Healthcare Policies and Systems in Europe and China

Comparisons and Synergies

Attilio Mucelli, Francesca Spigarelli

• Publisher: WSPC
• Year: 2017
• ISBN:
  9789813231238
• Topic: Economics
• Subtopic: International Economics
• Index: Economics

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Healthcare Policies and Systems in Europe and China, a product of an interdisciplinary European Union-funded project, comprehensively investigates opportunities for mutual integration in the healthcare sector of the two regions and analyses policies at both national and local levels, the legal environment, medical practices, as well as the state of respective healthcare industries and related businesses. The book sheds light on both the potential benefits and obstacles to the integration of Chinese and Western medicine, as well as practices and industries in Europe and China. An interdisciplinary approach is adopted throughout using tools and technical knowledge derived from the economics, social sciences, legal and medical fields.

This edited volume seeks to provide guidelines and policy proposals for policy-makers both in Europe and China, as well as offer operational suggestions for companies working in or with China, to enhance bilateral trade and investment flows. It also presents medical evidence and economic/legal analysis that will help boost the integration of traditional Chinese medicine with Western medicine through research studies. This is a recommended read for graduates, researchers and policy-makers seeking for a holistic understanding of healthcare policies and systems, both in theory and in practice.

--> Contents:

• Healthcare System and Industry in Europe and China: Common Issues and Future Opportunities:
  • Relevance of Western Medicine and TCM in the Chinese and European Markets: An Overview (Attilio Mucelli)
  • New Horizons of Chinese Healthcare System: Reforms and Perspectives (Daniela Caruso)
  • Effect of Aging on Healthcare Industry's Cooperation Opportunities Between Europe and China (Dan Yang, Qinhong Wu and Attilio Mucelli)
  • The Chinese TCM Industry: Growth, Changes and Policies (Marco R Di Tommaso, Manli Huang, Yue Qi and Chiara Pollio)
  • Trade in Medical Products Between China and EU (Qu Ruxiao, Zeng Yanping and Liu Xia)
  • The Healthcare Industry in the Chinese Economy: Insights from Input–Output Analysis (Noemi Ferracuti, Claudio Socci and Francesca Spigarelli)
  • European Healthcare Industry and Chinese FDI: Where Do Chinese Firms Invest? (Ping Lv, Yu Liang and Francesca Spigarelli)
  • Monopoly in the Chinese Healthcare Market: Norms and Practices (Lihong Zhang and Changmian Zhang)
  • The Chinese Private Hospital Sector and FDI: From Socialization to Opening Up (Federica Monti)
  • Investments, Research, Education, and TCM (Paolo Sospiro)
• The Integration of Western and Traditional Chinese Medicine: Challenges and Opportunities:
  • Assessing Costs, Benefits, and Cost-Effectiveness in TCM (Attilio Mucelli and Olena Liakh)
  • Evaluating the Use of TCM Through the Theory of Planned Behaviour: A Consumer Survey Analysis (Olena Liakh)
  • Legal Framework on Health Foods in China and Food Supplements in the EU: A Comparison Study in the Perspective of TCM (Pamela Lattanzi and Qingle Hu)
  • The Balance Between Patients' Choice and Economic Constraint in the Use of TCM Therapies: Two European Cases (Erik Longo and Laura Vagni)
  • Understanding Traditional Chinese Medicine from a Legal and Semantic Perspective (Saisai Wang and Kim Van der Borght)
  • Female Doctors in Ancient China: Comparative Studies Through Literature and Science (Elena Santilli)
• Traditional Chinese Medicine: Evidences from the Medical Field:
  • Using International Perspective to Develop Traditional Chinese Medicine (Xiaolin Yuan and Xu Zhang)
  • Cancer-Related Digestive Symptoms (Qijun Fang, Yujuan Wang and Tianshu Xu)
  • Cancer-Related Fatigue (Qijun Fang, Yujuan Wang and Tianshu Xu)
  • An Introduction of Zhou Zhongying's Experience in Diagnosing and Treating Osteoarthritis with GuBi Decoction Based on the Pattern Differentiation of Kidney Deficiency and Collateral Obstruction (Xueping Zhou and Jing Wang)
  • The Crisis of European Healthcare Systems in the 21st Century: The Patient with Chronic Disease and the Potential Role of Acupuncture in the National Healthcare Systems (Carlo Maria Giovanardi, Mauro Devecchi, Giuseppina M Farella, Alessandra Poini and Giuseppe Tallarida)
  • Focus on Headache, Migraine, Low Back Pain, and Infertility: Effectiveness and Cost-Effectiveness of Acupuncture in Chronic Diseases (Mauro Devecchi and Giuseppina M Farella)
  • Scientific Evidences in Acupuncture (Umberto Mazzanti and Maria Letizia Barbanera)
  • A Correct Methodology of Research in Acupuncture: The Problem of the Sham Procedures (Carlo Maria Giovanardi, Alessandra Pavesi and Alessandra Poini)
  • Safety of Acupuncture (Umberto Mazzanti and Maria Letizia Barbanera)
  • A Window on Acupuncture Research in China: Systematic Review of Clinical Trials in Treating Low Back Pain, Headache, and Infertility (Federico Marmori, Yang Shuo, Zhang Huamin, Li Zongyou, Tong Yuanyuan, Liu Yang, He Wei, Yin Renfang, Yang Kunjie, Zhang Lei, Claudia Skopalik and Carlos Llopis)
  • Regenerative Medicine Approaches: Different Culture Backgrounds but Similar Strategies (Monica Mattioli-Belmonte, Monia Orciani, Giulia Sorgentoni, Miriam Caffarini and Roberto Di Primio)
  • Endometriosis Treatment Opportunities: Western Conventional Medicine, Chinese Alternative Medicine, and Novel Strategies (Andrea Ciavattini, Nina Montik, Alessandra Biagini and Matteo Serri)
  • Western Medicine and Traditional Chinese Medicine in Chronic Pelvic Pain Treatment: A Literature Review (Andrea Ciavattini, Nina Montik, Matteo Serri and Alessandra Biagini)
  • The Role of the CAG Polymorphism of the Androgen Receptor in Conditioning Male Metabolic Profile (Gianmaria Salvio, Giacomo Tirabassi, Monica Mattioli Belmonte, Roberto Di Primio and Giancarlo Balercia)
  • China and Traditional Chinese Medicine (TCM) Policies: Medical Education System and Vocational Training (Daniela Caruso)

