Healthcare system reform in the People's Republic of China
Encyclopedia
The healthcare system reform in the People's Republic of China refers to the healthcare system transition in modern China.
The Ministry of Health of the State Council
oversees the health services system, which includes a substantial rural collective sector but little private sector. Nearly all the major medical facilities are run by the government.
, Ministry of Health
, Ministry of Finance
, Ministry of Labour and Social Security, Ministry of Civil Affairs, SFDA
Research institute and universities: Development Research Center of the State Council, Ministry of Health Statistics and Information Center, China Health Economics Institute, Peking University
, Fudan University
, Tsinghua University
, Beijing Normal University
, Tongji Medical College
, Dalian Medical University
Foreign organizations: World Bank
, WHO
, McKinsey & Co.
rather than curative medicine on the premise that preventive medicine is "active" while curative medicine is "passive." The health-care system dramatically improved the health of the people, as reflected by the remarkable increase in average life expectancy from about thirty-two years in 1950 to sixty-nine years in 1985.
After 1949 the Ministry of Public Health was responsible for all health-care activities and established and supervised all facets of health policy. Along with a system of national, provincial-level, and local facilities, the ministry regulated a network of industrial and state enterprise hospitals and other facilities covering the health needs of workers of those enterprises. In 1981 this additional network provided approximately 25 percent of the country's total health services. Health care was provided in both rural and urban areas through a three-tiered system. In rural areas the first tier was made up of barefoot doctors
working out of village medical centers. They provided preventive and primary care
services, with an average of two doctors per 1,000 people. At the next level were the township health centers, which functioned primarily as out-patient clinic
s for about 10,000 to 30,000 people each. These centers had about ten to thirty beds each, and the most qualified members of the staff were assistant doctors. The two lower-level tiers made up the "rural collective health system" that provided most of the country's medical care. Only the most seriously ill patients were referred to the third and final tier, the county hospital
s, which served 200,000 to 600,000 people each and were staffed by senior doctors who held degrees from 5-year medical school
s. Health care in urban areas was provided by paramedic
al personnel assigned to factories and neighborhood health stations. If more professional care was necessary the patient was sent to a district hospital, and the most serious cases were handled by municipal hospitals. To ensure a higher level of care, a number of state enterprises and government agencies sent their employees directly to district or municipal hospitals, circumventing the paramedical, or barefoot doctor, stage.
An emphasis on public health
and preventive treatment characterized health policy from the beginning of the 1950s. At that time the party began to mobilize the population to engage in mass "patriotic health campaigns" aimed at improving the low level of environmental sanitation
and hygiene
and attacking certain diseases. One of the best examples of this approach was the mass assaults on the "four pests"--rat
s, sparrow
s, flies
, and mosquito
es--and on schistosoma
-carrying snail
s. Particular efforts were devoted in the health campaigns to improving water quality through such measures as deep-well construction and human-waste treatment. Only in the larger cities had human waste
been centrally disposed. In the countryside, where "night soil" has always been collected and applied to the fields as fertilizer
, it was a major source of disease. Since the 1950s, rudimentary treatments such as storage in pits, composting, and mixture with chemicals have been implemented.
As a result of preventive efforts, such epidemic diseases as cholera
, plague, typhoid, and scarlet fever
have almost been eradicated. The mass mobilization approach proved particularly successful in the fight against syphilis
, which was reportedly eliminated by the 1960s. The incidence of other infectious
and parasitic disease
s was reduced and controlled. Relaxation of certain sanitation and anti-epidemic programs since the 1960s, however, may have resulted in some increased incidence of disease.
and schistosomiasis
. Tuberculosis
, a major health hazard in 1949, remained a problem to some extent in the 1980s, as did hepatitis
, malaria
, and dysentery
. In the late 1980s, the need for health education and improved sanitation was still apparent, but it was more difficult to carry out the health-care campaigns because of the breakdown of the brigade system. By the mid-1980s, China recognized the acquired immune deficiency syndrome (AIDS
) virus as a serious health threat but remained relatively unaffected by the deadly disease. As of mid-1987 there was confirmation of only two deaths of Chinese citizens from AIDS, and monitoring of foreigners had begun. Following a 1987 regional World Health Organization
meeting, the Chinese government announced it would join the global fight against AIDS, which would involve quarantine
inspection of people entering China from abroad, medical supervision of people vulnerable to AIDS, and establishment of AIDS laboratories in coastal cities. Additionally, it was announced that China was experimenting with the use of traditional medicine
to treat AIDS.
In the mid-1980s the leading causes of death in China were similar to those in the industrialized world: cancer
, cerebrovascular disease
, and heart disease
. Some of the more prevalent forms of fatal cancers included cancer of the stomach, esophagus, liver, lung, and colon-rectum. The frequency of these diseases was greater for men than for women, and lung cancer
mortality was much greater in higher income areas. The degree of risk for the different kinds of cancers varied widely by region. For example, nasopharyngeal cancer was found primarily in south China, while the incidence of esophageal cancer
was higher in the north.
To address concerns over health, the Chinese greatly increased the number and quality of health-care personnel, although in 1986 serious shortages still existed. In 1949 only 33,000 nurses and 363,000 physicians were practicing; by 1985 the numbers had risen dramatically to 637,000 nurses and 1.4 million physicians. Some 436,000 physicians' assistants were trained in Western medicine and had two years of medical education after junior high school. Official Chinese statistics also reported that the number of paramedics increased from about 485,400 in 1975 to more than 853,400 in 1982. The number of students in medical and pharmaceutical colleges in China rose from about 100,000 in 1975 to approximately 160,000 in 1982.
Efforts were made to improve and expand medical facilities. The number of hospital beds increased from 1.7 million in 1976 to 2.2 million in 1984, or to 2 beds per 1,000 compared with 4.5 beds per 1,000 in 1981 in the United States. The number of hospitals increased from 63,000 in 1976 to 67,000 in 1984, and the number of specialized hospitals and scientific research institutions doubled during the same period.
The availability and quality of health care varied widely from city to countryside. According to 1982 census data, in rural areas the crude death rate was 1.6 per 1,000 higher than in urban areas, and life expectancy
was about four years lower. The number of senior physicians per 1,000 population was about 10 times greater in urban areas than in rural ones; state expenditure on medical care was more than ¥26 per capita in urban areas and less than ¥3 per capita in rural areas. There were also about twice as many hospital beds in urban areas as in rural areas. These are aggregate figures, however, and certain rural areas had much better medical care and nutritional levels than others.
