Possessing a viable healthcare system is essential for the social and financial wellbeing of a country. The Chinese healthcare system has changed dramatically since 1949 and the rise of the Communist Party of China. Since 1949, healthcare coverage has gone from universal to almost none in 1982, to now, reportedly, 95% (Wordbook 2012). The Health and Family Planning Commission aims to have universal health care by 2020. While coverage is broad, its depth has been questioned recently. In 2014, China spent 5.5% of its GDP on healthcare, compared to the U.S. who spent 17.1% of its GDP n healthcare for a population a fraction of China’s (World Bank).
Part of China’s most recent healthcare reform in 2008 is to provide a vast network of primary care, especially for those in rural areas which contain the majority of the Chinese population. The Chinese healthcare system is organized into three tiers of increasing intensity of care. With primary care facilities in villages or towns as the first tier, county hospitals as the second tier, and tertiary hospitals, usually located in major cities. As a patients visit facilities on higher tiers, their copayments often increase by orders
of magnitude for each tier (Bumenthal et al.). This can lead patients to fail to seek out necessary treatment.
The Chinese healthcare system is overseen by the Health and Family Planning Commission to ensure fair healthcare across all of china, however with 45% of hospitals privately owned and mainly for-profit, quality of care and professionalism can vary (The Commonwealth Fund). The majority of Chinese hospital profits come from prescriptions, which are often not covered by the general government provided health insurance. Hospitals are allowed a 15% markup in distribution of prescription drugs, givi
ng providers financial incentive to generate demand for more expensive drugs (The Commonwealth Fund). Pilot programs, including 3,077 public county hospitals and 446 public city hospitals, were put in place in 2015 to try to eliminate markups of prescription drugs (The Commonwealth Fund). For perspective, as of 2013 there were 24,706 total hospitals and 915,368 primary care facilities in China. Thus, eliminating the profit maximizing behaviors of drug companies and healthcare providers, potentially harming patient quality of care, still has a long way to go.
Recently, quality of care in China has been under fire following an HIV outbreak in Hangzhou hospital on January 26th, 2017. The Wall Street Journal reports the outbreak was caused by a technical violating protocol and reusing a needle that had come into contact with a patient positive for HIV. Interestingly, this story was scrubbed from Chinese news stations, suggesting a lack of transparency in the Chinese public health system. This is alarming, especially considering the consequences of the delayed public announcement resulting in the SARs outbreak in 2003.
In conclusion, China continues to develop its healthcare and public health system to meet the needs of its massive population. Comprehensive coverage and quality care still remain issues, but China has come a long way in the past 20 years and continues to implement new policies and programs to provide the best healthcare for its citizens.