This document provides an overview of population health characteristics in China. It discusses morbidity rates for both communicable and non-communicable diseases. For communicable diseases, it outlines China's disease surveillance system and provides data on declining morbidity rates for several diseases from 1999-2003 to 2004-2008. Chronic disease rates are increasing and projected to account for most deaths in China by 2015. Substance abuse, especially alcohol, is also discussed as a growing public health issue.

1. PEOPLE'S REPUBLIC OF CHINA

2. CONTENTS
I. GENERAL SOCIAL-ECONOMIC CHARACTERISTICS OF RESIDENTIAL LIFE IN
CHINA (KWONG HENG SHENG)
II. POPULATION STATISTICS (BELTON WINFORD)
III. CHARACTERISTIC OF THE POPULATION’S HEALTH IN THE COUNTRY (LIM
KHENG HAO & KWONG HENG SHENG)
IV. ORGANIZATION OF THE HEALTH SERVICE SYSTEM IN THE COUNTRY
(CHARLENE CHAI & GERALDINE ANG)
A. MODEL OF A HEALTH SERVICE SYSTEM
B. THE MANAGEMENT OF A HEALTH SERVICE SYSTEM
C. ORGANIZATION OF HOSPITAL CARE TO URBAN POPULATION
D. ORGANIZATION OF MEDICAL CARE TO RURAL POPULATION
E. THE MAIN PRINCIPLES OF EMERGENCY CARE ORGANIZATION
F. THE SYSTEM OF PROTECTION OF MOTHERHOOD AND CHILDHOOD
V. CONCLUSION
VI. BIBLIOGRAPHY

3. (I) General social economic
characteristics of residential life in
a given country (region)

4. Government structure and
Political regime

5. Administrative and Territorial
subdivisions

7. Climatic and Geographic
Pecularities
 In China, a vast land spanning many degrees of
latitude with complicated terrain, climate varies
radically.
 Five Temperature Zones:
1. Cold-Temperate Zone
2. Mid-Temperate Zone
3. Warm-Temperate Zone
4. Subtropical Zone
5. Tropical Zone
 Plateau Climate Zone

8. Economy of China
 China's socialist market economy is the world's second largest
economy by nominal GDP, and the world's largest economy by
purchasing power parity according to the IMF.
Until 2015 China was the world's fastest-
growing major economy, with growth
rates averaging 10% over 30 years.

9. Types of production in China:
Agriculture and Industry
AGRICULTURE
 China is the world's largest producer and
consumer of agricultural products.
 China ranks first in worldwide farm
output, primarily
producing rice, wheat, potatoes,
tomato, sorghum, peanuts, tea, millet,
barley, cotton, oilseed and soybeans.
INDUSTRY
 Industry and construction account for about 48% of China's GDP.
 China ranks second worldwide in industrial output.
 Major industries include mining and ore
processing; iron and steel; aluminum; coal;
machinery; armaments; textiles and apparel;
petroleum; cement; chemical; fertilizers;
food processing; automobiles and other transportation equipment
including rail cars and locomotives, ships, and aircraft; consumer
products including footwear, toys, and electronics; telecommunications

10. (II) POPULATION STATISTICS

11. POPULATION STATISTICS
 Population ;1,375,114,753
 Population rank ; 1
 Urban-rural ratio
- Urban 49.68%
- Rural 50.32%
- Population growth rate 0.57% (2000-2010)

12. Area (km2) Population Density
China
9,650,000
(100%)
1,300,000,000
(100%)
134.7 h/km2
5 provinces
5,246,400
(54.45%)
79,533,000
(6.12%)
15.16 h/km2
Inner Mongolia
1,183,000
(12.28% )
24,051,000
Xinjiang
1,660,000
(17.23%)
20,952,000
Tibet
1,228,400
(12.75%)
2,842,000
Qinghai
721,000
(7.48%)
5,516,000
Gansu
454,000
(4.71%)
26,172,000
China proper
4,403,605
(45.55%)
1,221,000,000
(93.89%)
277.27 h/km2
Source: National Bureau of Statistics
Population density
and distribution

13. Ethnic groups
 The People's Republic of China (PRC) officially
recognizes 56 distinct ethnic groups, the largest
of which are Han, who constitute 91.51% of the
total population in 2010.
 Ethnic minorities constitute 8.49% or
113.8 million of China's population in 2010.
 During the past decades ethnic minorities have
experienced higher growth rates than the majority
Han population, because they are not under the
one-child policy. Their proportion of the population
in China has grown from 6.1% in 1953, to 8.04%
in 1990, 8.41% in 2000 and 8.49% in 2010.

14. Religions
■ Chinese traditional religions:
including worship of gods and
ancestors, Confucianism, Taoism,
and aspects from Buddhism ■
Buddhism ■ Islam ■ Ethnic
minorities' indigenous religions ■
Mongolian shamanism ■ Dongbei
folk religion and Manchu
shamanismPresently, the Party formally and
institutionally recognises five
religions in China: Buddhism, Taoism,
Islam, Protestantism, and Catholicism
(though despite historic links, the
Party enforces a separation of the
Chinese Catholic Church from the
Roman Catholic Church).