In 1987 economic reforms were causing a fundamental transformation of the rural health-care system. The decollectivization of agriculture resulted in a decreased desire on the part of the rural populations to support the collective welfare system, of which health care was a part. In 1984 surveys showed that only 40 to 45 percent of the rural population was covered by an organized cooperative medical system, as compared with 80 to 90 percent in 1979.
This shift entailed a number of important consequences for rural health care. The lack of financial resources for the cooperatives resulted in a decrease in the number of barefoot doctors, which meant that health education and primary and home care suffered and that in some villages sanitation and water supplies were checked less frequently. Also, the failure of the cooperative health-care system limited the funds available for continuing education for barefoot doctors, thereby hindering their ability to provide adequate preventive and curative services. The costs of medical treatment increased, deterring some patients from obtaining necessary medical attention. If the patients could not pay for services received, then the financial responsibility fell on the hospitals and commune health centers, in some cases creating large debts.
Consequently, in the post-Mao Zedong
era of modernization
, the rural areas were forced to adapt to a changing health-care environment. Many barefoot doctors went into private practice, operating on a fee-for-service basis and charging for medication. But soon farmers demanded better medical services as their incomes increased, bypassing the barefoot doctors and going straight to the commune health centers or county hospitals. A number of barefoot doctors left the medical profession after discovering that they could earn a better living from farming, and their services were not replaced. The leaders of brigades, through which local health care was administered, also found farming to be more lucrative than their salaried positions, and many of them left their jobs. Many of the cooperative medical programs collapsed. Farmers in some brigades established voluntary health-insurance programs but had difficulty organizing and administering them.
Although the practice of traditional Chinese medicine
was strongly promoted by the Chinese leadership and remained a major component of health care, Western medicine was gaining increasing acceptance in the 1970s and 1980s. For example, the number of physicians and pharmacists trained in Western medicine reportedly increased by 225,000 from 1976 to 1981, and the number of physicians' assistants trained in Western medicine increased by about 50,000. In 1981 there were reportedly 516,000 senior physicians trained in Western medicine and 290,000 senior physicians trained in traditional Chinese medicine. The goal of China's medical professionals is to synthesize the best elements of traditional and Western approaches.
In practice, however, this combination has not always worked smoothly. In many respects, physicians trained in traditional medicine and those trained in Western medicine constitute separate groups with different interests. For instance, physicians trained in Western medicine have been somewhat reluctant to accept "unscientific" traditional practices, and traditional practitioners have sought to preserve authority in their own sphere. Although Chinese medical schools that provided training in Western medicine also provided some instruction in traditional medicine, relatively few physicians were regarded as competent in both areas in the mid-1980s.
The extent to which traditional and Western treatment methods were combined and integrated in the major hospitals varied greatly. Some hospitals and medical schools of purely traditional medicine were established. In most urban hospitals, the pattern seemed to be to establish separate departments for traditional and Western treatment. In the county hospitals, however, traditional medicine received greater emphasis.
Traditional medicine depends on herb
al treatments, acupuncture
, acupressure, moxibustion
(the burning of herbs over acupuncture points), and "cupping
" of skin with heated bamboo
. Such approaches are believed to be most effective in treating minor and chronic diseases, in part because of milder side effects. Traditional treatments may be used for more serious conditions as well, particularly for such acute abdominal conditions as appendicitis
, pancreatitis
, and gallstones; sometimes traditional treatments are used in combination with Western treatments. A traditional method of orthopedic treatment, involving less immobilization than Western methods, continued to be widely used in the 1980s.
Although health care in China developed in very positive ways by the mid-1980s, it exacerbated the problem of overpopulation. In 1987 China was faced with a population four times that of the United States and over three times that of the Soviet Union. Efforts to distribute the population over a larger portion of the country had failed: only the minority nationalities seemed able to thrive in the mountainous or desert-covered frontiers. Birth control programs implemented in the 1970s succeeded in reducing the birth rate, but estimates in the mid-1980s projected that China's population will surpass the 1.2 billion mark by the turn of the century, putting still greater pressure on the land and resources of the nation.
. While the Cultural Revolution
pushed the balance toward widespread minimum care with great attention paid to traditional medicine, policy after the late 1970s moved in the other direction on both issues; by the late 1980s the proportion of doctors of Western medicine had exceeded those of traditional practices.
At the same time, the medical establishment also more or less has been affected by this major influence: along with 1980s initial period people's commune
disintegration, the original rural cooperatives medical service system rapidly disintegrates in the majority of areas; In the cities scope, the public health services system and the labor insurance medical service system also gradually declines in the varying degree. But the medical service relates to national economy and the people's livelihood and the social stability, and the related problems are extremely complex,the establishment of this new system is slower continuously, compared to other professions.
The health of the Chinese populace has improved considerably since 1949. Average life expectancy has increased by about three decades and now ranks nearly at the level of that in advanced industrial societies. Many communicable diseases, such as plague, smallpox, cholera, and typhus, have either been wiped out or brought under control. In addition, the incidences of malaria and schistosomiasis have declined dramatically since 1949.
As evaluated on a per capita basis, China's health facilities remain unevenly distributed. Only about half of the country's medical and health personnel work in rural areas, where approximately three-fifths of the population resides. The doctors of Western medicine, who constitute about one-fourth of the total medical personnel, are even more concentrated in urban areas. Similarly, about two-thirds of the country's hospital beds are located in the cities.
China has a health insurance
system that provides virtually free coverage for people employed in urban state enterprises and relatively inexpensive coverage for their families. The situation for workers in the rural areas or in urban employment outside the state sector is far more varied. There are some cooperative health care
programs, but their voluntary nature produced a decline in membership from the late 1970s.
The severest limitation on the availability of health services, however, appears to be an absolute lack of resources, rather than discrimination in access on the basis of the ability of individuals to pay. An extensive system of paramedical care has been fostered as the major medical resource available to most of the rural population, but the care has been of uneven quality. The paramedical system feeds patients into the more sophisticated commune-level and county-level hospitals when they are available.
The annual cost of medical cover under the NRCMCS is 50 yuan (US$7) per person. Of that, 20 yuan is paid in by the central government, 20 yuan by the provincial government and a contribution of 10 yuan is made by the patient. As of September 2007, around 80% of the whole rural population of China had signed up (about 685 million people). The system is tiered, depending on the location. If patients go to a small hospital or clinic in their local town, the scheme will cover from 70-80% of their bill. If they go to a county one, the percentage of the cost being covered falls to about 60%. And if they need specialist help in a large modern city hospital, they have to bear most of the cost themselves, the scheme would cover about 30% of the bill.
system, in particular general practice. The introduction of general practice in parts of urban China began in 1999. Acceptance of general practice has been slow against the background of a strong urban tradition of hospital
s as primary care providers, the widespread belief that specialists are more skilled than generalists even for minor complaints, and the perceived right of the individual to use the provider of their choice. But these attitudes are changing slowly. In several cities, notably in Zhejiang
, Jiangsu
, and Guangdong
provinces, general practitioners (GPs) are acquiring a good local reputation and are attracting large numbers of patients.