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--> Readership: Graduates, researchers and policy-makers seeking for a holistic understanding of healthcare policies and systems, both in theory and in practice. -->
Keywords:Healthcare Industry;China;Traditional Chinese Medicine;Business;LawReview: Key Features:

• Provides a comprehensive legal analysis of obstacles for the integration of Western–Chinese medicine (comparative law and international law)
• Provides scientific evidence of the effectiveness of integrating traditional Chinese medicine and Western medicine in the treatment of specific pathologies
• Integrates business, policy, legal and medical issues in the analysis of the challenge of integrating China and Europe healthcare systems and practices

Part 1

Healthcare System and Industry in Europe and China: Common Issues and Future Opportunities

Chapter 1

Relevance of Western Medicine and TCM in the Chinese and European Markets: An Overview

Attilio Mucelli

1.INTRODUCTION

Traditional Chinese Medicine (TCM) was developed more than 2,500 years ago as a system for studying human physiology and pathology, as well as for preventing, diagnosing, and treating illnesses. The most common TCM practices include herbal and nutritional therapy, restorative physical exercises (qigong), meditation, acupuncture (stimulating specific points of the body using various techniques), remedial massage (tuina), moxibustion (applying heat to acupuncture points by burning herbs above the skin’s surface) and tai chi (dance-like body movements combined with coordinated breathing and mental focus).¹

Over the period 2003–2011, it was estimated that the TCM industry sales had a 24% Compounded Average Growth Rate (CAGR), with respect to the 21% for Western Medicine (WM), indicating that it is not only one of the fastest emerging activities within the Chinese territory but also an increasingly recognized practice abroad. In value terms, TCM reached USD 14.135 million by 2014.²

From 2007 to 2014, the fastest growing suppliers of raw materials for TCM were Thailand (+59.7% per year) and Germany (+35.7% per year).

According to the China Chamber of Commerce for Import & Export of Medicines & Health Products (CCCMHPIE), the exports of TCM products from China had increased by 25.54% (totaling USD 3.14 billion) in 2013, thanks to the rising international demand for Chinese herbal medicine.³ The CCCMHPIE reported that, in 2012, China’s top 10 export markets included only Germany and France among the EU countries,⁴ while the leading destinations of TCM exports in 2014 were Japan, Indonesia, the Philippines, Malaysia, and Thailand, which together comprised 44.8% of TCM export volume.

According to China Daily, the global promotion of TCM has been boosted by the establishment of an official relationship between the World Federation of Chinese Medicine Societies (WFCMS) and the World Health Organization (WHO), in order to provide technical support to the WHO as well as achieve cooperation with other nongovernmental institutions.¹

While TCM has been expanding abroad, WM in China has become increasingly popular. An analysis of the revenue composition in TCM hospitals in China showed that, from 1999 to 2008, the percentage revenue coming from WM increased from 59.6% to 66.1%, whereas that from TCM declined from 18% to 13.7%.⁵ It is obvious that WM represents a key financial source for the survival of TCM hospitals, which mainly generate revenues by providing WM services. The main reasons for this trend is related to the significant decline in government subsidies toward healthcare facilities, as well as to the fall in the demand for TCM services: 94.8% of rural residents and 84.9% of healthcare providers admitted to seeking WM care as the first choice, compared to 5.2% and 15.1%, respectively, of those opting for TCM therapies first.⁵