15. Languages
 The official spoken standard in the People's Republic of
China is Putonghua. Its pronunciation is based on the
Beijing dialect of Mandarin, which was traditionally the
formal version the Chinese language.
 Other languages include other varieties of Chinese:
Mandarin dialects, as well as Wu (Shanghainese), Yue
(Cantonese), Minbei (Fuzhou), Minnan (Hokkien or
Taiwanese and Teochiu), Xiang, Gan and Hakka; there are
also minority languages spoken in China
 Non-Chinese languages spoken widely by ethnic minorities
include Mongolian, Tibetan, Uyghur and other Turkic
languages (in Xinjiang), Korean (in the northeast), and
Vietnamese (in the southeast).
 In addition to Chinese, in the special administrative
regions, English is an official language of Hong Kong and
Portuguese is an official language of Macau.

16. Age – sex
composition
More young due
to the
implementation
of one child
policy.

17. -
•Infant mortality rate
•Total: 15.2 deaths/1,000 live births
(2013 est)
•Male: 15.16 deaths/1,000 live births
(2013 est)
•Female: 15.25 deaths/1,000 live
births (2013 est)
Major causes of death per 100,000
population, based on 2004 urban
population samples:
•malignant neoplasms (cancers): 119.7
•cerebrovascular disease: 88.4
•respiratory diseases: 78.1
•heart diseases: 74.1
•accidents, violence, and poisoning:
43.5

18. －
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Emigration data
年(月)別
Year (Month) Grand Total

19. 0
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
年(月)別
Year (Month) Total Entry Persons

21. (III) Characteristic of the
population's health in China

22. Morbidity and Injuries
 General incidence and prevalence rate of the
population

25. Specific Morbidity indicators
 Surveillance for communicable diseases is the main
public health surveillance activity in China. Currently,
the disease surveillance system in China has three
major components:
 National Disease Reporting System (NDRS): The system
covers the entire population (1.3 billion persons) living in all
the provinces, prefectures, and counties that make up
mainland China. Thirty-five communicable diseases are
reportable under this system.
 Nationwide Disease Surveillance Points (DSPs): This
surveillance system, comprising 145 reporting sites selected
by stratified cluster random sampling, covers a 1%
representative sample of China's population.
 Surveillance system for specific infectious diseases,
occupational diseases, food poisoning, etc.

26. General Occupational Morbidiy
and Injuries
 Migrant workers account for a disproportionate
burden of occupational injury morbidity and mortality
in China. However, data are inconsistent and
inadequate to detail injury incidence or to evaluate
interventions. The following are suggestions to
decrease injury incidence among migrants:
strengthen the national system of occupational injury
surveillance; focus surveillance and interventions on
high-risk occupations employing migrants such as
construction operations; improve occupational safety
training and access to appropriate safety equipment;
evaluate recent changes in occupational health and
safety and evaluate outcome of multi-party
interventions to reduce occupational injury among
migrant workers.

27. Infectious Morbidity rate in
China
1999–2003 2004–2008 Percentage (%)
95% confidence
interval
Quarantinable
diseases
Plague 0.0100 0.0036 −22 −57 to +41
Cholera 0.0081 0.0002 −48* −70 to −12
Epidemic
haemorrhagic fever
0.0235 0.0159 −12* −20 to −3
Vaccine-preventable
diseases
Poliomyelitis 0.0001b 0.0001b 0 0 to 0
Measles 0.0101 0.0058 −6 −20 to +10
Pertussis 0.0081 0.0003 −44* −59 to −23
Diphtheria 0.0080 0.0080 0 −60 to +153
Tetanus 0.0323 0.0174 −12* −2 to −8

28. Gastrointestinal diseases
Bacillary and amoebic dysentery 0.0155 0.0087 −10* −18 to −1
Typhoid fever/paratyphoid fever 0.0086 0.0029 −22* −39 to −2
Vector-borne diseases
Epidemic/endemic typhus 0.0080 0.0001† −54 −87 to +61
Japanese encephalitis (scrub
typhus)
0.0254 0.0196 −6 −14 to +3
Visceral leishmaniasis (kala-azar) 0.0075 0.0035 −5 −69 to +20
Malaria 0.0087 0.0040 −14 −26 to +1
Dengue fever 0.0100 0.0051 −42* −80 to +66

29. Zoonotic infections
Leptospirosis 0.0112 0.0040 −20* −32 to −6
Brucellosis 0.0100 0.0035 −24 −64 to +63
Anthrax 0.0083 0.0025 −31* −100 to −1
Rabies 0.0753 0.2153 26* +14 to +37
Bacterial infections
Meningococcal meningitis 0.0099 0.0126 3 −2 to +8
Scarlet fever 0.0080 0.0034 −23 −66 to +74
Tuberculosis 0.0580 0.2244 28* +14 to +43
Sexually transmitted infections
HIV infection 0.0285 0.2185 44* 30 to 58
Gonorrhoea 0.0100 0.0002 −49* −63 to −30
Syphilis 0.0083 0.0059 −4 −19 to +15
Viral hepatitis
All 0.0697 0.0897 5* 2 to 8
Hepatitis A 0.0059 0.0025 −21* −32 to −8
Hepatitis B 0.0473 0.0642 9* 1 to 20
Hepatitis C 0.0027 0.0076 30* 16 to 46
Hepatitis E 0.0019 0.0031 9 −3 to +24

