Healthcare Reform in China

From Violence To Digital Healthcare

Carine Milcent

• Publisher: Palgrave Pivot
• Year: 2018
• ISBN:
  9783319697369
• Topic: Business
• Subtopic: Pharmaceutical, Biotechnology & Healthcare Industry
• Index: Business

How efficient is the Chinese healthcare system? Milcent examines the medication market in China against the global picture of healthcare organization, and how public healthcare insurance plans have been implemented in recent years, as well as reforms to tackle hospital inefficiency. Healthcare reforms, demographic changes and an increase in wealth inequity have altered healthcare preferences, which need to be addressed. Significantly, the patient–medical staff relationship is analysed, with new proposals for different lines of communication. Milcent puts forward digital healthcare in China as a tool to solve inefficiency and rising tensions, and generate profit. Where China is leading in the digitalization of healthcare, other countries can learn important lessons. Chinese social models are also put into context with respect to current reforms and experimentation.

© The Author(s) 2018

Carine MilcentHealthcare Reform in Chinahttps://doi.org/10.1007/978-3-319-69736-9_1

Begin Abstract

1. Introduction

Carine Milcent¹

(1)

CNRS and Paris School of Economics (PSE), Paris, France

Abstract

This book aims at presenting the Chinese healthcare system and its latest reforms. Chapter 2 presents the specific definition of a health good and its implications. Then, in Chap. 3, the general landscape of healthcare in China is described. Chapter 4 focuses on public hospitals and their evolution, while Chap. 5 analyzes the status and actual situation of medical staff. As a thread throughout these chapters, inefficiencies in the system tend to appear, as do the current reforms aimed at dealing with them. Public insurance plans implemented over the past two decades are discussed in Chap. 6. The medical drug market is presented in Chap. 7 and the determinants of the phenomenon of violence affecting Chinese hospitals are described, through the relationship between the patient or patient’s relatives and medical staff, in Chap. 8. Chapter 9 delves deeply into the development of digital healthcare in China and how it can solve inefficiencies in the hospital system. The concluding chapter (Chap. 10) offers a vision of the future directions that the Chinese social model could take, based on the observations in previous chapters of current reforms and experiments.

Keywords

Healthcare in ChinaInsuranceMedical staffPublic hospitalsMedical drug marketDigital healthcare

End Abstract

The healthcare industry in China is experiencing a period of high-speed development—it had grown to RMB 2 trillion in 2014 and was set to reach nearly RMB 3 trillion in 2016.¹ At the heart of this industry stand public hospitals . Indeed, China’s public hospitals manage 90% of consultations for ambulatory care or outpatient care, and 90% of hospital inpatient admissions .² As such, public hospitals deal with requests for outpatient treatment just as they must deal with inpatient treatment.

Access to healthcare is at the intersection of many challenges faced by China today. Aware of the stakes, the government has been engaged in a series of reforms in which two apparently opposite philosophies co-exist: a highly regulated market and incentive for competition in healthcare through the development of the private market. 2009³ marked a turning point. Given the need to establish basic access for all, the State Council announced the introduction of universal and comprehensive health coverage by 2020. This objective was pursued during the 12th Five Year Plan (2012–2016).

The 12th Five Year National Healthcare Service System Plan 2015–2010 announced a universal “safe, effective and affordable basic healthcare services” by 2020. Five major issues were pinpointed:

• Expand basic medical-insurance programmes
• Establish a national essential drug system
• Develop a primary healthcare service system
• Provide equal access to urban and rural residents
• Continue the reforms of public hospitals.

The 13th Five Year Plan (2016–2020) pursues the same objective with some new directions. The “Healthy China Action Plan” focuses on deepening healthcare reform through:

• Strong efforts to develop advanced medical equipment
• The development of traditional Chinese medicine (TCM) healthcare services
• The implementation of a “fitness for all” strategy
• The encouragement of non-governmental participation in the healthcare services industry
• Granting non-profit private hospitals the same status as public hospitals.