2.THE ROLE OF TCM IN THE CHINESE CONTEXT

The regulation on TCM is embedded into the Chinese constitution. Regulation of TCM by the People’s Republic of China in 1982 affirms that the State protects, supports, and promotes the development of TCM, as well as its integration with WM (both types of medicine have equal importance, should complement each other, and improve through mutual learning and knowledge exchange). There is a TCM Department at the Ministry of Public Health,⁶ and the responsibility of formulating all of the related regulations, policies, and guidelines are entrusted to the State Administration of TCM, which also has the task to build its standardized management and development.⁷ TCM is fully covered under the government and private insurance schemes. Patients have the right to freely choose which type of medicine to resort to (either traditional or conventional), and TCM practitioners are able to practice in either public or private hospitals and clinics.⁸

In 2012, TCM accounted for 31.24% of the entire domestic medicine market (with expenses above USD 79.5 billion), according to the National Bureau of Statistics in China.⁹

The China Academy of the Chinese Medical Sciences assessed that, by 2013, the total output value of TCM had already reached one-third of the domestic medicine industry (estimated at USD 91.4 billion).¹⁰ The yearly revenue growth of 18.1% (from 2008) led to a total of USD 29.6 billion during the same year, thanks to the increasing demand for these services by the patients. The top four industry competitors accounted for almost 3.1% of the entire industry revenue that year, as estimated by IBIS World (whereas the top eight participants held a combined share of less than 5%). In 2013, the number of TCM hospitals was estimated to be around 2,930, each with an average of 196 beds.¹¹ In terms of higher education institutions, by 2013, 45 schools were dedicated to TCM and 93 were specialized in WM.⁷ In 2014, the visits to TCM hospitals accounted for 17.9% of the total hospital visits across the country (530 million visits) and the overall value of the TCM industry increased to USD 110.8 billion.¹²

The revenue of the TCM hospital industry in 2016 rose to USD 53.7 billion, which represented an 11.8% growth from 2015. On the whole, there has been an annualized revenue expansion of 16.3% from 2011 till 2016. In terms of profitability, estimates went from 0.9% in 2007 up to 4.6% in 2016.

At present, there are nearly 440,700 Chinese healthcare institutions at all levels (from general hospitals, clinics, and health stations in both urban and rural areas to TCM hospitals), offering TCM services: approximately 90% of the general hospitals include a TCM department, for inpatients and outpatients alike,⁸ while the TCM institutions account for 4.3% of the total.⁷ The total number of TCM hospitals in China have increased by 500 in the past five years (+15.5%): there are about 3,059 TCM hospitals to date, with 252 beds on average, employing around 831,463 people.¹¹ The TCM outpatient departments increased as well (by 531) and so did the TCM clinics (by 5,890).¹²

3.TCM STILL LAGS BEHIND IN EUROPE

In 2010, the WFCMS estimated that there were about 120,000 TCM ­practitioners and acupuncturists in Europe at the time. By that year, acupuncture as a distinct therapeutic system was recognized by law in 12 EU Member States, including Austria, Belgium, Bulgaria, Czech Republic, Denmark, Germany, Greece, Hungary, Latvia, Portugal, Slovenia, and Spain.⁷

In 2012, only 10% of China’s total TCM export volume went to the EU (e.g., the exports to the UK dropped by 70%).¹³ Nevertheless, over the past four years, a significant number of TCM products entered the EU market, corresponding to annual export sales of traditional Chinese herbal medicinal products to the EU of around USD 12 million (CCCMHPIE data).¹⁴ Germany represents the main European TCM market, from which an expansion toward other EU countries can be easily achieved. In general, the EU is a high-potential market for herbal medicine trade: it is estimated to have a 47% share in the global herbal market (USD 26 billion), with more than 1,270 types of herbal medicines in circulation, and over 60% Europeans using TCM.¹⁵

The main trade barrier for the development of TCM in Europe is related to the EU Directive 2004/24/EC, also known as Traditional Herbal Medicinal Products Directive (THMPD), which provides the legal basis for TCM and other types of herbal medicines, in terms of entry into the EU market.¹⁶ Its objective is the establishment of a unified regulatory regime for the medicinal products market across all the member nations (each Member State had then to apply their own rules/procedures to regulate TCM accordingly). THMPD planned to introduce a simplified registration procedure of such products, which would have been subject to the EU quality and safety guarantees (this was particularly important as some TCM products had a very poor reputation of quality in other markets: they were either mixed with WM; contained heavy metal, rare animals, or plants; or lacked specifications regarding shelf life).¹⁷

The Directive stipulated that only those TCM products that had obtained the authorization could be sold within the EU (with a safety proof of utilization of 30 years, 15 of which within the EU).¹⁸ After a transitional period of seven years (till April 2011), the products that were not registered yet could not be imported into the EU market: the products had to meet the definition of “traditional medical product” and the representative Chinese TCM producers and exporters should have applied for a marketing authorization well in advance, in order to benefit from the transitional period and be able to sell their products in the EU market as medicines (those products that were already marketed in ...

Table of contents

• Cover
• Halftitle
• Title
• Copyright
• Preface
• Contents
• List of Contributors
• Part 1 Healthcare System and Industry in Europe and China: Common Issues and Future Opportunities
• Part 2 The Integration of Western and Traditional Chinese Medicine: Challenges and Opportunities
• Part 3 Traditional Chinese Medicine: Evidences from the Medical Field