30. Chronic Disease rate in China

31.  Facts :
 In china, chronic diseases are projected to account for 79% of all
deaths
 Total projected deaths in china, 2015 = 9,427, 000
 Total projected deaths due to chronic disease in China, 2015 = 7,471,
000
 WHO projects that over the next 10 years in China
 over 80 million people will die from a chronic disease
 deaths from infectious disease, maternal and perinatal conditions,
and nutritional deficiencies combined will increase by 2%
 deaths from chronic disease will increase by 19% - most markedly,
deaths from diabetes will increase by 50%

32. Substance abuse disorder
 Alcohol abuse
 China’s rapidly growing middle class and pressurised
workplace culture have created a nation of boozers, with
the average Chinese drinker now consuming more alcohol
than his or her British peer.
 Alcohol consumption per capita in China has risen
from an average of 4.9 litres between 2003 and
2005 to 6.7 litres five years later, according to data
from the World Health Organisation cited in a recent
medical journal report.
 When non-drinkers are excluded, seeing as 56pc of
China’s population are teetotal, consumption per
capita soars to an annual 15.1 litres of pure alcohol.

33.  Drug Addict population
 There are over 900,000 registered drug addicts in
China, but the Government recognizes that the
actual number of users is far higher. Some unofficial
estimates range as high as 12 million drug addicts.
Of the registered drug addicts, 83.7 percent are male
and 73.9 percent are under the age of 35. In 2001,
intravenous heroin users accounted for 70.9 percent
of the confirmed 22,000 human immunodeficiency
virus (HIV) and acquired immune deficiency
syndrome (AIDS) cases. Chinese officials are
becoming increasingly concerned about the abuse of
methamphetamine and other amphetamine-type
stimulants.

34.  Smoking
 Main article: Smoking in the People's Republic of
China
 Smoking related illnesses kill 1.2 million in the
People's Republic of China; however, the state
tobacco monopoly, the China National Tobacco
Corporation, supplies 7 to 10% of government
revenues, as of 2011, 600 billion yuan, about 100
billion US dollars.[35]

35. Injuries incidence rate in China
 Transport accidents
Year
Number of
accidents
Number of deaths Number of injuries
Number of deaths
per 10,000 vehicle 1)
Number of deaths per
100,000 population
1996 287,685 73,655 174,447 20.41 6.02
1997 304,217 73,861 190,128 17.50 5.97
1998 346,129 78,067 222,721 17.30 6.25
1999 412,860 83,529 286,080 15.45 6.82
2000 616,971 93,853 418,721 15.60 7.27
2001 754,919 105,930 546,485 15.46 8.51
2002 773,137 109,381 562,074 13.71 8.79
2003 667,507 104,372 494,174 10.81 8.08
2004 517,889 107,077 480,864 9.93 8.24
2005 450,254 98,738 469,911 7.57 7.60

36. Suicide rates in china
 The most recent government data provides statistics
more inline with external estimations. According a
2011 Centre for Disease Control and Prevention
report, China's suicide rate is 22.23 people out of
every 100,000. This rate places the country among
the countries with the highest suicide per capita in the
world. However, a 2014 study conducted by the
Centre for Suicide Research and Prevention at the
University of Hong Kong reported that China's suicide
rate has dropped significantly, among the lowest
levels in the world. An average annual rate of about
9.8 people out of every 100,000 committed suicide as
of 2009 to 2011, a 58% drop, largely as a result of
population migration from rural areas and
urbanization of middle class

37. Homicide rate in China
 Homicide rate in China is as low as
Switzerland, a country known as one of the
safest nations, reported Southern Metropolis
Daily on Thursday.
 "The homicide rate in China in 2014 is 0.7 per
100,000 residents, which is better than those
in developed countries such as the United
States, the United Kingdom or France," said
Meng Jianzhu, head of the Commission for
Political and Legal Affairs of the Communist
Party of China Central Committee, during a
national conference in Dalian, Liaoning
province.

38. Disability
 Of the total number of disabled individuals, men account for
42.77 million (51.55%) and women account for 40.19 million
(48.45%), making the gender ratio 106.42 disabled men for
every 100 disabled women.
 Furthermore, 20.71 million (25.96%) individuals of the disabled
community reside in urban areas, whereas 62.25 million
(75.04%) in rural areas.
 According to the China Disabled Persons' Federation,
approximately
a. 12.33 million (14.86%) people have visual disabilities,
b. 20.04 million (24.16%) have a hearing disability,
c. 1.27 million (1.53%) have a speech disability,
d. 24.12 million (29.07%) have a physical disability,
e. 5.54 million (6.68%) have an intellectual disability,
f. 6.14 million (7.40%) have a mental disability,
g. 13.52 million (16.30%) have multiple disabilities.