General practice in China is criticized for failing to perform a gate-keeping role, but such a role is virtually impossible to establish in the presence of a diversity of payment schemes including government insurance, employer-paid insurance, private insurance, community-based insurance (mostly with only part reimbursement), and out-of-pocket payment. Training and pay have not presented problems. The system of payment of GPs is similar to that of hospital practitioners - ie, a basic salary supplemented by bonuses according to performance. In popular hospitals and busy specialties, these bonuses may be up to ten times the basic salary, whereas some hospital doctors may receive only the basic salary. Likewise, GPs get a basic salary, which is topped up from patients' fees and prescriptions. Thus there are clear incentives to improve quality, hence attracting more patients and increasing income. The desire of newly-trained doctors to work in cities will ensure there will be an unlikely shortage of GPs for the foreseeable future.
There are several important problems facing health policy-makers. First, a system that keeps basic wages low, but allows doctors to make money from prescription
s and investigations, leads to perverse incentive
s and inefficiency at all levels. Second, as in many other countries, to develop systems of health insurance and community financing which will allow coverage for most people is a huge challenge when the population is ageing
and treatment
s are becoming more sophisticated and expensive. Several different models have been developed across the country to attempt to address the problems.
An example of a reform model based on an international partnership approach was the Basic Health Services Project. This was implemented between 1998 and 2007 by the Government of China in 97 poor rural counties in which 45 million people live. Its aim was to encourage local officials to test innovative strategies for strengthening their health service to improve access to competent care and reduce the impact of major illness. In particular it supported county implementers to translate national health policy into strategies and actions meaningful at a local level.
Chronic diseases are now the main cause of death and disability worldwide, and China is experiencing the same health problems as western countries. The difference is that the problems occur in a country with the largest population in the world yet relatively limited health resources. To tackle the challenge posed by chronic diseases, a robust primary care system has been called for as necessary. This is the weakness of China's health system, as, especially in big cities, health care is almost entirely hospital-based and people with minor illnesses prefer to be seen by doctors in large hospitals. The qualification and professional competence of general practitioners is always questioned because of lack of training and appropriate regulation. General practitioners therefore fail to function well as gatekeepers. In such a situation, it is very common that doctors in large hospitals see about 30–40 patients within the first 4 h. Doctors hardly have any time to talk with patients, getting to know what they really need, and seldom give advice on diet
, physical activity, compliance
etc, which is the key to high-quality care for chronic diseases. When the patient is a passive recipient, optimum outcomes cannot be expected.
In view of China managing major health system reform against a background of rapid economic and institutional change, the Institute of Development Studies
outlines policy implications based on collaborative research around the Chinese approach to Health System Development. This approach includes testing innovations at local level, encouraging learning from success, and gradually building institutions that support new ways of doing things. It suggests that analysts from other countries and officials in organisations that support international health need to understand this approach if they are to strengthen mutual learning with their Chinese counterparts.
, China Medical Board
, and Peking University Health Science Center
. Full collection of China Series available here.
The Ministry of Health of the State Council
State Council of the People's Republic of China
The State Council of the People's Republic of China , which is largely synonymous with the Central People's Government after 1954, is the chief administrative authority of the People's Republic of China. It is chaired by the Premier and includes the heads of each governmental department and agency...
oversees the health services system, which includes a substantial rural collective sector but little private sector. Nearly all the major medical facilities are run by the government.
Main organizations involved in the reform
Government: NDRCNational Development and Reform Commission
The National Development and Reform Commission , formerly State Planning Commission and State Development Planning Commission, is a macroeconomic management agency under the Chinese State Council, which has broad administrative and planning control over the Chinese economy...
, Ministry of Health
Ministry of Health (China)
The Ministry of Health of the Government of the People's Republic of China is 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...
, Ministry of Finance
Ministry of Finance of the People's Republic of China
The Ministry of Finance of the People's Republic of China is the national executive agency of the Central People's Government which administers macroeconomic policies and the national annual budget. It also handles fiscal policy, economic regulations and government expenditure for the state.The...
, Ministry of Labour and Social Security, Ministry of Civil Affairs, SFDA
Research institute and universities: Development Research Center of the State Council, Ministry of Health Statistics and Information Center, China Health Economics Institute, Peking University
Peking University
Peking University , colloquially known in Chinese as Beida , is a major research university located in Beijing, China, and a member of the C9 League. It is the first established modern national university of China. It was founded as Imperial University of Peking in 1898 as a replacement of the...
, Fudan University
Fudan University
Fudan University , located in Shanghai, is one of the oldest and most selective universities in China, and is a member of the C9 League. Its institutional predecessor was founded in 1905, shortly before the end of China's imperial Qing dynasty...
, Tsinghua University
Tsinghua University
Tsinghua University , colloquially known in Chinese as Qinghua, is a university in Beijing, China. The school is one of the nine universities of the C9 League. It was established in 1911 under the name "Tsinghua Xuetang" or "Tsinghua College" and was renamed the "Tsinghua School" one year later...
, Beijing Normal University
Beijing Normal University
Beijing Normal University , colloqiually known as 北师大 or Beishida, is a public research university located in Beijing with strong emphasis on basic disciplines of humanities and sciences...
, Tongji Medical College
Tongji Medical College
Tongji Medical College , formerly Tongji Medical University is a top medical School in China. Now the college has been a significant part of the new Huazhong University of Science and Technology since 2000...
, Dalian Medical University
Dalian Medical University
Dalian Medical University is a university in Dalian, Liaoning, China under the provincial government. It was founded in 1947 in the southern part of Dalian city, China by Mao Ze Dong.....
Foreign organizations: World Bank
World Bank Group
The World Bank Group is a family of five international organizations that makes leveraged loans, generally to poor countries.The Bank came into formal existence on 27 December 1945 following international ratification of the Bretton Woods agreements, which emerged from the United Nations Monetary...
, WHO
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
, McKinsey & Co.
