Healthcare in China: The World’s Largest Health System

ND&P President Susan Dubuque discusses the health system in China in this first installment of a three-part series. 

I recently had the pleasure of touring China for three weeks. Between visiting temples, paying homage to countless Buddhas, sampling strange and often unidentifiable delicacies and running on the Great Wall, I had some time to consider the healthcare system in this vast land. (Just imagine the challenges of managing health services for a population of 1.3 billion.) This blog series is based on my wholly unscientific observations, interviews, visits to Chinese medicine shops, a lecture on alternative treatments and a number of Google searches to fill in some informational gaps. 

Let's start with an overview of the healthcare delivery system. In 1949, when the People's Republic of China was established, the government assumed responsibility for the provision of healthcare for its citizens. However, in the mid-90s the concept of medical insurance was introduced. Individuals employed in the private sector may now receive health insurance as a benefit.  In such cases, the insurance premium is primarily paid by the employer with a small contribution made by the government. These policies cover 80% of the healthcare costs, with the patient being responsible for the 20% balance. (Sounds remarkably like my parent's indemnity plan from the 60s and 70s).  State employees as well as the aged, infirm, disabled and unemployed are insured by the government. 

Checking it out.

During our trip, one member of our group was kind enough to conduct a bit of mystery shopping. (OK, so he didn't exactly see if that way - but let’s give it a positive spin.)  Alan had a diabetic-related issue and was taken to a hospital in Chongqing by ambulance, where he had an overnight stay. After arriving in the emergency department, he was immediately transferred to an inpatient room.  Actually, "room" is an understatement - it was a large, private suite complete with a kitchenette and ample room for a roll-away bed for Alan’s sister to sleep.  Having a family member present during the hospitalization was not a nicety, rather it was required.  During his stay, Alan was cared for by a nurse, who drew blood, administered IVs and monitored vitals.  The doctor attended briefly upon admission and discharge.  

Perhaps the most dramatic difference between this little healthcare foray and a hospital visit in the USA was the finances. This service was a cash transaction. The ambulance had to be paid upon delivering the patient to the hospital. The sum for this service: 300 Yuan (roughly $60 US). The entire hospital bill including the physician's charges, lab tests, overnight accommodations, nursing care, food, and even a pair of shoes to wear home (Alan arrived barefoot): a walloping 706 Yuan (about $120 US). 

It is hard to tell what level of service a Chinese resident would have received vs. a tourist, or if the level of care would be different for a patient who is privately insured vs. a government-sponsored patient. 

Where is healthcare in China headed? 

A little online research shows that the Chinese government is launching several healthcare initiatives – the two most notable being an effort to reduce the disparity of health delivery in rural communities and the introduction of a primary healthcare system - a relatively new concept in China. I spotted a hospital exclusively for brain surgery and an ad for a facility dedicated to minimally invasive gynecological surgery in Shanghai. (By the way, the ad was written in English and appeared on a rickshaw!) 

This brief look into the Chinese health system left me wondering – will China soon become the next great destination for medical marketing and tourism? McDonald's and 7-11 stores are found throughout China. Could The Joint Commission accredited hospitals, board certified physicians and surgical + tourism packages be next on the horizon? 

Could ND&P/China be our newest venture?  Stay tuned!

(Susan Dubuque)