39. Age-specific incidence rates of
disability

40. Current government programs of the
assistance and support of disabled
persons
 The Government of China has adopted and implemented a
number of laws, policies standards and initiative pertaining to
people with disabilities, including their right to productive and
decent work.
 The main ones are:
1. The China Constitution
2. The Law on the Protection of Disabled Persons
3. The Rehabilitative Medical Education Plan (1992)
4. The Regulations on the Education of Persons with
Disabilities (1994)
5. The Provisional Regulations of the Qualification System for
Prosthetists and Orthotists (1997)
6. The Rules on the Employment of Disabled Persons
adopted in 2007
7. The Employment Promotion Law (2007)
8. The 12th Five Year National Programme on Disability
(2011-2015)

41. (IV) ORGANIZATION OF THE
HEALTH SERVICE SYSTEM IN
THE COUNTRY

42. A. Model Of A Health Service
System

43. State Sources Of Health Service
Financing
 There are 3 major insurance programs which
cover specific groups
1) Rural residents under NCMS [new rural
cooperative medical scheme]
2) Urban employees under UR-BMI [urban
employees basic medical insurance]
3) Unemployed urban residents under UR-BMI
[urban residents basic medical insurance]

45. System Of Medical Insurance
 The government, employers, and individuals pay for healthcare. In
December 1998, a national medical insurance scheme was launched by
the State Council. By end of 2002, most of the county or above level
cities had joined the scheme and covered a population of about 100
million. Social Insurance Fund Administration Centre, a department of
the Ministry of Labor and Social Security, oversees this insurance
system. Currently, this system only focuses on employees of enterprises
at or above township level. Those in remote or less developed areas
cannot enjoy the benefits of this scheme, which is considered a
shortcoming of the social medical insurance scheme.
 The National Basic Medical Insurance Scheme ensures basic medical
access by the public under the social security system. Individuals pay an
annual insurance premium for their basic medical treatment
entitlements. This scheme has replaced the previous government-
funded labor insurance medical system.
 Foreign-invested enterprises are required to provide health insurance
benefits, but are not required to participate in the basic plan. For
example, for employees of foreign enterprises in Beijing hired through
Foreign Enterprises Service Corp. (FESCO), foreign enterprises pay
FESCO, and FESCO then buys insurance policies for these employees.
The government also allows commercial health insurers to operate in
China.

46. Private Medical Institutions. Paid
Medical Services Forms.
 In 2000, a reform started to occur in the Chinese
hospital system. Government owned hospitals are
being restructured, some of them being sold to
individual investors, and more and more private
hospitals are founded.
 In 2004, Beijing Aikang Medical Investment
Company bought a state-run-enterprise owned
AAA hospital (the highest standard), and the
acquisition was the first of this kind in China. The
investment company plans to buy 10 hospitals in
the next three to five years. In Fuzhou, the capital
city of Fujian province, four government-owned
hospitals have been sold to private investors.

47. Other Financing Sources (Private,
Profitable Insurance Organizations,
Non-profitable Organizations, etc.)
 According to a news report, 44.8% of urban residents
and 79.1% of rural residents have no medical
insurance. Many of people are private payers. They
either cannot afford to buy medical insurance, or do
not understand the value of medical insurance.
 In contrast to rural residents, urban residents have
much better situation. Many employers have bought
for their employees group or supplementary medical
insurance, and employers deduct from employees’
payrolls a small percentage of their monthly incomes.

48. Relations Between International
Organizations and Health Service
System In The Country
 National immunization program has been implemented. The national
immunization program represents one of the most notable and influential
undertakings of China's healthcare work. In the early 1960s, China
eliminated smallpox through vaccine inoculation, a dozen years ahead
before the World Health Organization (WHO) announced the eradication
of the disease in 1980. China attained the goal of eliminating
poliomyelitis in 2000. In 2002, the Chinese government decided to
include hepatitis B vaccination for the newborn in the national
immunization program, increasing the number of four vaccines against
six infectious diseases to five vaccines against seven infectious
diseases. In 2007, China decided to further expand the scope of the
program, increasing the number of vaccines to 14 to prevent 15
infectious diseases and extending the scope of vaccination from children
to including adults. Since the launch of the new round of medical reform,
the scope of the national immunization program has kept expanding,
and it has played a positive role in reducing the morbidity of infectious
diseases and improving the health of the public. Already, the morbidity of
most infectious diseases that can be prevented by vaccination has fallen
to the lowest level in history.

