4. Economic Resource Health
Demographics Allocation Statistics
โข How Much Does โข Where is Money โข What is the
China Have? Spent/What Chinese
Does it Buy? Healthcare ROI?
6. The Growth of NHE and GDP๏ผ1978-2004๏ผ
GDP
NHE
25
20 19.47
15.28
Percentage
15
9.5
10 10.57
7.6
5
0
7. Yip W , Hsiao W C Health Aff 2008;27:460-468
ยฉ2008 by Project HOPE - The People-to-People Health Foundation, Inc.
8. Nurses and Hospital
Hospitals Physicians Midwives beds
China 13,119 1,862,630 1,259,240 30/10,000
US 5,010 793,648 2,927,000 31/10,000
World Health Organization 2009
9. % Total Health Expenditure (THE) on
Pharmaceuticals
Devel'd Nations
Pharma Other
15%
Total
Pharma 85%
Expenditure
as %GDP China
Pharma Other
40%
60%
Source: OECD, 2007 and China MoH, 2007
10. % Population Obese, 2009
Obese Adults in millions
200
100
18
2005 2010 2015 (est.)
30x
0% 10% 20% 30% 40%
OECD 2009 Health Data Report
12. Infant Mortality (Deaths per 1,000 Births), 2010
30.00
25.00
Sing (1)
20.00
Japan (4)
Germ (14)
15.00
Switz (15)
10.00
UK (31)
US (44)
5.00
China
(117)
0.00
2003 2004 2005 2006 2007 2008 2009 2010
Source: CIA World Factbook
13. Age
86
84.36
2009 Statistics
84
82.12
82
80.85
80 79.26 79.01
78.11
78
76
74 73.47
72
70
68
Macau (1) Japan (3) Switz (11) Germany (32) UK (36) US (48) China (N/A)
Countries (rank of 100 total)
Source: CIA World Factbook
15. โข Take-home Message:
โ Chinaโs healthcare growth outpaces GDP growth
by almost 10% annually
โ Fee-for-service incentives warp healthcare cost-
structure, driving individual spending
โ China ranks very low in a number of health
statistics compared to other industrialized nations
โ China would benefit from a change in fee-
structure, and investment in public health
Editor's Notes
-One of the lowest per capita healthcare expenditures in the world (rule of large numbers)-4 drivers of cost-inflation: 1) growing middle-class, 2) increased utilization by urbanization, 3) less exercise/higher fat diet, and 4) growing aging population ~100M in 10yrs
-Out-of-pocket individual composition has increased ~20% to ~60% over 24 year period-Govโt contribution has decrโd from ~25% to ~19%-80% of Govโt health expenditures go to urban areas, even though only 45% of the population lives in these areas-Currently about 9-10% of individual income allocated to healthcare; expected to grow to 16% by 2025
Transition: Resource Allocation-Despite Chinaโs large population, aspects of its health-sector human capital and infrastructure are lacking in proportion-80% of Govโt health expenditures go to urban areas, even though only 45% of the population lives in these areas
-Due to fee-for-service incentives for Chinaโs physicians and hospitals, out-of-pocket costs on pharmaceuticals are close to 3x that of other developed nations-<10% of hospital income comes from Govโt, the rest comes from fees-U.S. pharma expense as %GDP ~2.1%; T.H.E. ~13%
Transition: Health Statistics-20% of worldโs obese people are Chinese-Chinaโs obesity rate as a percent of population is about 7%, relatively low, but the rate of growth in obesity is climbing fast-The causes and correlations of obesity in China seem to be the opposite of many industrialized nations, where the poor are usually the most obese (e.g. the growing middle-class makes up the majority of growing obese in China)-Childhood obesity in China is also a major issue, as the rate has jumped 30-fold b/w 1985-2000-One-child policy leads to six pocket syndrome: 2 parents, and 4 grandparents lavishing food and amenities to 1 child
-Rising diabetes rates go hand-in-hand with the rising obesity rates-Approximately 3,000 new Type II diabetics are said to be diagnosed per day
-Chinaโs infant mortality has consistently been ~10x higher than other developed nations, but it is trending downward-Very high infant mortality when compared to other industrialized nations (normalized for deaths <1 year-old/1000 births)-Clearly an area for Chinaโs healthcare investment
-Comparative low LE, despite Chinaโs healthy diet and culture of physical activity-Age increase has grown the slowest of developed countries, 2nd only to the US
-Become #1 killer since the โ90s; Despite large population, cancer rates are not excessively high-One of highest in world in Stomach, Liver and Esophageal cancers-Breast cancer up 37% in last 10 years; estimated to reach 2.5M by 2021-Cancer rates expected to grow dramatically particularly in rural areas due to pollution, and in urban areas due to adoption of Western diet
-The data seems to point to the need to change Chinaโs healthcare fee-structure/system-Nikki will now explain some of the prior changes in Chinaโs system that brought the country to this point