Post-1949
Since the founding of the People's Republic, the goal of health programs has been to provide care to every member of the population and to make maximum use of limited health-care personnel, equipment, and financial resources. The emphasis has been on preventivePreventive medicine
Preventive medicine or preventive care refers to measures taken to prevent diseases, rather than curing them or treating their symptoms...
rather than curative medicine on the premise that preventive medicine is "active" while curative medicine is "passive." The health-care system dramatically improved the health of the people, as reflected by the remarkable increase in average life expectancy from about thirty-two years in 1950 to sixty-nine years in 1985.
After 1949 the Ministry of Public Health was responsible for all health-care activities and established and supervised all facets of health policy. Along with a system of national, provincial-level, and local facilities, the ministry regulated a network of industrial and state enterprise hospitals and other facilities covering the health needs of workers of those enterprises. In 1981 this additional network provided approximately 25 percent of the country's total health services. Health care was provided in both rural and urban areas through a three-tiered system. In rural areas the first tier was made up of barefoot doctors
Barefoot doctors
Barefoot doctors are farmers who received minimal basic medical and paramedical training and worked in rural villages in the People's Republic of China. Their purpose was to bring health care to rural areas where urban-trained doctors would not settle...
working out of village medical centers. They provided preventive and primary care
Primary care
Primary care is the term for the health services by providers who act as the principal point of consultation for patients within a health care system...
services, with an average of two doctors per 1,000 people. At the next level were the township health centers, which functioned primarily as out-patient clinic
Clinic
A clinic is a health care facility that is primarily devoted to the care of outpatients...
s for about 10,000 to 30,000 people each. These centers had about ten to thirty beds each, and the most qualified members of the staff were assistant doctors. The two lower-level tiers made up the "rural collective health system" that provided most of the country's medical care. Only the most seriously ill patients were referred to the third and final tier, the county hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
s, which served 200,000 to 600,000 people each and were staffed by senior doctors who held degrees from 5-year medical school
Medical school
A medical school is a tertiary educational institution—or part of such an institution—that teaches medicine. Degree programs offered at medical schools often include Doctor of Osteopathic Medicine, Bachelor/Doctor of Medicine, Doctor of Philosophy, master's degree, or other post-secondary...
s. Health care in urban areas was provided by paramedic
Paramedic
A paramedic is a healthcare professional that works in emergency medical situations. Paramedics provide advanced levels of care for medical emergencies and trauma. The majority of paramedics are based in the field in ambulances, emergency response vehicles, or in specialist mobile units such as...
al personnel assigned to factories and neighborhood health stations. If more professional care was necessary the patient was sent to a district hospital, and the most serious cases were handled by municipal hospitals. To ensure a higher level of care, a number of state enterprises and government agencies sent their employees directly to district or municipal hospitals, circumventing the paramedical, or barefoot doctor, stage.
An emphasis on public health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
and preventive treatment characterized health policy from the beginning of the 1950s. At that time the party began to mobilize the population to engage in mass "patriotic health campaigns" aimed at improving the low level of environmental sanitation
Sanitation
Sanitation is the hygienic means of promoting health through prevention of human contact with the hazards of wastes. Hazards can be either physical, microbiological, biological or chemical agents of disease. Wastes that can cause health problems are human and animal feces, solid wastes, domestic...
and hygiene
Hygiene
Hygiene refers to the set of practices perceived by a community to be associated with the preservation of health and healthy living. While in modern medical sciences there is a set of standards of hygiene recommended for different situations, what is considered hygienic or not can vary between...
and attacking certain diseases. One of the best examples of this approach was the mass assaults on the "four pests"--rat
Rat
Rats are various medium-sized, long-tailed rodents of the superfamily Muroidea. "True rats" are members of the genus Rattus, the most important of which to humans are the black rat, Rattus rattus, and the brown rat, Rattus norvegicus...
s, sparrow
Sparrow
The sparrows are a family of small passerine birds, Passeridae. They are also known as true sparrows, or Old World sparrows, names also used for a genus of the family, Passer...
s, flies
Fließ
Fließ is a municipality in the Landeck district and is located5 km south of Landeck on the upper course of the Inn River. It has 9 hamlets and was already populated at the roman age; the village itself was founded around the 6th century. After a conflagration in 1933 Fließ was restored more...
, and mosquito
Mosquito
Mosquitoes are members of a family of nematocerid flies: the Culicidae . The word Mosquito is from the Spanish and Portuguese for little fly...
es--and on schistosoma
Schistosoma
A genus of trematodes, Schistosoma, commonly known as blood-flukes and bilharzia, includes flatworms which are responsible for a highly significant parasitic infection of humans by causing the disease schistosomiasis, and are considered by the World Health Organization as the second most...
-carrying snail
Snail
Snail is a common name applied to most of the members of the molluscan class Gastropoda that have coiled shells in the adult stage. When the word is used in its most general sense, it includes sea snails, land snails and freshwater snails. The word snail without any qualifier is however more often...
s. Particular efforts were devoted in the health campaigns to improving water quality through such measures as deep-well construction and human-waste treatment. Only in the larger cities had human waste
Human waste
Human waste is a waste type usually used to refer to byproducts of digestion, such as feces and urine. Human waste is most often transported as sewage in waste water through sewerage systems...
been centrally disposed. In the countryside, where "night soil" has always been collected and applied to the fields as fertilizer
Fertilizer
Fertilizer is any organic or inorganic material of natural or synthetic origin that is added to a soil to supply one or more plant nutrients essential to the growth of plants. A recent assessment found that about 40 to 60% of crop yields are attributable to commercial fertilizer use...
, it was a major source of disease. Since the 1950s, rudimentary treatments such as storage in pits, composting, and mixture with chemicals have been implemented.
As a result of preventive efforts, such epidemic diseases as cholera
Cholera
Cholera is an infection of the small intestine that is caused by the bacterium Vibrio cholerae. The main symptoms are profuse watery diarrhea and vomiting. Transmission occurs primarily by drinking or eating water or food that has been contaminated by the diarrhea of an infected person or the feces...
, plague, typhoid, and scarlet fever
Scarlet fever
Scarlet fever is a disease caused by exotoxin released by Streptococcus pyogenes. Once a major cause of death, it is now effectively treated with antibiotics...
have almost been eradicated. The mass mobilization approach proved particularly successful in the fight against syphilis
Syphilis
Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The primary route of transmission is through sexual contact; however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis...
, which was reportedly eliminated by the 1960s. The incidence of other infectious
Infectious disease
Infectious diseases, also known as communicable diseases, contagious diseases or transmissible diseases comprise clinically evident illness resulting from the infection, presence and growth of pathogenic biological agents in an individual host organism...
and parasitic disease
Parasitic disease
A parasitic disease is an infectious disease caused or transmitted by a parasite. Many parasites do not cause diseases. Parasitic diseases can affect practically all living organisms, including plants and mammals...
s was reduced and controlled. Relaxation of certain sanitation and anti-epidemic programs since the 1960s, however, may have resulted in some increased incidence of disease.
