 and Tier 2 hospitals - Get financed from the regional government funding Tier 3 A+ - Responsible for assessing the Tier 3 and Tier 2 hospitals - Managed by National Health and Family Planning Commission of the PRC - Responsible for assessing the Tier 3 A+ hospitals - The top level of the health management system in China 4
  5. 5. Public hospitals in China1 • The public hospitals in China are not pure non-profit organisations (In reality) – Public funding only covers part of hospitals operational expenses – Public hospitals have to and are allowed to generate and keep the profits in order to cover all their operational expenses. – However, public hospitals have to declare the total amount of salaries as well as the bonus they distributed to doctors to Health Commissions. Health Commissions will assess this amount with other relating governmental departments to set the total amount of salaries that hospitals could distribute to doctors in the next year. The bonusdistributed under this amount is allowed. – Hospitals’ research expenses are mainly from some specific public funding, aiming at supporting the scientific researches. Hospitals can apply for these funds from the National Health Commission or from other governmental organisations. • However, in theory, China’s hospitals should be non-profit organisations, meaning that they have to distribute all their incomes back to the public funding. However, since the financial supports from the public funding are too limited, which can hardly support public hospitals’ daily operations, it has become an unspoken rule in the health system in China that public hospitals have to find their waysto generate profits in order to maintain their day-to-day operation. Different from what the public believes, many public hospitals in China are suffering from losses everyyear. • Cash generators in public hospitals – Registration fees – Treatment fees – Inspection fees – Drug sales 5
  6. 6. Classification of Chinese hospitals • In China, hospitals are classified into 3 tiers, which are Tier 1, 2 and 3. • Each tier will be further classified into three sub-tiers, which are 甲 (Jia = A), 乙(Yi = B),丙 (Bing = C). Tier 3 3 B 3 A 3 C Tier 2 2 B 2 A 2 C Tier 1 1 B 1 A 1 C Tier 3 A+2 - Comprehensive or general hospitals1 at the city, provincial or national level with a bed capacity exceeding 500. - Responsible for offering specialist service, conducting scientific research to solve major medical challenges and providing medical education for 1 and 2 tier hospitals. - Mainly national and provincial major hospitals or affiliated hospitals of major medical universities. - Regional hospitals providing medical services across several communities. - Provide medical trainings and limited medical education to tier 1 hospitals. - Hospitals mainly affiliated with medium or small cities, counties or districts in big cities. - Directly provide medical service to communities regarding disease prevention, recovering and other health care services - Township hospitals in rural areas and community hospitals in big cities - Hospitals with the most advanced facilities and able to provide medical services to the top governmental leaders - Assessed by National Health Commission Have very strong influence on lower - tier hospitals with regard to new drug publicizing Rarely exist in big cities such as Beijing and Shanghai 6
  7. 7. Chinese physicians’ work conditions and salaries1 • All physicians working at public hospitals are salariedby the hospitals. • The majority of doctors in China (88.4%) are not satisfied with their salaries; 3.8% hold neither positive nor negative opinions; Only 7.8% are satisfiedwiththeir salaries. • The doctors in Beijing enjoy the highest annual salaries on average, earning over 100,000RMB annually. Shanghai and Guangdong are number two and three, withan average of salaries over 80,000RMB annually. • Doctors’ salaries are composed of basic salaries, hospitals’ and departments’ pay for performance, dividends from pharmaceutical companies, incomes from training and researches as well as other incomes. • The top 3 factors that are believed to impact doctors’ salaries most are “hospitals’ and departments’ pay for performance”, “job titles and working years” as well as “economic context in the region”. • However, as the amount of basic salaries and pay for performance from the department and hospital in some cases is very limited, the dividends from pharmaceutical companies and the so called “red package” could be fundamental of physicians’ salaries insome hospitals. 47.70% 27.40% 17.70% 4.40% 1.60% 1.20% Basic salary Hospital Pay for Performance Department Pay for Performance Dividends from pharmaceurical companies Rev from training and research Others The composition of doctors annual salaries 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% Hospital or department bonus Job titles and working years Economic situation in the region The scale of the hospitals Workload Specialty knowledge and medical … Others 81.2% 60.4% 53.0% 44.1% 33.5% 17.5% 10.3% Main factors impacting doctors' annual salaries 7
