3. Medical Service in China – Structure
Principally a network of hospitals each bear a national
grading based on level of facilities, functions, technology
advancement and specialties: I, II, III –reviewed periodically
Mostly public with increasing number of private institutions,
few individual clinics
Continuous evolution and reform of the medical regime
Government supervision and centralized guidelines
Provincial implementation with certain autonomy
4. Medical Ecosystem in China – Main Actors
Hospitals
& Doctors
Health
Bureau
Pharmaceuticals
Companies
Patients
Aid Station
& Clinics
Drug Administration
5. Medical Service in China – Coverage 1
Basic medical coverage
o 全民基本医保≈Sécurité Sociale en France≈Medicare & Medicaid
Implemented not until 2012
One patient paid 30000 € of medical expense in 2009 for leukemia
treatment, her medical coverage started in 2010 and received 15000 €
reimbursement
6. Medical Service in China – Coverage 2
Private medical insurance offers exist, especially for
critical illness
Mostly capped for reimbursement amount, patients always
need to pay a portion
Reimbursement level varies according to regime for both
private & public
7. Medical Service in China – Financing Model
• Medical institutions receive limited public subsidies due to
fiscal burden
• 50% of total medical expenses on medication (vs. 20% in
other countries)
• Extremely low consultation charge <1 € to 10 €
• Funding model: 以药补医
(Medicine sales subsidize consultation)
Breakeven Insufficient
public funding
Government
permitted
additional
income channels
8. Medical Service in China – To Improve
Medical service providers improperly leverage information
asymmetry advantage over patients
– Over-prescribe medication
– Advise costly treatments that are not strict necessity
Overall low satisfaction from patients both low and high
income, increased accidents and conflicts
Doctor-Patient mistrust cooperation
9. Medical Service in China – Doctors Dilemma
• Doctors - overwhelming majority state employed at public
hospitals
• Low base salary(<1000€) + variable bonus + commission on
prescribed medicine and additional income from surgery
which represent major portion
• Medical responsibility insurance has just started to develop,
most doctors bear their own accident risk --pay out of their own
pocket for accident settlement
10. How We Fill the Gap
Peer pressure does help improve treatment –experience
showed over 52% patients had their treatment modified after
obtaining a second medical opinion
Clear and structured audit trail of doctor/patient exchange
Provide impartial and tailored second medical advice –
empower the patient and his family
11. What Patients May Expect
Doctor, don’t hesitate to give frank advice!
Is my
treatment
appropriate?
Do I need this
operation
now?
What is the
secondary effect
of this medicine?
Can it be a
medical
accident?
……
……
12. Key Elements of Patient/Doctor Exchange
Doctors are experts in diseases
Patients are experts of their own body