Post-1970s
In the early 1980s, continuing deficiencies in human-waste treatment were indicated by the persistence of such diseases as hookwormHookworm
The hookworm is a parasitic nematode that lives in the small intestine of its host, which may be a mammal such as a dog, cat, or human. Two species of hookworms commonly infect humans, Ancylostoma duodenale and Necator americanus. A. duodenale predominates in the Middle East, North Africa, India...
and schistosomiasis
Schistosomiasis
Schistosomiasis is a parasitic disease caused by several species of trematodes , a parasitic worm of the genus Schistosoma. Snails often act as an intermediary agent for the infectious diseases until a new human host is found...
. Tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
, a major health hazard in 1949, remained a problem to some extent in the 1980s, as did hepatitis
Hepatitis
Hepatitis is a medical condition defined by the inflammation of the liver and characterized by the presence of inflammatory cells in the tissue of the organ. The name is from the Greek hepar , the root being hepat- , meaning liver, and suffix -itis, meaning "inflammation"...
, malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
, and dysentery
Dysentery
Dysentery is an inflammatory disorder of the intestine, especially of the colon, that results in severe diarrhea containing mucus and/or blood in the faeces with fever and abdominal pain. If left untreated, dysentery can be fatal.There are differences between dysentery and normal bloody diarrhoea...
. In the late 1980s, the need for health education and improved sanitation was still apparent, but it was more difficult to carry out the health-care campaigns because of the breakdown of the brigade system. By the mid-1980s, China recognized the acquired immune deficiency syndrome (AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
) virus as a serious health threat but remained relatively unaffected by the deadly disease. As of mid-1987 there was confirmation of only two deaths of Chinese citizens from AIDS, and monitoring of foreigners had begun. Following a 1987 regional World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
meeting, the Chinese government announced it would join the global fight against AIDS, which would involve quarantine
Quarantine
Quarantine is compulsory isolation, typically to contain the spread of something considered dangerous, often but not always disease. The word comes from the Italian quarantena, meaning forty-day period....
inspection of people entering China from abroad, medical supervision of people vulnerable to AIDS, and establishment of AIDS laboratories in coastal cities. Additionally, it was announced that China was experimenting with the use of traditional medicine
Traditional Chinese medicine
Traditional Chinese Medicine refers to a broad range of medicine practices sharing common theoretical concepts which have been developed in China and are based on a tradition of more than 2,000 years, including various forms of herbal medicine, acupuncture, massage , exercise , and dietary therapy...
to treat AIDS.
In the mid-1980s the leading causes of death in China were similar to those in the industrialized world: cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
, cerebrovascular disease
Cerebrovascular disease
Cerebrovascular disease is a group of brain dysfunctions related to disease of the blood vessels supplying the brain. Hypertension is the most important cause; it damages the blood vessel lining, endothelium, exposing the underlying collagen where platelets aggregate to initiate a repairing process...
, and heart disease
Heart disease
Heart disease, cardiac disease or cardiopathy is an umbrella term for a variety of diseases affecting the heart. , it is the leading cause of death in the United States, England, Canada and Wales, accounting for 25.4% of the total deaths in the United States.-Types:-Coronary heart disease:Coronary...
. Some of the more prevalent forms of fatal cancers included cancer of the stomach, esophagus, liver, lung, and colon-rectum. The frequency of these diseases was greater for men than for women, and lung cancer
Lung cancer
Lung cancer is a disease characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread beyond the lung in a process called metastasis into nearby tissue and, eventually, into other parts of the body. Most cancers that start in lung, known as primary...
mortality was much greater in higher income areas. The degree of risk for the different kinds of cancers varied widely by region. For example, nasopharyngeal cancer was found primarily in south China, while the incidence of esophageal cancer
Esophageal cancer
Esophageal cancer is malignancy of the esophagus. There are various subtypes, primarily squamous cell cancer and adenocarcinoma . Squamous cell cancer arises from the cells that line the upper part of the esophagus...
was higher in the north.
To address concerns over health, the Chinese greatly increased the number and quality of health-care personnel, although in 1986 serious shortages still existed. In 1949 only 33,000 nurses and 363,000 physicians were practicing; by 1985 the numbers had risen dramatically to 637,000 nurses and 1.4 million physicians. Some 436,000 physicians' assistants were trained in Western medicine and had two years of medical education after junior high school. Official Chinese statistics also reported that the number of paramedics increased from about 485,400 in 1975 to more than 853,400 in 1982. The number of students in medical and pharmaceutical colleges in China rose from about 100,000 in 1975 to approximately 160,000 in 1982.
Efforts were made to improve and expand medical facilities. The number of hospital beds increased from 1.7 million in 1976 to 2.2 million in 1984, or to 2 beds per 1,000 compared with 4.5 beds per 1,000 in 1981 in the United States. The number of hospitals increased from 63,000 in 1976 to 67,000 in 1984, and the number of specialized hospitals and scientific research institutions doubled during the same period.
The availability and quality of health care varied widely from city to countryside. According to 1982 census data, in rural areas the crude death rate was 1.6 per 1,000 higher than in urban areas, and life expectancy
Life expectancy
Life expectancy is the expected number of years of life remaining at a given age. It is denoted by ex, which means the average number of subsequent years of life for someone now aged x, according to a particular mortality experience...
was about four years lower. The number of senior physicians per 1,000 population was about 10 times greater in urban areas than in rural ones; state expenditure on medical care was more than ¥26 per capita in urban areas and less than ¥3 per capita in rural areas. There were also about twice as many hospital beds in urban areas as in rural areas. These are aggregate figures, however, and certain rural areas had much better medical care and nutritional levels than others.
In 1987 economic reforms were causing a fundamental transformation of the rural health-care system. The decollectivization of agriculture resulted in a decreased desire on the part of the rural populations to support the collective welfare system, of which health care was a part. In 1984 surveys showed that only 40 to 45 percent of the rural population was covered by an organized cooperative medical system, as compared with 80 to 90 percent in 1979.
This shift entailed a number of important consequences for rural health care. The lack of financial resources for the cooperatives resulted in a decrease in the number of barefoot doctors, which meant that health education and primary and home care suffered and that in some villages sanitation and water supplies were checked less frequently. Also, the failure of the cooperative health-care system limited the funds available for continuing education for barefoot doctors, thereby hindering their ability to provide adequate preventive and curative services. The costs of medical treatment increased, deterring some patients from obtaining necessary medical attention. If the patients could not pay for services received, then the financial responsibility fell on the hospitals and commune health centers, in some cases creating large debts.