  8. 8. Chinese physicians’ work condition and salaries1 0 1000 2000 3000 4000 5000 6000 7000 8000 9000 Cardiothoracic surgery Neurology Geriatries Gastroenteralogy Intensive Care Medicine Anesthesiology Urology Oncology Emergency Internal Medicine-Cardiovascular Stamatology Resparitory Nephrology General Surgery Infectious Disease Orthopedics Pediatrics Physical Medicine and Rehabilitation General Neurosurgery Hematology OBGYN Immunology - Rheumatology Mental health Otorhinolaryngology Imaging & radiology Endocrinology Ophthalmology Dermatology & sexually transmitted disease General medicine Surgery Traditional Chinese Medicine GPs 8898 8877 8874 8743 8636 8627 8563 8491 8454 8425 8384 8346 8328 8293 8243 8051 8000 7979 7952 7909 7836 7833 7784 7764 7755 7622 7615 7579 7510 7453 6688 5938 • The top 5 departments earning the highest annual salaries are Departments of Cardiothoracic surgery, Neurology, Geriatries, Gastroenteralogyand Intensive Care Medicine. • The bottom 5 departments earning the lowest annual salaries are Departments of Dermatology & Sexually Transmitted Diseases, General Medicine, Surgery, Traditional Chinese Medicine as well as GPs. • Moreover, nearly 73% of Chinese physicians work over 9 hours per day. • 100% of physicians working overtime at Tier 3A hospitals in big cities such as Beijing and Shanghai Ranking of the departments by annual salaries/ Euros2 27.0% 67.5% 4.9% 0.5% below 8 hrs 9 - 12 hrs 13 - 16hrs over 16hrs Physicians’ working hour per day 8
  9. 9. Outpatient consultation in China Step 1 •The patient can briefly explain his/her health problems to the nurse at the consultation desk, who will provides guidance on to which departments of specialties patients could go for consultation. However, the final decision will be made by patients. (Optional) Step 2 •The patient asks an appointment with the physicians they would like to visit and pays for the registration fees Step 3 •If it was the first time that the patients come to this hospital, they have to buy a consultation notebook used for physicians only in this hospital to write down patients’ medical records (This notebook cannot be used across different hospitals) Step 4 •Waits for the consultation according to the time range given on the registration ticket Step 5 •After the consultation, physicians will give the prescriptions to patients. Step 6 •Patients pay for all medicines on the prescriptions in the hospital and take the invoice. Step 7 •Go to the medicine collection desk in the hospital to collect all their medicines with the invoice. Issue 1: In China, patients don’t go through the process for the consultation with GPs and approach to the specialties according to their guidance. In fact, they ask the appointments with some specialties based on the understanding of their own illness, leading to the waste of professional resources in many regards: - Go to specialties to deal with issues that GPs could deal with - Approach the wrong specialties due to the wrong conception on their own diseases Issue 2: Limited Professional Resources vs Extremely High Demand - The top physicians are highly concentrated in a few Tier 3A hospitals in some big cities such as Beijing and Shanghai. Patients coming from all the other regions in the country plunge into this limited number of hospitals. Issue 3: - The consultation fees in China are very low, normally ranging from 3-70RMB in public hospitals, an equivalent of 0,35 – 8,25 euros. Due to the lack of public funds from the gov and the very low consultation fees, many public hospitals true to drugs to increase their profits. 9
  10. 10. Introduction of Healthcare Market in China An overview of the healthcare market The hierarchy of the medical system Public hospitals Physicians’ work condition and salaries Outpatient patient consultation Medical Insurance System in China The development of the system Universal healthcare insurance Continued Medical Education for Physicians in China CEM policy and credit system Major issues of CME activities Accreditation criteria for national CME courses Table of Contents 10
  11. 11. The development of the medical insurance system in China • 1950s - 1970s: 1 – Half a billion people – Most of them are young – 36% age less than 15 – 80% rural – 1/3 Illiterate – Living absolutely in poverty – Rural residences have access to basic health services under cooperative medical schemes – Urban: work unit based health insurance either through the Labor Insurance System or the Government Insurance System • 1980s – 1990s: – Urban area: implementation of user fees as public funding declined – Rural area: the dissolution of rural cooperatives and association of cooperative medical schemes with the radicalism of the Cultural Revolution caused insurance coverage levels in rural areas to drop to 7% of counties by 1999 – The majority of China’s population did not have health insurance between 1980 and 2000 – Supply-side subsidies typically covered less than 10% of provider expenses, with the remainder earned through fee- for-service payment from uninsured patients. • Nowadays: – A population of 1,3397bn by 2010 • Aging: 13,3% over age 60 and only 16,6% below age 15 • Half (49,7%) urban; 96% literate Demographic change: 11
