Modern Healthcare System in China - Coursework Example

Sociology Healthcare Issues in China The People’s Republic of China has been considered to be one of the strongest and most influential world’s countries, holding the status of a superpower and the leading place in population number. A single country hosting more than a million of residents is though one of the most prosperous states with rather strong economy and organization built on the foundations of socialism. China has surprised the global community with its economic achievements, demonstrating not only the highest economic growth rates, but also a brilliant ability to convert all global economic obstacles to its use. Over the recent two decades, national GDP growth rate has reached 10% mark (Kan, 2009). has The credit mainly goes to the country leaders who have managed to create a new direction of social-economic development and increase the population’s activity, offering an attractive and favorable national idea to them. However, the wide range of reforms in the state policy didn’t go unnoticed for the ordinary citizens: the country faces all the more social issues, and socialistic trajectory of development comes across numerous challenges. Here, of course, the very first social issue is demographics in China and all the problems connected with it. Previous high population growth rates in the republic lead to overpopulation and the necessity to undertake decisive measures to control the number of population, including the notorious one-child policy leading to aging of the nation and many more social problems. The social issue directly connected with demographics and population as a whole is the state of healthcare and medicine in China. Although the initial opolicy meant for Chinese as the residents of a socialistic country offered a wide range of healthcare facilities, numerous flaws has been emerging in the system, which pose considerable risk both to the government and to the ordinary citizens. Healthcare System in China According to the system of state healthcare and labor insurance initiated in 1950’s, the state is responsible for covering costs of medical treatment for employees in urban areas, while healthcare wasn’t free of charge in rural areas. Such approach has played a significant role in encouragement of economic development and ensuring social stability. Today, healthcare system is placed under jurisdiction of the National Health and Family Planning Commission, though much power is granted to local Bureaus of Health of the provinces (Deiaco, 2013). Notwithstanding the government’s efforts, development of economy and economic reformation has been bringing the flaws of the healthcare system to the foreground. As the new enterprises and plants were opened, state expenditures for medical services provided for workers started increasing, making it extremely difficult for the state budget to meet the needs of the population. Thus, the need for profound changes and improvement in the Chinese healthcare system arose – this improvement was to be focused on establishment of a special mechanism that would enable compensating expenses of medical institutions. Such reorganization began in 1978: state expenditures were reduced, whereas the share of expenses to be covered by individual citizens increased. As a result, the share of expenditures covered by the state had reached the point of around 17%; enterprises and social institutions covered about 30%; and the burden of 53% of costs laid on the shoulders of individual citizens. In other words, the state wasn’t responsible for ensuring healthcare services for the citizens that much anymore, but their cost continued to grow at a fast pace, while the average income did not grow that fast enough. By 2006, high cost of medical services had made healthcare one of the most critical social issues in China. Healthcare expenditures now hold the third place in an average family budget after nutrition and education expenses. This problem is especially relevant for people living in rural areas, that often don’t have enough financial resources to pay for medical aid due to urbanization processes and increasing level of poverty. Thereby, the general level of health in China has been the product of various factors’ influence: hard work, poor quality of food and meds, ecological problems etc. The general lifestyle of Chinese citizens has been the key factor causing health impairment and increasing popularity of certain diseases. It should be mentioned, that – owing to healthcare improvement of the recent decades – extension of infectious diseases decreased (Adetunji, 2013). On the other hand, other ailments has been a growing concern for the Chinese – for instance, cancer, blood pressure issues and strokes. A factor posing great hazard is widespread smoking: more than a half of Chinese men smoke, and most women tend to be passive smokers (Adetunji, 2013). According to the data of 2010, the nymber of smokers in the country reached 300 million (Nordqvist, 2013). One more health problem that is closely connected with the lifestyle in China and needs to be handled in eye care delivery with China being the first country in the list by the number of blind people (World Health Organization). The primary reason causing blindness in China is cataract, a problem associated with ageing. Among other factors related to eye diseases, there’s deficiency of vitamin A, the issue of public health. Until the recent years, the system of medical insurance implemented by the authorities covered rather small population group, being focused mainly on inhabitants of urban areas, while this program wasn’t relevant for students, unemployed citizens and those who came to work from rural