by Fred Fortin
April 20, 2007 at 8:31 pm
· Filed under Uncategorized
Having traveled to China on a number of occasions for reasons related to health care, I’d like to pursue a line of discussion on the blog about what’s happening there. As many of you know, China is opening up to ideas from around the world as to the direction of the country’s health care reform. Germany, Great Britain and the U.S.and other nations — both their private and governmental sectors — are engaging the Chinese, through delegations, conferences, joint research and other exchanges intent on bringing the experiences of the world to China’s doorsteps.
Why this international attention? Well first and foremost, of course, is the recognition of the tragic human suffering being experienced by the Chinese people. Just a few chosen at random statistics:
But there’s another very serious and global concern emerging here. Let me put it this way: it is no exaggeration to say that the health of the world’s people will increasingly depend on how well China addresses the health care needs of its own people.
Many of the health threats faced by China’s 1.3 billion people do not respect national borders whether it be infectious diseases like HIV, SARS, Avian Flu, syphilis, Hepatitis B, or air pollution, or bogus medicines. And when these and other threats do manage to stay within China’s boundaries, the social unrest, instability and international tension they cause certainly does not. So we must engage in a more serious attempt to cross the cultural and deeply political divide and develop a better understanding of China’s problems even as we struggle with our own.
The question that I’d like to keep as a subtext to any of the issues we may discuss is this: what is valuable in the American experience in health care that could make a significant contribution to Chinese health care reform?
No matter where we start we’re still looking at only one part of the elephant — or in this case the dragon — so here’s one area we could build a dialog around. You may have many others and I’d certainly like to hear from you about them.
Let’s focus on the physician for the moment. Physicians across China are employees of the public hospitals. There is little, if any at all, “physician private practice” in China. They work out hospital offices with long lines of patients stacked up down the hallways. Patients waiting will often be even in the physician’s room watching as the patient ahead of them is being examined or talking to the doctor. The financial relationships between the patient and doctor, patient and hospital, and doctor and hospital, can be confusing and murky. And these relationships can turn tense given doctors low salaries, the inadequate funding of hospitals, and many patients who lack sufficient money or insurance to pay for care.
Health care reform advocates see here a breeding ground for corruption and error. Whether it be patients bribing the doctor for some special consideration, fraudulent and or unnecessary drugs being prescribed, or simply high charges for bad medicine. For anyone who have traveled in developing countries this may not be an unusual situation. But China calls us, if for no other reason, because of the sheer scale of the problems — thousands of hospitals and millions of patients.
I’ll expand on these and other issues as time goes on, but for now I’d be interested in your take on them and any other issues you may have regarding health care reform in China. Let’s talk.
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tony wrote @ April 20th, 2007 at 11:16 pm
Fred, great insight and great topic for discussion. What constantly amazes me is how quickly China learns. Say what you will about Chinese officials; 10-15 years ago, they were forward-thinking enough to visit the world’s greatest cities in order to figure out the best way to plan out Shanghai. Boy did they get it right.
Much of what we’ve discussed here is very relevant. I think China is learning that healthcare is really about health - making good lifestyle choices and maintaining a healthy mindset about what’s important in life. For example, they’ve learned that anorexia has increased six-fold in young women in some areas since the advent of “western advertising.” They’ve experienced a surge in the “affluent diseases” of diabetes, obesity, and all the related implications. I believe the government could effectively link staying healthy with “being a good Chinese citizen.” Call it peer pressure or control or whatever, for Chinese, imagine living in a society in which it’s patriotic to be healthy. And patriotism in China is arguably stronger than ever. Win over the heart and mind, and the body will follow.
Makes me wonder if we can learn from that here. We’ve started to reduce teen smoking through what amounts to a savvy (and well-funded) marketing campaign. We didn’t tell them smoking could kill them - they don’t care about that. We convinced them smoking ain’t cool, and that’s deadly for them. Could we do the same thing to develop and reinforce the habits of healthy living?
Certainly worthy of talk. The good news about China is that the population is fairly stable, fairly well monitored for health, and fairly literate and capable of following instructions. The bad news is that very few hospitals have decent equipment, most doctors are underpaid and corrupt, with patients often too poor to pay. The last bit of good news though, is that the government knows it has a huge problem and is trying to fix it, however slowly. The other bit of good news is that foreign companies are coming in with all sorts of solutions, from medicines, to healthcare softawe, to bandages. Not sure if it is a countrywide trend or not, but my firm has certainly seen more of a commercial interest in China’s healthcare in the last six months than in the whole year previous to that.
I too would love to hear more of what people have to say and I thank you for your excellent post.
Everything else is globalizing….it makes sense that health and health care will become global issues as well. Thanks for your enlightening and thought provoking post.
Thanks for your thoughtful comments.Tony brings up a great point that learning is a two way street. In trying to address health care is China, what are, or will be, lessons learned for the west? Some areas are ripe for this kind of thinking. One is the building of cultural bridges in health care, that is, trying to learn what Chinese characteristics help us towards a better understanding of multi-ethnic, racial and nationality groups within our own borders. Another is in assessing the value of traditional Chinese medicine and its integration into a broader, globally oriented, redefining of medicine. One more area has to do with bringing the right kind of health care to rural communities. Their experiments in small collectives of farmers coming together to support doctors and health centers is something to keep an eye on.
Thanks also to China Law Blog for again reminding us of the recent good things happening in China. It’s very easy to get fixated on the bad stuff and overlook what many in China are achieving. Foreign interest is picking up as China welcomes more input into their planning on health care. The point here is to reinforce how private sector entities can help support the public interest.
And Vince, once again, thanks for you kind words.
lancet wrote @ April 23rd, 2007 at 1:06 pm
Being a physician for five years in China, I would agree most of them are true. However, I am not quite sure about the “Congenital syphilis infections have risen by an average of 72% a year since the early 1990s and that rate seems to be accelerating.” I have been an OBGYN for four years and had never noticed anything like that.
The medicines in Unties States and in China are quite different. In US, the medical resources are relatively even while in China, if you live in Beijing, Shanghai, Shenzhen, Guangzhou these types of big cities, the quality of care is really very good. It’s even better than most of the hospitals I had visited in US. However, if you are living in some small cities, that would be a completely different story. Also, the increasing conflict between physicians and patients are actually caused by the government. The government didn’t provide insurance to their people and transfer the problems to physicians. A physician in China earns more than average people earn but still not much considering the time they spent at school and at work. They need the patients to pay the bills to get their bonus. While only 30% of Chinese has insurance and the most of the rest 70% are poor people, it is just hard for them to pay any big bills like CT, MRI and even ultrasound. There are a lot of sad stories there. Physicians and patients relation is just going down and down everyday. Physician is a high risk job and you didn’t get paid too much and there is not much respect.
Is there anything wrong with the medical training so the physicians are all bad people? I didn’t see too much problems with the medical training. I went to both undergraduate medical school and the graduate medical school which are all very high ranking medical schools. The graduate medical school even ranks NO. 17 in the whole world. You ask the patients to trust you. They just don’t trust you. I myself also got beat by the friends by one of the patients I saw at ED. Government don’t take care of the patients and let the newspapers keep on attacking the hospitals and physicians… So, finally I choose to leave China. I hope someday I still can go back to do something for China. But China is still not ready for me to come back yet.
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