  12. 12. The development of medical insurance system in China • The transition of disease burden in China – China’s primary burden of disease has shifted definitively from infectious to chronic non- communicable disease – However, the burden for some infectious diseases such as TB remains large – Cancer, heart conditions and cerebrovascular diseases are now top killers – Hypertension is the leading preventable risk factor for premature mortality in China, accounting for 2,33 deaths in 2005 – By in 2007 – 2008, the age-standardized prevalence of diabetes among adults in China was 9,7 percent, with the majority of patients undiagnosed and untreated – China’s health system faces the challenge of transitioning from focus on acute care and control of communicable disease to a system supporting prevention and cost-effective management of chronic disease 12
  13. 13. Universal Healthcare Insurance System Urban Residence Urban Workers Rural Residence Other Healthcare Insurance Overview of China’s Universal Healthcare Insurance System Population Coverage: 237 million Population coverage rate in 2010: 97% Target people: Urban workers and retiring workers Population coverage: 194 million Population coverage rate in 2010: 97% Target people: Children, students, unemployed urban residence Population coverage: 836 million Population coverage rate in 2010: 95% Target people: farmers Population coverage: 2600 million Population coverage rate: 100% Target people: civil servants and soldiers 13
  14. 14. Structure of the universal healthcare insurance system in China1 A Tax Public Fiscal Budget Public Health Service Bed expense, inspection expense, drug expenses, treatment costs, proportion of import organ or organ transplanting expense and other expenses - Working employees: - Personal contribution: 2% wage per month - Enterprises contribution: 6% wage per month - The retired: Don’t need to contribute any more Urban comprehensive medical care scheme Personal contribution + 30% enterprise contribution 70% enterprise contribution Individual Account Society Plans Outpatient expenses or under deductible line or according to lists of illnesses Inpatient expenses or above deductible line or according to lists of illnesses Contributions from farmers : Minimum 50RMB (€6) annually per person since 2012 Contribution from village commission : Minimum 240MB (€29) annually per person since 2012 New rural cooperatives medical services Basic medical care and Prophylaxis B C A: Civil Servants & Staff working for public institutions B: Urban workers, C: Rural Residence 14
  15. 15. Healthcare insurance policies in China • All the health care insurance funds are administrated by provincial governments, leading to an issue that patients have to pay by their own money for all health care costs and cannot get immediate reimbursement. Sometimes, the reimbursement across provinces can delay by several months. • The health care insurance policies vary by cities, for example the threshold of the amount that patients can get reimbursed. It mainly depends on the local economic context. • Health care insurance policies in Beijing: – Both industries and public organisations have to pay the medical expenses by individuals until the expenses reach a threshold (varies by tiers of the hospitals). Patients can get reimbursement when their medical expenses are over this amount. – The part of medical expenses covered by Universal health insurance system will be paid by hospitals first. And hospitals will get reimbursed afterwards. Hospital Types Medical Expenses Individual Insurance Tier 3 X - 10 000 80% 20% 10 000 - 30 000 85% 15% 30 000 - 40 000 90% 10% Over 40 000 95% 5% Tier 2 X - 10 000 82% 18% 10 000 - 30 000 87% 13% 30 000 - 40 000 92% 8% Over 40 000 97% 3% Tier 1 X - 10 000 85% 15% 10 000 - 30 000 90% 10% 30 000 - 40 000 95% 5% Over 40 000 97% 3% Health insurance policies for urban workers in Beijing This is the health care insurance policies for Urban workers in Beijing (Group B in the graph on the previous page). However, the percentage of reimbursement for this group of people may be a little different from what it is shown here. The health insurance policies to the public institution workers and civil servants as well as that to rural residences are different from this one. 15
  16. 16. Introduction of Healthcare Market in China An overview of the healthcare market The hierarchy of the medical system Public hospitals Physicians’ work condition and salaries Outpatient patient consultation Medical Insurance System in China The development of the system Universal healthcare insurance Continued Medical Education for Physicians in China CEM policy and credit system Major issues of CME activities Accreditation criteria for national CME courses Table of Contents 16