Consequently, in the post-Mao Zedong
Mao Zedong
Mao Zedong, also transliterated as Mao Tse-tung , and commonly referred to as Chairman Mao , was a Chinese Communist revolutionary, guerrilla warfare strategist, Marxist political philosopher, and leader of the Chinese Revolution...
era of modernization
Modernization
In the social sciences, modernization or modernisation refers to a model of an evolutionary transition from a 'pre-modern' or 'traditional' to a 'modern' society. The teleology of modernization is described in social evolutionism theories, existing as a template that has been generally followed by...
, the rural areas were forced to adapt to a changing health-care environment. Many barefoot doctors went into private practice, operating on a fee-for-service basis and charging for medication. But soon farmers demanded better medical services as their incomes increased, bypassing the barefoot doctors and going straight to the commune health centers or county hospitals. A number of barefoot doctors left the medical profession after discovering that they could earn a better living from farming, and their services were not replaced. The leaders of brigades, through which local health care was administered, also found farming to be more lucrative than their salaried positions, and many of them left their jobs. Many of the cooperative medical programs collapsed. Farmers in some brigades established voluntary health-insurance programs but had difficulty organizing and administering them.
Although the practice of traditional Chinese medicine
Traditional Chinese medicine
Traditional Chinese Medicine refers to a broad range of medicine practices sharing common theoretical concepts which have been developed in China and are based on a tradition of more than 2,000 years, including various forms of herbal medicine, acupuncture, massage , exercise , and dietary therapy...
was strongly promoted by the Chinese leadership and remained a major component of health care, Western medicine was gaining increasing acceptance in the 1970s and 1980s. For example, the number of physicians and pharmacists trained in Western medicine reportedly increased by 225,000 from 1976 to 1981, and the number of physicians' assistants trained in Western medicine increased by about 50,000. In 1981 there were reportedly 516,000 senior physicians trained in Western medicine and 290,000 senior physicians trained in traditional Chinese medicine. The goal of China's medical professionals is to synthesize the best elements of traditional and Western approaches.
In practice, however, this combination has not always worked smoothly. In many respects, physicians trained in traditional medicine and those trained in Western medicine constitute separate groups with different interests. For instance, physicians trained in Western medicine have been somewhat reluctant to accept "unscientific" traditional practices, and traditional practitioners have sought to preserve authority in their own sphere. Although Chinese medical schools that provided training in Western medicine also provided some instruction in traditional medicine, relatively few physicians were regarded as competent in both areas in the mid-1980s.
The extent to which traditional and Western treatment methods were combined and integrated in the major hospitals varied greatly. Some hospitals and medical schools of purely traditional medicine were established. In most urban hospitals, the pattern seemed to be to establish separate departments for traditional and Western treatment. In the county hospitals, however, traditional medicine received greater emphasis.
Traditional medicine depends on herb
Herb
Except in botanical usage, an herb is "any plant with leaves, seeds, or flowers used for flavoring, food, medicine, or perfume" or "a part of such a plant as used in cooking"...
al treatments, acupuncture
Acupuncture
Acupuncture is a type of alternative medicine that treats patients by insertion and manipulation of solid, generally thin needles in the body....
, acupressure, moxibustion
Moxibustion
Moxibustion is a traditional Chinese medicine therapy using moxa, or mugwort herb. It plays an important role in the traditional medical systems of China, Japan, Korea, Vietnam, Tibet, and Mongolia. Suppliers usually age the mugwort and grind it up to a fluff; practitioners burn the fluff or...
(the burning of herbs over acupuncture points), and "cupping
Cupping
Cupping can refer to:* Coffee cupping* Fire cupping, and other alternative health cupping methods* "Cupping", a form of unusual tire wear due to bad wheel alignment...
" of skin with heated bamboo
Bamboo
Bamboo is a group of perennial evergreens in the true grass family Poaceae, subfamily Bambusoideae, tribe Bambuseae. Giant bamboos are the largest members of the grass family....
. Such approaches are believed to be most effective in treating minor and chronic diseases, in part because of milder side effects. Traditional treatments may be used for more serious conditions as well, particularly for such acute abdominal conditions as appendicitis
Appendicitis
Appendicitis is a condition characterized by inflammation of the appendix. It is classified as a medical emergency and many cases require removal of the inflamed appendix, either by laparotomy or laparoscopy. Untreated, mortality is high, mainly because of the risk of rupture leading to...
, pancreatitis
Pancreatitis
Pancreatitis is inflammation of the pancreas. It occurs when pancreatic enzymes that digest food are activated in the pancreas instead of the small intestine. It may be acute – beginning suddenly and lasting a few days, or chronic – occurring over many years...
, and gallstones; sometimes traditional treatments are used in combination with Western treatments. A traditional method of orthopedic treatment, involving less immobilization than Western methods, continued to be widely used in the 1980s.
Although health care in China developed in very positive ways by the mid-1980s, it exacerbated the problem of overpopulation. In 1987 China was faced with a population four times that of the United States and over three times that of the Soviet Union. Efforts to distribute the population over a larger portion of the country had failed: only the minority nationalities seemed able to thrive in the mountainous or desert-covered frontiers. Birth control programs implemented in the 1970s succeeded in reducing the birth rate, but estimates in the mid-1980s projected that China's population will surpass the 1.2 billion mark by the turn of the century, putting still greater pressure on the land and resources of the nation.
Today
The Chinese government still faces a mammoth task in trying to provide medical and welfare services adequate to meet the basic needs of the immense number of citizens spread over a vast area. Although China's overall affluence has grown dramatically since the mid-1980s — per capita income has increased many times over, and caloric intake has become comparable to that for western Europe — a great many of its people live at socioeconomic levels far below the national average. The medical system, moreover, labours under the tension of whether to stress quality of care or to spread scarce medical resources as widely as possible. In addition, there has been repeated debate over the relative balance that should be struck between the use of Western and traditional Chinese medicineTraditional Chinese medicine
Traditional Chinese Medicine refers to a broad range of medicine practices sharing common theoretical concepts which have been developed in China and are based on a tradition of more than 2,000 years, including various forms of herbal medicine, acupuncture, massage , exercise , and dietary therapy...