49.  Major infectious and endemic diseases have been brought
under effective control. Patients of many major infectious
diseases, such as AIDS, tuberculosis, snail fever, hydatid
disease, leprosy and malaria, are provided medicines and
treatment free of charge. In 2011, China's living HIV-infected
persons and AIDS patients were estimated at 780,000, far
below China's goal of controlling the HIV-infected population
within 1.5 million. The morbidity of infectious tuberculosis has
fallen to only 66 per 100,000 people, attaining the goal defined
in the UN Millennium Development Goals ahead of time. All
counties where epidemics of snail fever used to break out have
attained the goal of bringing under control such epidemics,
limiting the number of snail fever patients to 326,000. China
took the lead in eradicating filariasis among the 83 countries
where epidemics of filariasis hit. China keeps improving its
capabilities of influenza control and prevention, taking
monitoring at the major task. In 2010, the National Influenza
Center of the Chinese Center for Disease Control and
Prevention was officially nominated the fifth WHO Collaboration
Center for Reference and Research on Influenza. China
steadily promotes endemic disease prevention and treatment.
It has eradicated the diseases caused by iodine deficiency at

50. Financial Problems In Health Service
System and Other Disadvantages
 Implementing health reform first requires a
thorough and comprehensive view of the current
issues with the healthcare sector today.
Identifying problems can set the blueprint for
changes to be made in the future. There are three
main challenges:
a) The lack of access to affordable healthcare
b) Inefficient use of healthcare resources
c) A lack of high-quality patient care.

51.  Simply put, a significant portion of China’s urban and
rural population is without access to affordable
healthcare. Rural areas are particularly hard hit, with
39 percent of the rural population unable to afford
professional medical treatment.14 Furthermore, 30
percent of respondents in rural areas indicated that
they have not been hospitalized despite having been
told they need to be.15 This grim situation is largely
attributed to the abolishment of farming communes
and rural health clinics that were replaced with private
medical practices in the 1980s – without any
alternatives established to date. The situation is not
much better for urban residents, with 36 percent of
the population also finding medical treatment

53.  The second key challenge is that current healthcare
resources are often not allocated to and used
effectively by the segments of the population that
need them most. This imbalance is driven by
inefficiencies in the supply and demand of healthcare
services.
 A disproportionate amount of China’s healthcare
resources have traditionally been concentrated on
larger hospitals, particularly those in urban areas.
More than 80 percent of health expenditures are
allocated to urban areas even though 70 percent of
the total population resides in rural areas.23 This
spending disparity is reflected in the number of
hospital beds and healthcare personnel in rural and
urban areas (see Figure 2) and is in line with the

54.  Another factor contributing to the lack of high-quality
patient care is the difficulty in monitoring the level of
quality care within China’s very complex healthcare
system. Currently, there is a lack of integrated health
policies that apply to all hospitals. The provision and
regulation of health service delivery is largely
decentralized and managed by a multitude of different
stakeholders, including the Ministry of Health,
provincial and city governments, military, and even
large state enterprises that continue to operate their
own hospitals. This decentralization not only creates
great variation in terms of quality of care across the
healthcare system, it also makes it difficult to
consistently monitor the level of care.

55. B. The Management Of A Health
Service System

56. Structure Of The Health Ministry Of
the Republic Of China
the Ministry of Health of the People's Republic
of China (MOH) was an executive agency of the
state which plays the role of providing information,
raising health awareness and education, ensuring
the accessibility of health services, and monitoring
the quality of health services provided to citizens
and visitors in the mainland of the People's
Republic of China. In the reforms of 2013 the
ministry has been dissolved and its functions
integrated into the new agency called the National
Health and Family Planning Commission. As part of
the National Health and Family Planning
Commission it is now headed by Ms. Li Bin.

57. The organization structure of Chinese health Care system
State Department
Government of
Provincial, Municipal,
Autonomous Region
Prov Dept of
Health
Local Dept.of Health
Chinese Academy of Medical Science
Chinese Academy of Preventive
Medicine
Medical Colleges and Universities
Drug and Bioengineering Product
Research Institute
The Ministry of
Health
General and Specialized hospital
Epidemic Prevention Station
Maternity and Children Health Care
Hospital (Clinic)
Drug Inspection Station
Regional Administrative
Office
General and Specialized hospital
Epidemic Prevention Station
Maternity and Children Health Care
Hospital (Clinic)
Drug Inspection Station
Government of Municipal,
County, District
Township hospital (clinic), District
hospital
Outpatient clinic
Municipal (District) hospital, County
hospital, Epidemic Prevention Station,
Endemic Disease Prevention Station
Maternity and Children Health Care Hospital
(Clinic), Secondary Health School
Township government,
Subdistrict Office
Villagers’ committee,
Neighborhood
residents’ committee Village health station, Red Cross
health station
District department
of Health
Three tiered
prevention and
health care
system

58. Number And Types Of Medical
Institutions Of Outpatient and
Inpatient Care, The Main Ways And
Tasks Of Their Work
 Hospitals in China are organized according to a 3-
tier system that recognizes a hospital's ability to
provide medical care, medical education, and
conduct medical research. Based on this,
hospitals are designated
as Primary, Secondary or Tertiary institutions.