  17. 17. CME policy in China • All the doctors and nursesin China are obliged to participate in continuing medical education • Accreditation distributingauthorities: National CME committees and Department of CME (provincial or municipal) • Overallstructure of CME system in China The Ministry of Health The Bureau of Health (Provincial) The Board of Health (Regional) Steering Committee of CME (1996) Academic Subgroups Department of CME Academic Subgroups CME Bases Office of CME Office of CME (Hospital) Chinese Medical Association • Overall Planning & Policy Making • Approving State Level CME Courses • Organizing the Development of Teaching Materials • Managing Distance Learning System • Evaluating & Instructing • Local Planning • Approving Provincial Level CME Courses • Managing CME Bases • Evaluating & Instructing • Implementing CME Programs • Running the CME Base • Courses Arrangement • Managing Credit • Organizing Hospital Level CME Courses • Running the CME Base • Services 17
  18. 18. CME Credit System in China • According to the policy issued by Chinese National Health Commission, all doctors and nurses are obliged to earn at least 25 credits annually, including 5-10 credits in category I and 15 – 20 credits in category II. Doctors working in health care organisations on provincial or municipal levels have to pass the exams and earn at least 10 credits from CME programme on national level. Credits in Category I and Category II are not interchangeable. • Credit Categories: – CategoryI: 1. National CME programme: programmes assessed, authorized and published by national CME commission ; programmes applied by national CME organisations and published by national CME commission. 2. Provincial CME programme: programmes assessed, authorized and published by provincial CME commission; programmes applied by provincial CME organisations and published by provincial CME commissions; programmes applied by the sub – associations of Chinese Medical Association, Chinese Stomatological Association, Chinese Preventive Medicine Association, Chinese Nursing Association, Chinese Hospital Association and Chinese Medical Doctor Association and authorised by the associations mentioned above 3. Promotional programmes: programmes aiming at providing healthcare workers with professional trainings designed for emergency events and other necessary trainings such as those on professional ethics in the industry; programmes authorised by national health commission and provincial health commission. – Category II: self – study, publishing medical papers, conducting medical researches and other academic activities. 18
  19. 19. CME credit system in China • Category I: • Category II: – Self – study on relevant specialties: reflections reviewed and authorised by the dean of the department in the hospital are eligible for crediting. 1pt = 2000 characters – Self – study on materials including magazines as well as video and audio materials drawn up by national CME commission or provincial CME commissions, the credits are assigned according to crediting policy set by the commission. – Papers published: • Foreign publications: 10 – 8 credits • National publications: 6 - 4 credits • Provincial publications: 4 – 2 credits • Internal publications: 2 – 1 credits Participants Key speakers National Programmes 1pt = 3hr 2pt = 1hr Provincial Programmes 1pt = 6hr 1pt = 1hr National eLeaning Programmes 1pt = 3hr 19
  20. 20. CME credit system in China – Authorized scientific medical researches: credits will be assigned to researchers based on their ranking in the scientific researches by their responsibilities: • National researches: Ranking: 1, 2, 3, 4, 5 – Credits: 10, 9, 8, 7, 6 • Provincial researches: Ranking: 1, 2, 3, 4, 5 – Credits: 8, 7, 6, 5, 4 • Municipal researches: Ranking: 1, 2, 3, 4, 5 – Credits: 6, 5, 4, 3, 2 – Publish medical literary work • Reports on international and national medical conferences: 1pt – 3000 characters • Publish medical translating articles: 1pt – 1500 characters – Scientific conferences, instruction on operations and promotion of new technologies organised by the health organisations where health workers work: (Participants can only be granted up to 10pts per year) • Speakers: 2pt – 1 time • Participants: 0,5pt – 1 time – Clinical Pathology Symposium, case study organised by several departments: (participants can only be granted up to 10pts per year) • Speaker: 1pt – 1 time • Participants: 0,5pt – time – How credits assigned in eLearning medical education is based on the specific regulation set by provincial or municipal health commissions. • Authorised medical training in superior medical organisations (including training abroad) over 6 months: – If the concerning people pass all necessary exams, it is regarded that they get all the required 25 credits in the year. 20