. While the Cultural Revolution
Cultural Revolution
The Great Proletarian Cultural Revolution, commonly known as the Cultural Revolution , was a socio-political movement that took place in the People's Republic of China from 1966 through 1976...
pushed the balance toward widespread minimum care with great attention paid to traditional medicine, policy after the late 1970s moved in the other direction on both issues; by the late 1980s the proportion of doctors of Western medicine had exceeded those of traditional practices.
At the same time, the medical establishment also more or less has been affected by this major influence: along with 1980s initial period people's commune
People's commune
The people's commune was the highest of three administrative levels in rural areas of the People's Republic of China during the period of 1958 to 1982-85 until they were replaced by townships. Communes, the largest collective units, were divided in turn into production brigades and production teams...
disintegration, the original rural cooperatives medical service system rapidly disintegrates in the majority of areas; In the cities scope, the public health services system and the labor insurance medical service system also gradually declines in the varying degree. But the medical service relates to national economy and the people's livelihood and the social stability, and the related problems are extremely complex,the establishment of this new system is slower continuously, compared to other professions.
The health of the Chinese populace has improved considerably since 1949. Average life expectancy has increased by about three decades and now ranks nearly at the level of that in advanced industrial societies. Many communicable diseases, such as plague, smallpox, cholera, and typhus, have either been wiped out or brought under control. In addition, the incidences of malaria and schistosomiasis have declined dramatically since 1949.
As evaluated on a per capita basis, China's health facilities remain unevenly distributed. Only about half of the country's medical and health personnel work in rural areas, where approximately three-fifths of the population resides. The doctors of Western medicine, who constitute about one-fourth of the total medical personnel, are even more concentrated in urban areas. Similarly, about two-thirds of the country's hospital beds are located in the cities.
China has a health insurance
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
system that provides virtually free coverage for people employed in urban state enterprises and relatively inexpensive coverage for their families. The situation for workers in the rural areas or in urban employment outside the state sector is far more varied. There are some cooperative health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
programs, but their voluntary nature produced a decline in membership from the late 1970s.
The severest limitation on the availability of health services, however, appears to be an absolute lack of resources, rather than discrimination in access on the basis of the ability of individuals to pay. An extensive system of paramedical care has been fostered as the major medical resource available to most of the rural population, but the care has been of uneven quality. The paramedical system feeds patients into the more sophisticated commune-level and county-level hospitals when they are available.
New Rural Co-operative Medical Care System
The New Rural Co-operative Medical Care System (NRCMCS) is a new 2003 initiative to overhaul the healthcare system, particularly intended to make it more affordable for the rural poor. Nowadays the permanent urban population (except migrants) take out medical insurance. But the poor, many of them in the countryside, go into debt to pay their medical bills or go without treatment. Many in the rural areas struggle to afford with the new burden of healthcare fees, a result of the collapse of the old state-funded health system which existed before China's program of economic reforms in the 1980s.The annual cost of medical cover under the NRCMCS is 50 yuan (US$7) per person. Of that, 20 yuan is paid in by the central government, 20 yuan by the provincial government and a contribution of 10 yuan is made by the patient. As of September 2007, around 80% of the whole rural population of China had signed up (about 685 million people). The system is tiered, depending on the location. If patients go to a small hospital or clinic in their local town, the scheme will cover from 70-80% of their bill. If they go to a county one, the percentage of the cost being covered falls to about 60%. And if they need specialist help in a large modern city hospital, they have to bear most of the cost themselves, the scheme would cover about 30% of the bill.
Primary care reform
China has no national primary carePrimary care
Primary care is the term for the health services by providers who act as the principal point of consultation for patients within a health care system...
system, in particular general practice. The introduction of general practice in parts of urban China began in 1999. Acceptance of general practice has been slow against the background of a strong urban tradition of hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
s as primary care providers, the widespread belief that specialists are more skilled than generalists even for minor complaints, and the perceived right of the individual to use the provider of their choice. But these attitudes are changing slowly. In several cities, notably in Zhejiang
Zhejiang
Zhejiang is an eastern coastal province of the People's Republic of China. The word Zhejiang was the old name of the Qiantang River, which passes through Hangzhou, the provincial capital...
, Jiangsu
Jiangsu
' is a province of the People's Republic of China, located along the east coast of the country. The name comes from jiang, short for the city of Jiangning , and su, for the city of Suzhou. The abbreviation for this province is "苏" , the second character of its name...
, and Guangdong
Guangdong
Guangdong is a province on the South China Sea coast of the People's Republic of China. The province was previously often written with the alternative English name Kwangtung Province...
provinces, general practitioners (GPs) are acquiring a good local reputation and are attracting large numbers of patients.
General practice in China is criticized for failing to perform a gate-keeping role, but such a role is virtually impossible to establish in the presence of a diversity of payment schemes including government insurance, employer-paid insurance, private insurance, community-based insurance (mostly with only part reimbursement), and out-of-pocket payment. Training and pay have not presented problems. The system of payment of GPs is similar to that of hospital practitioners - ie, a basic salary supplemented by bonuses according to performance. In popular hospitals and busy specialties, these bonuses may be up to ten times the basic salary, whereas some hospital doctors may receive only the basic salary. Likewise, GPs get a basic salary, which is topped up from patients' fees and prescriptions. Thus there are clear incentives to improve quality, hence attracting more patients and increasing income. The desire of newly-trained doctors to work in cities will ensure there will be an unlikely shortage of GPs for the foreseeable future.
There are several important problems facing health policy-makers. First, a system that keeps basic wages low, but allows doctors to make money from prescription
Medical prescription
A prescription is a health-care program implemented by a physician or other medical practitioner in the form of instructions that govern the plan of care for an individual patient. Prescriptions may include orders to be performed by a patient, caretaker, nurse, pharmacist or other therapist....
s and investigations, leads to perverse incentive
Incentive
In economics and sociology, an incentive is any factor that enables or motivates a particular course of action, or counts as a reason for preferring one choice to the alternatives. It is an expectation that encourages people to behave in a certain way...
s and inefficiency at all levels. Second, as in many other countries, to develop systems of health insurance and community financing which will allow coverage for most people is a huge challenge when the population is ageing
Ageing
Ageing or aging is the accumulation of changes in a person over time. Ageing in humans refers to a multidimensional process of physical, psychological, and social change. Some dimensions of ageing grow and expand over time, while others decline...
and treatment
Therapy
This is a list of types of therapy .* Adventure therapy* Animal-assisted therapy* Aquatic therapy* Aromatherapy* Art and dementia* Art therapy* Authentic Movement* Behavioral therapy* Bibliotherapy* Buteyko Method* Chemotherapy...
s are becoming more sophisticated and expensive. Several different models have been developed across the country to attempt to address the problems.