Before examining the healthcare system in all its various incarnations, I first offer a brief overview of the current state of the population’s health and healthcare. In 2015, mainland China had a natural population growth of 5.21 per thousand, with a gross birth rate of 12.37% and a gross death rate of 7.16%. Urban residents now account for 54.8% of the total population (or 1.4 billion people). The population is 51.2% male and 48.8% female.⁴ Life expectancy has improved considerably over the years: while in 1990 it was 67 years for men and 70 for women, by 2010 it had risen to 72.5 for men and 76.8 for women. Likewise, the mortality rate for children under five and the maternal mortality rate have seen distinct improvements. However, it is also apparent that medication (especially antibiotics ) is currently being over-consumed. It is acknowledged that 70% of prescription medicines contain antibiotics .⁵ One consequence of this inappropriate use of medication is an increase in morbidity and mortality. Lianping Yang et al.⁶ estimate that each year, 2.5 million patients are admitted to hospital suffering from unwelcome medicinal side-effects.⁷ On the economic front, China’s gross domestic product (GDP) is not far behind that of the United States.⁸ While the growth rate appears to be slowing,⁹ it was nonetheless estimated to reach 6.9% for 2016.¹⁰ Overall, the general level of wealth among the population is on the rise. In 1990 per capita GDP was RMB 1644, whereas by 2012 it had reached RMB 38,420.

Access to healthcare in China today poses a completely different challenge to that of 30 years ago, mainly because of rapid ageing of the population, a result of the one-child policy, which led to a low birth rate, and an increase in life expectancy made possible by the organization of the health system set up during the Maoist period, and finally by the economic growth of the past three decades (Fig. 1.1). In this new demographic context, the system of access to healthcare needs to be reorganized in order to treat patients in long-term care or in situations of dependence. The creation of reception structures is under discussion, and pilot experiments have been put in place. Although the third plenum of the 18th Party Congress in November 2013 decided to progressively relax the one-child policy, with the possibility of a second child in a specified number of cases,¹¹ demographic inertia makes the impact of ageing inevitable.

Fig. 1.1

Ageing population, the demographic shift. The dotted line indicates the excess male or female population in certain age groups. The data are in thousands or millions. Source: United Nations, Department of Economic and Social Affairs, Population Division (2017). World Population Prospects: The 2017. https://​esa.​un.​org/​unpd/​wpp/​Graphs/​DemographicProfi​les/​

Alongside these developments, the demand for healthcare has also undergone a transformation due to the drastic reduction of poverty.¹² However, the distribution of the fruits of growth is far from homogeneous. Central and provincial government spending is much higher in rich and urban areas than in poor and rural areas.¹³ Thus, the Chinese health system is now confronted with a highly segmented population in terms of income and expectations.

As a result, the Chinese healthcare system has been forced to adapt, not only to demographic changes but also to a demand for new treatments: from dealing with a low-income population with high birth and death rates, primarily requiring basic care, it has moved to looking after a comparatively older population with a low birth rate and higher income, demanding ever-more-effective healthcare treatment. Since the economic reforms, the expected level of treatment quality has risen considerably, which de facto reduces the number of establishments able to meet these expectations to only the very best urban hospitals, thus creating high demand and low supply for such treatment, while less reliable healthcare establishments have found themselves in a situation where there is too much supply, but insufficient demand.

Beyond the external shocks associated with demographic, economic, and social transition, China’s healthcare system faces particular challenges due to the specific role played by public hospitals. The quality of care now expected by a growing proportion of the population is only accessible in some public hospitals, mainly those with a high level of care, referred to as Level 3 (sanji 三级), and which are therefore at the heart of the Chinese health system. Contrary to practice in the West where the patient consults a general practitioner in a healthcare practice for problems that are considered min...

Table of contents

• Cover
• Front Matter
• 1. Introduction
• 2. The Notion of a Health Good in China and Elsewhere
• 3. Organization of Healthcare in China and its Reforms
• 4. Hospital Institutional Context and Funding
• 5. Medical Staff
• 6. Health Insurance in China
• 7. The Medical Drug Market and its Reforms
• 8. The Rise of Violence as a Result of Inefficiency in the Healthcare System
• 9. Digital Healthcare
• 10. Conclusion and Discussion
• Back Matter