  21. 21. Credit registrations and distribution of CME medical certificates • Creditsregistrations: – The organisers of the programmes grant credits to the participants. Participants’ working organisations are responsible for registration. – Provincial and municipal health organisations are responsible for printing and distributing the CME registration cards or implementing the electronic information system, both of which should include the CME programme number, data, name of the programme, entities of the concerning organisations, credits, results as well as the corporate stamps. The registration cards should be under the management of physicians or nurses themselves and could be used as the proofsfor their enrolment of the CME activities. – Organisations responsible for CMEs should make a record of participants’ performance and the total number of credits they earn. This record should be taken as one of the most important criteria in the annual appraisal. The qualification of CME should be the prerequisites amid of the recruiting, promotion, and re- registration. • Supervision on creditsregistrations: – Certificates to national and provincial CME programmes are made respectively by national or provincial CME committees. Authorized associations or organisations could also make such certificates, but based on the format regulated by the national CME committee. – Regarding the certificates to Distance Learning of CME in category I, organisers should first provide participants with relevant learning materials. After the materials have been evaluated by the Department of CME on provincial level, the Department could grant the certificates to the concerning participants. – The CME activities, which are organised on national level or by the authorized associations and are published by the national health commission, should be under the supervision of the Department of CME in the particular province where the events are held. The organisers are obliged to report the CME materials to the Department. 21
  22. 22. CME coverage in China • The coverage rate of CME has reached 85% by 2010, successfully achieving the goal of the 11th 5-year national plan in China. It is expected that this rate will reach 100% by 2015 according to the 12th 5-year national plan. 1 • It is also expected that the rural doctors’ pass rate in CME could reach 80% by 2015, and this rate could reach 70% for those in remote rural areas or in western part of China. • Until the end of 2011, there were up to 750,000 health workers are enrolled into the national Distance Leaning2 CME programmes. Alongside the national programmes, over 3,000,000 health workers participate into the provincial or municipal Distance Leaning CME activities.3 • According to a survey, 95% of clinical health workers say that Internet CME is the most preferred way forthem to get involved into the CME activities. 3 • To develop Distance CME activities in China: – Only five units are licensed by the Chinese Ministry of Health for the Distance Learning of CME. (National Level of distance CME activities)4 – Credits earned on Internet CME websites that are authorised on provincial or municipal level may be authenticated in other provinces or cities. 70% 80% 90% 100% Y2010 Y2015 85% 100% 22
  23. 23. Distance CME activities • Internet CME courses • Satellite transmission 23
  24. 24. 618 554 357 224 203 137 118 111 110 92 85 83 4 4 0 Geography Distribution of CME Courses,2009 Major issues of the current CME systems – Imbalance Development Among Different Provinces 24
  25. 25. Major issues of the current CME systems Major complains to CME course among 700 physicians in Beijing • Monotonous content • Few consideration of the differences in physicians’ knowledge level • Backward teaching methods • Outdated knowledge • Few apply of educational theories • Insufficient of patient – centred related courses • Challenges in Rural Area – Staff aging: Transform from barefoot doctor; Lack of staff recruiting – Low academic level – Geographically dispersed 0% 5% 10% 15% 20% 25% 30% Not related to current clinical practice Low accessibility to Base Course out of date Dull teaching methods 26% 24% 14% 10% 25
  26. 26. Accreditation criteria for national CME courses • The prerequisite requirements to apply for the national CME courses (the courses must fulfil one of the requirements below): Category I CME courses – Courses introduce the most advanced in the field with China or around the globe – The latest progress of interdisciplinary – The introduction and the publicisation of the advanced international technology or research results; Or the introduction and publicisation of the advanced technology or research results in China. – Training and programmes designed for coping with the public health emergencies or fulfilling the key demands emerged amid the revolutionary developments of the Chinese health system. – Courses could compensate for the blank in a field in China and focuses on a technology or method that could generate significant social and economic benefits • Eligibility for candidates to apply for developing the national CME courses – Health medical, educational and scientific organisations could apply for developing the national CME courses by following the application procedure. Other organisations have to first get the application eligibility first from the National CME Committee. – People in charge of the national CME courses should have Deputy Senior professional positions. The programmes for which they are responsible should be related to their specialties. One person can apply for at most 2 national CME courses under his/her charge in the same year. 26