59.  A primary hospital is typically a township hospital that contains
less than 100 beds. They are tasked with providing preventive
care, minimal health care and rehabilitation services. Secondary
hospitals tend to be affiliated with a medium size city, county or
district and contain more than 100 beds, but less than 500. They
are responsible for providing comprehensive health services, as
well as medical education and conducting research on a regional
basis. Tertiary hospitals round up the list as comprehensive or
general hospitals at the city, provincial or national level with a
bed capacity exceeding 500. They are responsible for providing
specialist health services, perform a bigger role with regard
to medical education and scientific research and they serve as
medical hubs providing care to multiple regions.
 Further, based on the level of service provision, size, medical
technology, medical equipment, and management and medical
quality, these 3 grades are further subdivided into 3 subsidiary
levels: A, B and C (甲[jiǎ], 乙[yǐ], 丙[bǐng]）. This results in a total
of 9 levels. In addition, one special level - 3AAA (三级特等)- is
reserved for the most specialized hospitals.

60. System Of Disease Surveillance In
China
Surveillance for communicable diseases is the main public
health surveillance activity in China. Currently, the disease
surveillance system in China has three major components:
 National Disease Reporting System (NDRS): The
system covers the entire population (1.3 billion persons)
living in all the provinces, prefectures, and counties that
make up mainland China. Thirty-five communicable
diseases are reportable under this system.
 Nationwide Disease Surveillance Points (DSPs): This
surveillance system, comprising 145 reporting sites
selected by stratified cluster random sampling, covers a
1% representative sample of China's population.
 Surveillance system for specific infectious
diseases, occupational diseases, food poisoning, etc.

61.  There are 35 notifiable infectious diseases, which are
divided into Classes A, B, and C. The functions of the
surveillance include explaining the natural history of
infectious diseases, describing the distribution of case
occurrence, triggering disease-control effort, monitoring
epidemic of infectious diseases during natural disasters,
predicting and controlling epidemics and providing the
base of policy adjustment.
 Data collected through the disease surveillance network
serve as the basis for formulating health policies and
devising strategies for preventing disease. A computerized
reporting system for notifiable diseases has been
established that links China's 30 provinces, autonomous
regions, and municipalities. Mechanisms for providing
timely feedback to units that report data and for
systematically assessing the quality of those data are
important attributes of this system.

62. Sources Of Disease Surveillance
Data For All Medical Institutions Of
Outpatient And Inpatient Care
 Morbidity and Mortality Monthly Reports (MMMR)
Each month, all provinces transmit country-level summaries
of the numbers of cases and deaths associated with 35
notifiable communicable diseases to the Academy of
Preventive Medicine. Reports are sent on the 13th to 15th
day of each month via the NACTN. At the central node of
NACTN, the Academy's Center of Computer Science and
Health Statistics compiles and analyzes the data, provides
feedback to the provinces, and creates national summaries
within one week. Copies of the MMMR are distributed
regularly to health authorities at various levels.

63.  Morbidity and Mortality Annual Report (MMAR)
Each January, all provinces
provide supplementary reports to revise and update
the monthly reports submitted during the previous
year. Age- and occupation-specific reports of
mortality and morbidity are also submitted at this
time. In April, after the surveillance data have been
reviewed at the national meeting on epidemic
diseases, the MMAR and other analytical reports
are distributed.

64. System Of Disease Eradication In
China (State and International
Programmes)
 China’s surveillance system has been strengthened in the
post-SARS era. Both the U.S. centres of disease control
and prevention and the who Bejing office have been
working closely with the Chinese ministry of health and
Chinese centres of disease control to strengthen and
computerize routine disease reporting for many infectious
diseases in accordance with china’s strengthened law and
regulations on infectious disease reporting.
 By mid-2005, all 2800 counties in china had direct
connection to the minister of agriculture monitoring system
for avian influenza and 93% of higher level hospitals or
43% of township hospitals now have direct connections to
the Chinese centres for disease control reporting system.
 Rural doctors are now required to report by telephone to
township health centres all cases of suspicious pneumonia

65. Medical Education In China
 There are 94 educational institutions in china which include medical
universities, colleges, institutes and schools.
 The Chinese medical education system follows the British system, but it
compressed from six years to five years to shorten the educational
cycle. To become a medical doctor, a person usually needs to study for
five years at a medical school. After graduation, young doctor needs to
complete 3-6 years residency training, some need extended training for
subspecialty. Internal medicine usually takes 3-4 years residency
training, but surgical specialties may takes 5-8 years to complete the
training.
 Upon graduation, the graduate must work as a resident physician for
few years to be eligible to take a National Medical Licensing
Examination (NMLE) for physician certification. This examination is
conducted by the National Medical Examination Centre (NMEC).
Without approval of registration by the Ministry of Health one can not
practice medicine in China as a physician or assistant physician.

66.  There are general hospitals and specialty hospitals. A
medical graduate rotates through several departments
and then assigned to a specialty department
according to his or her strengths and the hospital’s
needs.
 a Specialty physician usually are attendants who are
specialized in a certain specialty during the training
process in a specialty hospital or in a subspecialty at
a general hospital. Some medical experts have called
for a standardized training and testing system for
specialty physicians in accordance to American
system. The classification of specialties at a Chinese
hospital is similar to that at a U.S. hospital.