An example of a reform model based on an international partnership approach was the Basic Health Services Project. This was implemented between 1998 and 2007 by the Government of China in 97 poor rural counties in which 45 million people live. Its aim was to encourage local officials to test innovative strategies for strengthening their health service to improve access to competent care and reduce the impact of major illness. In particular it supported county implementers to translate national health policy into strategies and actions meaningful at a local level.
Chronic diseases are now the main cause of death and disability worldwide, and China is experiencing the same health problems as western countries. The difference is that the problems occur in a country with the largest population in the world yet relatively limited health resources. To tackle the challenge posed by chronic diseases, a robust primary care system has been called for as necessary. This is the weakness of China's health system, as, especially in big cities, health care is almost entirely hospital-based and people with minor illnesses prefer to be seen by doctors in large hospitals. The qualification and professional competence of general practitioners is always questioned because of lack of training and appropriate regulation. General practitioners therefore fail to function well as gatekeepers. In such a situation, it is very common that doctors in large hospitals see about 30–40 patients within the first 4 h. Doctors hardly have any time to talk with patients, getting to know what they really need, and seldom give advice on diet
Diet (nutrition)
In nutrition, diet is the sum of food consumed by a person or other organism. Dietary habits are the habitual decisions an individual or culture makes when choosing what foods to eat. With the word diet, it is often implied the use of specific intake of nutrition for health or weight-management...
, physical activity, compliance
Compliance (medicine)
In medicine, compliance describes the degree to which a patient correctly follows medical advice...
etc, which is the key to high-quality care for chronic diseases. When the patient is a passive recipient, optimum outcomes cannot be expected.
In view of China managing major health system reform against a background of rapid economic and institutional change, the Institute of Development Studies
Institute of Development Studies
The Institute of Development Studies based at the University of Sussex is a global organisation for research, teaching and communications on international development....
outlines policy implications based on collaborative research around the Chinese approach to Health System Development. This approach includes testing innovations at local level, encouraging learning from success, and gradually building institutions that support new ways of doing things. It suggests that analysts from other countries and officials in organisations that support international health need to understand this approach if they are to strengthen mutual learning with their Chinese counterparts.
See also
- Healthcare reform
- Health care systemHealth care systemA health care system is the organization of people, institutions, and resources to deliver health care services to meet the health needs of target populations....
- Social structure of ChinaSocial structure of ChinaThe social structure of China has a very long history, going from the feudal society of imperial times to the industrializing and urbanizing society of today.The teaching of Confucius taught of five basic relationships in life:...
- Public health in the People's Republic of China
- Universal health careUniversal health careUniversal health care is a term referring to organized health care systems built around the principle of universal coverage for all members of society, combining mechanisms for health financing and service provision.-History:...
- Medical savings accountMedical savings accountMedical savings account refers to an account in which tax-deferred deposits can be made for medical expenses.-In Singapore:Medisave was introduced in April 1984 as a national medical savings system for Singaporeans...
- Two-tier health careTwo-tier health careTwo-tier health care is a term used to describe a situation that arises when there is a basic health care system financed by government providing medically necessary but perhaps quite basic health care services, and a secondary tier of care for those with access to more funds who can purchase...
- Journal of Health Care for the Poor and UnderservedJournal of Health Care for the Poor and UnderservedThe Journal of Health Care for the Poor and Underserved is an academic journal founded in 1990 by David Satcher, then President of Meharry Medical College who later became the 16th Surgeon General of the United States...
Further reading
- Bloom, Gerald and Tang, Shenglan. ed(s) (2004) Health care transition in urban China. Ashgate, Aldershot
- Ofra Anson, Sun Shifang (2005) Health Care in Rural China: Lessons From HeBei Province. Ashgate Publishing
External links
- China Health Reform
- Will patients be rewarded? - The EconomistThe EconomistThe Economist is an English-language weekly news and international affairs publication owned by The Economist Newspaper Ltd. and edited in offices in the City of Westminster, London, England. Continuous publication began under founder James Wilson in September 1843...
, Apr 16th 2009 - Health care reform in the Republic of China: formulating policy in a market based health system
- Chinese Health Care System Reform at a Crossroads Japan Center for Economic Research (JCER) report. (Mar 1, 2007)
- Qingyue Meng, Xingzhu Liu, Reforming China's Healthcare System: Beijing's Strategy for Establishing Universal Coverage China Brief, 6(24). (December 6, 2006)
- Gregory C Chow. An Economic Analysis of Health Care in China.doc Princeton University. (August 8, 2006)
- Analysis: Chinese healthcare gap widens United Press International (UPI). (April 10, 2007)
- WHOWhoWho may refer to:* Who , an English-language pronoun* who , a Unix command* Who?, one of the Five Ws in journalism- Art and entertainment :* Who? , a 1958 novel by Algis Budrys...
-Community based Health Insurance Schemes in Developing Countries - Books about China rural area
- Overview of India's Healthcare System Yahoo! Answers
- Community Health Care Reform and General Practice Training in China - Lessons Learned Liang Wannian, MD and Daniel Kam Yin Chan, MD
Published studies
- Study in HSOP. Health and social protection: experiences from Cambodia, China and Lao. 2008, Institute of Tropical Medicine Antwerp.
- Meng, Qingyue. Health care pricing and payment reforms in China : The implications for health service delivery and cost containment. PhD Thesis, 2006, Karolinska Institutet. ISBN 91-7140-576-3
- Dong, Hengjin. Health financing systems & drug use in rural China. PhD Thesis, 2000, Karolinska Institutet. ISBN 91-628-3982-9
- Andrew Green. An Introduction to Health Planning in Developing Countries. New York: Oxford University Press, 1999 (2nd ed). ISBN 0-19-262984-0
- Willy L. De Geyndt. Managing the Quality of Health Care in Developing Countries. Washington DC : World Bank, 1994. ISBN 0-8213-3092-6
The Lancet Series
The largest international research collaboration (October 2008) on the Health System Reform in China led by The LancetThe Lancet
The Lancet is a weekly peer-reviewed general medical journal. It is one of the world's best known, oldest, and most respected general medical journals...
, China Medical Board
China Medical Board
The China Medical Board of New York is a nonprofit organization that promotes health education and research in the medical universities of China.-History:...
, and Peking University Health Science Center
Peking University Health Science Center
Peking University Health Science Center is a respected medical school in China attached to Peking University, and is affiliated to 14 other hospitals in the Beijing Metropolitan Area. It enjoys a reputation as the best medical school in the country...
. Full collection of China Series available here.