A country is like a person. Initial impressions matter, but if you really want to know them, you have to spend more time.
The Chinese health care system has many problems in common with the US: inequalities, lack of access, and widespread corruption due to the profit motives of pharmaceutical companies. Both systems are afflicted by overuse of services without clear health improvement. In the US, doctors get paid more if they order more tests; and in China, doctors' salaries often do not meet their cost of living, while they are allowed to make direct profits on pharmaceuticals and tests: the resulting incentive is clear.
But generalizations don't go very far in the hugeness of China. Beijing has 18 million residents or so, but Shanghai is China's largest city, and its health care system is significantly different from Beijing's, thanks to the reforming efforts of its vice-mayor who is implementing the Chinese equivalent of accountable care organizations, reforming residency education, promoting family practitioners as the integrators and gatekeepers for health services, and pushing through vertical and horizontal EMR integration. (The article from which I gleaned this information is based on an interview with this very vice-mayor, so the successes should probably be taken with a grain of salt.)
In the cities, where two-thirds of Chinese now live, public hospitals deliver the vast majority of health care services (accounting for 65% of health care costs nationally), but do so inefficiently and ineffectively, and are thus a chief target of governmental efforts at reform.
Out in the villages, where significant numbers of Chinese still live, the situation is very different from these big cities: access to care is dismal and quality a big question mark.
For now, I am grateful to have come to China not just as a tourist, but to learn something, share some of my knowledge with my hosts at PUMCH, and hopefully to start up some substantive collaboration.
Thanks to Dr. Jun Zeng and the entire GIM division at PUMCH. Thanks also to Junya Zhu of the Johns Hopkins School of Public Health for a crash course in the Chinese health system.
The Chinese health care system has many problems in common with the US: inequalities, lack of access, and widespread corruption due to the profit motives of pharmaceutical companies. Both systems are afflicted by overuse of services without clear health improvement. In the US, doctors get paid more if they order more tests; and in China, doctors' salaries often do not meet their cost of living, while they are allowed to make direct profits on pharmaceuticals and tests: the resulting incentive is clear.
But generalizations don't go very far in the hugeness of China. Beijing has 18 million residents or so, but Shanghai is China's largest city, and its health care system is significantly different from Beijing's, thanks to the reforming efforts of its vice-mayor who is implementing the Chinese equivalent of accountable care organizations, reforming residency education, promoting family practitioners as the integrators and gatekeepers for health services, and pushing through vertical and horizontal EMR integration. (The article from which I gleaned this information is based on an interview with this very vice-mayor, so the successes should probably be taken with a grain of salt.)
In the cities, where two-thirds of Chinese now live, public hospitals deliver the vast majority of health care services (accounting for 65% of health care costs nationally), but do so inefficiently and ineffectively, and are thus a chief target of governmental efforts at reform.
Out in the villages, where significant numbers of Chinese still live, the situation is very different from these big cities: access to care is dismal and quality a big question mark.
For now, I am grateful to have come to China not just as a tourist, but to learn something, share some of my knowledge with my hosts at PUMCH, and hopefully to start up some substantive collaboration.
Thanks to Dr. Jun Zeng and the entire GIM division at PUMCH. Thanks also to Junya Zhu of the Johns Hopkins School of Public Health for a crash course in the Chinese health system.
RSS Feed