67. Medical Staff
 Nurses are normally well trained before being eligible
for working with a hospital, but support workers are a
problem. Some hospitals hire skill-less “underground”
labors and after giving them some simple training use
them as hospital support workers. These workers,
mostly originating from rural areas, are poorly paid by
those hospitals.
 To secure the quality of hospital services, Beijing
recently has passed a regulation on training and
hiring qualified hospital support workers. In Tianjin,
China’s third largest city, about 1,000 unemployed
people have been trained by local authority and
passed hospital support work test. These people
returned to work as certified support staff of a number

68.  One needs to study at a nursing school for
around three years before being eligible to work
as a nurse. Most nursing schools enroll middle
school graduates (Grade 9) and senior high
school graduates (Grade 12), and they run four-
year and three-year programs respectively.
 A bachelor’s degree in nursing has been available
since late 1980s and early 1990s in China. Many
medical schools including the School of Medicine
of Beijing University offer five-year programs in
nursing.

69. Organization of Hospital Care to Urban Population
Kinds of Hospital Medical Aid in China
Organization of the Health
Service System in China

70.  Health care in urban areas is provided by paramedical personnel assigned to
neighbourhood health stations - 1st tier.
 The patients who require more professional care are sent to a district hospital - 2nd tier.
 The most serious cases are handled by the municipal hospitals - 3rd tier.
Organization of Hospital Care
to Urban Population

71. Indices of Provision of Population with Hospital
beds (per 10,000 persons) & Frequency of
Hospitalization
 This is the availability of number of beds to 10,000 population.
 In China, this index is 22 per 10,000 population.
Number of inpatient beds (in millions):
Total admissions to hospitals (in millions):
The bed occupancy rate in 2014 was 83.2%
2012 2013 2014
4.16 4.58 4.96
2010 2011 2012
1000 1050 1200

72. Average Duration of Patient Stay in
Hospital
 It is 1 measure of the efficiency with which hospital resources are used.
 To calculate: total no. of days stayed by all patients in acute-care
inpatient institution during a year / no. of admissions or discharges
Average Duration of Patient Stay in Hospital in China in
2014, by region (in days)
• Shanghai: 11.2
• Beijing: 11
• Jilin: 9.8
• Yunnan: 9
• Guangdong: 8.8
• Fujian: 8.7
• Others: 243.5 T
Total: 302 days

73. Hospital Lethality
Death rate in the urban(1997) Indicators of hospital
activity
Cerebrovascular disease 22.28
Malignant tumor 21.66
Heart disease 16.37
Respiratory disease 15.28
Trauma and toxicosis 6.52
Digestive disease 3.22
Metabolic,immunity
disease
2.51
Urinary disease 1.51
Mental disease 1.12
Neuropathy 0.84
Total 91.31
1990 2000 2011
Life Expectancy 69.5 72.1 75
Total Fertility Rate 2.5 1.5 1.7
Infant Mortality
Rate
42.2 30.2 12.9
Child Mortality
Rate (under 5)
54.0 36.9 14.9
Maternal Mortality
Ratio
88.0 57.5 26.5

74. Types of Medical Institution for Outpatiend and Inpatient Care
 In rural areas, the first tier was made up of doctors working in village medical centers. They
provide preventive and primary care services.
 The township health centers categorise the 2nd level. It functions as out-patient clinics and
serve approximately 10,000 - 30,000 patients each. Staff consist of mainly assistant doctors.
 The lower 2 tiers provide most of the country’s medical care. Only the most seriously ill
patients are referred to the county hospitals - the 3rd tier.
Organization of Medical Care to
Rural Population

75. Main Indices of Provision with Medical Services and Medical
Institutions Activity
1. Prevention: immunization, prenatal care, family planning and sanitation, which was carried
out by government trained individuals (paraprofessionals)
2. New Rural Cooperative Medical Care System (NRCMCS)
 Established in 2003, to make health care more affordable in rural areas
 Aims to reform private and public sectors of health
 Funded by individual contributions and government subsidies for the poor
 Studies show a participation of more than 80%
Disadvantages and Principal Problems
• Lacks adequate funding
• Lacks medical staff
• Lacks medical equipment
• Only inpatient costs are covered, outpatient costs are not

76. Types of Medical Institution Rendering Emergency Care
 China has set up a response system for public health emergencies
featuring unified leadership, reasonable distribution, quick response,
efficient operation and powerful logistics.
 It can be divided into 3 sectors: Prehospital Care, Hospital
Emergency Department (ED), and Hospital Intensive Care Units.
 The emergency management system is divided into 4 levels:
national, provincial, city, and county.
 There are now 27 health emergency teams to respond to infectious
disease control, medical rescue, poisoning treatment, and nuclear
and radiation accident handling.
The Main Principles of
Emergency Care Organization

