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1、The Chinese Healthcare SystemLecture 10Tracey Lynn Koehlmoos, PhD, MHAHSCI 609 Comparative International Health SystemsWhere are we now?A few facts about ChinaCountry name: Peoples Republic of ChinaGovernment Type: Communist StateCapital: Beijing23 provinces (including Taiwan); 5 autonomous regions

2、and 4 municipalitiesFourth largest country in the worldMount Everestin the Tibetan Autonomous region shares a border with NepalUpdated informationPopulation: 1,313,900,000 (2006) Some 900,000,000 in rural areasLife Expectancy: 70.9 male/ 74.5 femaleInfant Mortality: 23.1 per 1000 (2006)Urban:11 per

3、1000 Rural: 37 per 1000 (1999)Population 65: 7.7%The Chinese ChallengeFor the last 30 years China has embraced a new political economy of market socialism. This is a dramatic shift from a health care system that was famously low-cost, bureaucratically controlled, collectivist and emphasized preventi

4、on. Now the philosophical, financial and organizational approach to the provision of healthcare is dramatically different from the Maoist/Socialist ideas that served the Peoples Republic of China since its inception.What does this dramatic change mean for the health of the Chinese people? (David & C

5、hapman)( accessed 12 May 2006)Organization of CareHierarchical Ministry of Public Heath: national policy and managementProvinces/Territories/Cities: Large departments of health responsible for local policy and managementBifurcatedUrban: 2.3 physicians per 1,000 population, about 1/3 of total Chinese

6、 populationRural: 1.1 physician per 1,000 populationFour Historical and Economic Steps to a Decline in Population Health es1st: 1978 to 1999, China reduced federal funding of healthcare from 32 to 15%-in favor of provincial/local govts having more “control” (result: disparities & privatization)2nd:

7、Govt imposed Perverse Price Regulations: hospitals and physicians that generated more e got bonuses; promoted use of new, expensive pharmaceutical products and high-technology servicesChinese Federal Health Expenditure as % of Total Health ExpendituresFour Steps to Poor Health (Continued)3rd: Disman

8、tling of Cooperative Medical System, 900 million rural Chinese became uninsured overnight, barefoot doctors became unqualified peddlers of high cost pharmaceuticals, loss of preventative emphasis4th: Reduced govt funding for public health efforts, local agencies switched to revenue generating focus

9、(restaurant/food inspection) vs. MCH, epidemic control & health ed.Blumenthal D, Hsaio W Privatization and Its Discontents The Evolving Chinese Health Care System. NEJM. Volume 353:1165-1170 (11) Macro Health FinanceHealth expenditure as % of GDP: 5.8 (2002)Per capita total health expenditures: $ 63

10、 US (2002)General Government expenditure on health as % of total expenditure on health: 33.7Private expenditures on health as % of total: 66.3Private expenditures out of pocket: 96.3%External resources for health as a % of total expenditures on health: 0.1% 50-70% of ALL healthcare spending is on ph

11、armaceuticalsmany of which are counterfeitPrivatizationSince 2000:Hospitals: 15% cooperative ownership, 15% private, for-profitRural area clinics and hospitals allowed to privatizeRural Healthcare Rural residents pay for 90% of their own healthcare (out-of-pocket)Public Health Campaigns: Government

12、and NGOs/INGOs frequently sponsor immunization or other healthcare campaignsNo opportunity for rural residents to purchase health insurance (no competitive market place for insurers)In 2002, officials launched several experiment inpatient care insurance plan as a rural health safety net. The governm

13、ent provides $2.50 a year, rural residents must match this with an annual $1.25. Urban HealthcarePublic hospitals: 70%, state mandated chargesTwo tier “National” insurance system: based on employer and employee contributionsstarted in 19981st Tier: Personal medical account2nd Tier: Universal fund av

14、ailable when the personal account is exhaustedA “young” program, not all employers participate, time will tell the impactInformed Patient/Rise of ConsumerismChinas former emphasis on prevention is no longer acceptableUrban Chinese have knowledge of modern curative approaches and want high technology

15、 and superior treatmentWith the One Child (One Son?!) policy, todays Chinese consumer demands the best for the child, a social guarantee for the health and future of the family. Low quality healthcare will lead to parents ignoring the one child rule Gender ImbalanceMexico City Policy, “Global Gag Ru

16、le,” which President Bush reinstated as his first act in office The “Gag Rule” prohibits recipients of U.S. international family planning assistance from counseling women on abortion or engaging in political speech on abortion. Rounding out your global health system cultural vocabularyRussian aborti

17、on rate: 2 abortions for every live birth (2002)Chinese abortion rate: 27% overall, 55% for unmarried urban women (a growing statisticnot counted by all agencies)US: 24.5 per 100 pregnancies (2002)Decline in Chinese abortion rateDistrust of birth control pillGender Imbalance120:100 male to female bi

18、rths overallIn some areas, 360 to 100 for second childrenAbortion: RU 486 prescribed & black marketFemale InfanticideSuspiciously high FEMALE infant mortalityRural Urban DisparitySome poor rural areas have seen an increase in infant mortality Rural areas have fewer trained providersRural areas have

19、lower access to high quality care, low access to new technologySchistosomiasis, an infectious, parasitic diseasepreviously eliminated has re-emerged and contributed to mortality ratesSchistosomiasis !?!Classic public health problem, previously “cured” or eliminated by extensive, collective public wo

20、rks programsCaused by parasitic worms, passed through feces into water, snails are the vector, caught through skin exposure200 million people are infected worldwidewith a rapid increase in ChinaCauses cirrhosis, causes deathMore on SchistosomiasisPreviously endemic along the Chang Jaing River (this

21、is a long river, almost all of Southern China)Mao and Communist Party vowed to eliminate SchistoCame to power started collective public works programdug hundreds of thousands of new canals, buried old canalssnails eliminatedexcept for in the mountains, source of the Chang JaingMore about SchistosomiasisSince 1978, shift away from collectivism toward private economyDisappearing emphasis on public worksNo new canals, INVADER SNAILS!Schistosomia