  27. 27. Accreditation criteria for national CME courses • Procedure to apply for the national CME courses – The organisation should first hand in the application forms to the provincial or municipal CME committees. After the assessment, the provincial or municipal CME committees will recommend the CME programmes to national CME committees. – Associations already having the qualifications to apply for the national CME courses, such as Chinese Medical Association, Chinese Stomatological Association, Chinese Preventative Medicine Association, Chinese Nursing Association, Chinese Hospital Association, Chinese Medical Doctor Association and the CME Committee of Health of Ministry, should hand in their proposals of the next year CME courses to National CME Committee; The affiliated organisations of National Health Commission should directly apply for the next year CME courses to National CME Committee. – Programmes initiated by National CME Committee, National Health and Family Planning Commission of PRC in the need for the public health emergencies and revolutionary development for Chinese health system should be directly applied to National CME Committee. – The eligibility for the accreditation of the national CME courses is 2 – year. If the courses are held in the second year, the organiser should hand in an application to national CME committee in order to reserve their eligibility to organise the course in the next year. – The application time for all national CME courses is between July and September. The organiser should fill in the application form and apply for the eligibility to conduct the courses according to the application procedure. • Accreditation – National CME Committee and National Health and Family Planning Commission will review and publish the accreditation results. – National CME Committee will publish the results of the accredited national CME courses from the end of the year to February in the next year. 27
  28. 28. Accreditation criteria as an organisation to provide national distance CME activities • The prerequisite requirements 1. The organisation must have acquired the authorization of the relevant governmental departments to work in the field of reporting health related information. 2. Have at least 2 year experience to develop and organise online CME courses 3. The CME system (developing system, education operational system, learning support system, education management system, internal quality assurance system) is already established and under the operation. 4. The organisation has enough resources to meet the education demands. The organisation should possess the online media library, courseware library, question bank, and learning – material database. 5. Possess a team of educational staff with different expertise, including instructors, tutors, editors and developers. 6. The distance education platform should be able to adapt to the continuing development needs of CME, possess optimised technology, and effectively develop the interactive teaching method. • Application time – Each year, candidates should hand in the applications from 1 March to 15 May to the National CME Distance Educational Centre. 28
  29. 29. • Accreditation Procedure – The assessment of the candidates will be organised once every year and the procedure includes material audit, site evaluation and result verification. 1. Material Audit: applications are regarded as invalid in the situations below • It is impossible to have a knowledge of candidate organisation’s basic situation, or the candidate organisations don’t fulfil will all the prerequisite requests • The application materials are different from the proof materials 2. Site evaluation • The ministry of health will send professionals to the organisations to evaluate the real situation. 3. Results verification a) The National CME Distance Education Centre will publish the organisations that have successfully passed the assessment. And the organisation can acquire both the eligibility to apply and organise the distance CME activities. b) Organisations not passing the assessment don’t have the eligibility to apply for the National Distance CME activities. c) Organisations not passing the assessment have to reapply for the eligibility after one year. 29 Accreditation criteria as an organisation to provide national distance CME activities
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A research on healthcare market in China covering topics including an introduction of Public Hospital System, Chinese Physicians' Work Condition and Salaries, as well as Continued Medical Education system.

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