77. Indices of Provision of Population with Emergency Doctors,
Medical Assistants & Staff Nurse
 The patients are triaged according to their chief complaints upon arrival and then
evaluated by on-call specialists.
 Currently there are 300 “emergency centres” throughout the country.
 There are at least 4 emergency medical systems (EMS) models. They include:
private ambulance service, stand-alone emergency centres, stand-alone 120 centres,
hospital-based ambulance services, & combinations of those mentioned
 Pre-hospital units include: a driver, a transporter (basic care giver), a nurse, a doctor
Indices of Emergency Care Activity
• The patient volume in urban emergency department is approximately 150,000 - 200,000 per year
• 6.7% call the ambulance
• 3.7% was treated for poisoning
• 14.9% was treated for CVD
• 1.7% was treated for cardiac diseases
• 44.3% was treated for trauma

78. Disadvantages & Principal
Problems
1. Pre-hospital aid development is unbalanced, with great
disparities in the nation.
2. There are no national standards for pre-hospital care
management, and certain current policies are counter-
productive.
3. Multiple emergency response systems co-exist, and
they are often in unhealthy and disordering competition.
4. There is a lack of systematic planning of emergency
systems.
5. There is a lack of information exchange and sharing.

79. System of Protection of Motherhood
& Childhood
Legislation about the protection of motherhood and childhood in the country
 China has worked out a series of laws concerning children's survival,
protection and development. With the Constitution of the People's Republic
of China as the core, some of these provisions include
The Marriage Law
The Education Law
The Law on the Protection of Women's Rights and Interests
The Law on Health Protection of Mothers and Infants
 These laws include comprehensive and systematic provisions on children's
right to life, survival and development, as well as basic health and health
care. Provisions also address children's family environment and
substitutional care, education, free time and cultural activities and the
special protection of disabled children. It is specified that criminal acts, such
as maltreating, abandoning and deliberately killing children, as well as
stealing, abducting and trafficking, kidnaping, selling and buying in children,
should be severely punished.

80. Organization of Medical Care to Women
out of Pregnancy, System of Family
Planning
 Intensive healthcare services for pregnant and lying-in women are available,
and a complete array of services for pregnant and lying-in women has been
developed, covering prenatal examination, prenatal defect screening and
diagnosis, screening and management of high-risk pregnant and lying-in
women, hospitalized delivery, infant healthcare and postnatal home visits.
 The network of family planning services in China consists of agencies at
province, city, county and town levels
 The Chinese Family Planning Policy guidelines include: controlling rapid
population growth and reducing birth defects; later marriages, later births and
fewer babies; and encouraging couples to have only one child.
 the total fertility rate decreased from 5.43 to 1.6, and the natural population
growth rate decreased from 23.33 per thousand to 5 per thousand between
1971 and 2012.

81. Systems of Prenatal Protection of Fetus, Health
Protection of Newborn, Health Protection of
Preschool and School-Age Children
 The state offers healthcare services for infants, young children and pre-
school children, and exercises health management of children under
seven years of age and comprehensive management of children under
three years of age.
 In 2011, 84.6% of children under 3 years and 85.8% of children under 7
years received comprehensive health management and medical
management services.
 Cases of malnutrition keep declining.
 The state strives to control birth defects and improve the quality of
newborn babies, and has conducted disease screenings for newborns,
early development programs for children under 3 years old, rehabilitation
training for children with growth deviation, early-stage intervention for high-
risk children, early-stage intervention in cases of food allergy, assistance
with sleep problems, early-stage help in case of damage to children's
health caused by environmental pollution, and adolescence healthcare.

82. The Basic Medical Institutions Giving the Obstetric-and-
Gynecological Care to Women (System of their Organization, a
Range of Services, Ways and Indicators of their Activity)
 All government hospitals in China follow practical guidelines from the
Ministry of Health, and hospital leaders are responsible for implementation.
For institutional deliveries doctors make decisions for childbirth
interventions. Midwives assist during birth, but the doctor always takes
medical decisions
 Over 60% of women deliver in health facilities.

83. The Basic Types of Paediatric Medical Institutions (Main
Tasks and Ways of Work in Children's Polyclinic and
Hospital, the Main Indicators of their Activity)
 The Capital Institute of Pediatrics (CIP) was founded in 1958. It was the first
research institution in China, specializing in child health care and basic
research, prevention and treatment of childhood disorders
 Tasks: medical services for children and higher education for college students.

84. Conclusion

85. Conclusion
With the quickened pace of the country's industrialization and urbanization, as
well as its increasingly aging population, the Chinese people are facing the dual
health threats of infectious and chronic diseases, and the public needs better
medical and health services. In the meantime, problems still exist regarding
China's health resources, especially the shortage of high-quality resources and
the unbalanced distribution of those resources. China has arduous tasks ahead
for reforming and developing its medical and health services.
The Chinese government has announced that it will establish a sound basic
medical and health system covering both urban and rural residents by 2020, so
as to ensure that everyone enjoys access to basic medical and health services.
For this goal, China will continue to reform and develop its medical and health
services, and better maintain, ensure and enhance the health of its people.
China will also continue its active role in international health affairs and work
together with different parties to make greater effort to improve the health of
mankind.

86. Bibliography
http://www.china.org.cn/e-white/children/c-2.htm
http://www.china-
embassy.org/eng/zt/bps/t1001641.htm