Descriptive account of the history of Healthcare system in China

13 May


Before 1949 there was no formal health care system provided by the state due to the fact that it was all privatised. When General Mao took power, 95% of the population were under poverty line and the life expectancy was as low as 35 years old. The country was rife with infectious diseases such as polio and rabbis. Factors such as these motivated Mao to create an established health system, which comprised of a three tiered hierarchy. The 1st level consisted of barefoot doctors, whom had little health experience.  2nd level was township health centres, whereby the doctors had slightly more experience and lastly, the 3rd level included district hospitals and enterprise hospitals in the city. However, this was extremely flawed.

In urban areas government funded health support for those who worked in schools, factories, education and other public sector employment. Unemployment was very little so nearly everyone had some form of insurance.  However, only 10% of the population lived in urban areas, meaning 90% of population, the majority, who lived in rural areas, received no government help.  China was extremely poor and unconnected from the western world throughout this time. Western medicines cost a lot to import meaning this wasn’t the most feasible method. As a result of this they used a lot of natural and herbal medicines, some very effective. However, over time it became more apparent that western medicines were required.

In combination with Chinese medicines, the government tried to promote a social campaign of healthy eating, an active lifestyle and appropriate vaccinations when needed. By doing this they felt they could keep people healthy and fit without the intervention of doctors and health services.  By 1975, life expectancy increased from 35 to 63 years and eradicated lots of diseases such as the previously mentioned polio and rabbis. In 1976 Mao died, which left the country feeling that the progress made in health services would be lost. However, this is when Deng Xioping took over. China then began its economic reform and opened up to the western World. Since then GDP has increased by 8-15% annually, showing the positive effects of Dengs era.

Only a third of practitioners have adequate training of a 4year degree in medicine, however this means 2/3 have college training or high school education. This statement demonstrates the huge demand for doctors; therefore they are resorted to calling those with college training “doctors”. This demand is also reflected in the amount of patients who queue hours on end, to be seen by a doctor. Quite often they can queue for days, as it is so important that they get seen. As expected, large amounts of tension have been created through this process whereby the public’s dissatisfaction has been displayed through violence. In 2008 the ministry of health reported 9,800 attacks on doctors in hospital resulting in 26 million dollars worth of damages. Conflicts over health care lead to a tense relationship between the patient and doctor as they become driven to desperation


3 Responses to “Descriptive account of the history of Healthcare system in China”

  1. np2g11 May 13, 2013 at 9:04 am #

    The problem of attacks against doctors certainly has a double face: on one hand it puts the doctor’s life in danger, on the other hand it puts at risk the wellbeing of many patients that depend on skilled and experienced doctors for their surgeries. It also interesting that about 96% of doctors are not satisfied with their salaries and about 76% would not recommend the medical career to their children. Certainly this is a sign that the health system needs to adapt to the rising standards of living of China, and an incentive to increase the number of skilled doctors could be to guarantee a higher wage and encourage training abroad. If the number of doctors increased the whole system should become more efficient and the population’s wellbeing will certainly benefit from this.,8599,2096630,00.html

  2. jc35g10 May 14, 2013 at 4:27 pm #

    China’s health system was ranked recently by “WHO as the lowest in the world in terms of health equity”. 800 million live in rural areas but urban residents living in enjoy 80% of the national health resources, yet only account for 20% of the population. There are also emerging differences between urban residents and others who are rural migrant workers and so are not covered by the state health care system due to “lack of permanent resident status”.

    The initial progress brought greater medical expense and difficulty with access to services as the system could not provide effective services to the whole public. Low-income families found it impossible to afford the costs. Prior to 1985, the patient-physician relationship was considered strong and trusting, but this has been under increasing strain. These weaknesses are due to many factors, such as the uneven allocation of healthcare resources. In the 70s, 2.5 million medical personnel were working in rural areas, but this has declined to 500,000 in the last decade. This means that, more often than not, rural patients have more advanced diseases at the time of diagnosis as it is harder for them to receive assistance, leading to larger costs.

    In terms of healthcare, an inverse care law is apparent. The provision demand for services is highest in villages, yet this is where it is most poorly funded. Small clinics are where care is provided, with larger hospitals reserved for life threatening illnesses. However, small clinics are often inexperienced or ill-equipped. The WHO explains how “antenatal checkups by village doctors are limited to examination of foetal heartbeat and position, which are only two of the six requirements of the provincial maternal and child health-care standards”.

    The disparities are extremely clear. In the richer areas of China, statistics are similar to that of Western countries. In Western China however, they are closer to that of Africa. According to the WHO, health expenditure per capita in international dollars ranks only at 139th, comparing to 133rd in India although China has a higher GDP per capita. The Chinese population reached 1.35 billion in 2011, yet its total healthcare expenditures account for only 2% of the world total due to inadequate government investment. National Health Accounts show that its total health expenditure has declined from 36% in 1980 to 17% in 2004. The ranking of overall health system performance puts China at the 144th place, behind India’s 112th place and far behind other Asian countries. Although China’s health indicators are comparable to countries at the similar development level, the trend and distribution are more worrisome.

    Sources: Li, C., 2001, ‘Health care in rural China: current development and strategic planning’, Chinese Health Econ, Vol.20, p.11-13

    Li, J., et al, 2006, ‘Multiple facets of China’s health inequality’, The Lancet, Vol. 367, No. 9520, pp.1397

    Wang, H., Xu, T., Xu, J., 2007, ‘Factors contributing to high costs and inequality in China’s healthcare system’, Journal of the American Medical Association, Vol. 298, No.16, pp.1928-1930

    Zhang, X., Kanbur, R., 2005, ‘Spatial Inequality in education and health care in China, China Economic Review, pp.189-204

    • timhaythorne May 15, 2013 at 12:13 pm #

      There is not only disparities between rural and urban China, but also within the urban sector, the rural migrants still suffer within the healthcare system.

      In the Townships and villages, on the outskirts of the cities, the clinics are often second-rate and poorly funded. They are gradually becoming used less and less, with the main hospitals drastically overcrowded in the city centres. Arguably, it is the health centre which should be the common resource of all and promote unity among urban dwellers and minorities, alas it is indeed the opposite, with many migrants feeling discriminated against by staff from the facilities, alongside the financial barriers to use.

      The argument to be made is that to encourage both mass and efficient use of health systems, there needs to be a uniform policy of financial access (ie. insurance like in the US or taxation like in the UK) and improvement of smaller, second-rate facilities. To improve the healthcare for all, these alterations must first be addressed before the absolute quality of services are addressed.

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