areas. Moreover, workers of private enterprises used to be deprived of the right to obtain medical insurance until the recent time. However, it was provided by the new legislation that all entrepreneurs provide medical insurance for their employees. Despite these efforts to expand healthcare insurance distribution among Chinese population, many employers tend to evade following this rule – hiring immigrants without signing a labor contract allows them not to provide medical insurance and save costs. Those who have no medical insurance often reduce the use of healthcare services to minimum for “purely financial reasons” (Office of WHO in China, 2006). Another concerning and relevant aspect of Chinese healthcare is high cost of medicinal drugs. Although the government tries to influence the situation, it controls only about 20% of all drugs presented in the pharmaceutical market. Even despite forcible process reduction, cost of medicinal drugs increases, literally giving people very few chances to afford them. In early 2000’s, drugs expenses made up more than a half of general healthcare expenditures, though they shouldn’t exceed 40%. At the same time, getting rather low salaries from the state, doctors may prescribe more expensive medications to their patients. Michael Sandel described one more problematic aspect of Chinese healthcare in his book considering interference of market relations into non-market spheres of life. Discussing violation of queue ethics, he appeals to healthcare as a non-market sphere of life, providing Chinese healthcare institutions as a particular example. According to Sandel, Chinese healthcare is stained by corruption in the sense of money being the measure of healthcare services’ quality and promptness. Paying additional money, one can get better service or have the doctor’s appointment sooner. Existence of these unspoken rules only worsens the general health condition of average citizens who have no financial capability to pay extra money and deepens the gap between the poor and the rich (which is already another serious social problem in China (Sandel, 2010). Ageing population as a result of one-child policy presents another considerable challenge for Chinese government: percentage of elderly population is constantly growing, and the nation is getting older. Thereby, there is the growing number of people who find themselves in need of special healthcare services, including home healthcare systems (Wharton School, 2013). Social Welfare Policy and Reforms Needless to say, that Chinese government doesn’t remain totally cold towards the challenges the healthcare system faces, and thus there are numerous social welfare programs and reformation packages that has been implemented in the country in order to improve the situation for the citizens. Medical Insurance Reforms Distribution of medical insurance among the population, especially in rural areas and among low-income families is rather deficient. Thus, as it was mentioned above, the group of population entitled to receive proper medical aid due to insurance was rather small. However, with the reformation of the entire healthcare system, healthcare distribution has been extended to almost 95% of Chinese citizens (Wharton School, 2013). Most of these people never had medical insurance, being virtually beyond the borders of social welfare policy, but reforms initiated by the government have changed that tendency. On the other hand, despite the wider healthcare insurance distribution is “shallow”, as professor Lawton Burns claimed (Wharton School, 2013). Having an opportunity to go to the major healthcare institutions with their insurances, people create enormous queues, and many of them often fail to get through the lines, and even those who finally get an appointment, may fail to get desirable results. The number of citizens who have medical insurance, exceeds the capacity of healthcare system, thus the latter faces great difficulties in providing healthcare services of proper quality. Overload in health care is – in its turn – caused by shortage of specialists, healthcare institutions and, of course, budget: the government is virtually unable to fund new healthcare facilities for those citizens who get insurance, yet have recently been unable to cover at least their basic medical and healthcare needs (Wharton School, 2013). Nevertheless, extending public access to healthcare, the state needs to ensure proper funding for that. Rural Cooperative System of Healthcare As rural areas experienced enormous difficulties in obtaining health care after reorganization of the agricultural sector in 1980’s, the social welfare initiative, started by the authorities in 2003 and called NRCMCS (New Rural Cooperative Medical Care System), was aimed at relieving the hardships of rural population in terms of healthcare services (Dib et al., 2008). Most aspects of the new system are aimed at reformation of both public and private sectors of rural health care (Liu and Eggleston, 1999). What is peculiar about this system is that its expenses are covered by the state, and that it is universally relevant and operates in all part of the People’s Republic of China. Another feature of the current healthcare program, typical for Chinese collectivist culture, is that it is mainly based on collective approach and agricultural collectivity. “Each collectivity was charged to ensure the accessibility of basic medical services to all the members given the budget constraint of insurance pool” (Huang et al., 2011). Researches carried out based on the data of certain part of the country – like that of Huang et al. – that the program’s overall outcomes are rather positive, with increasing activity of township hospitals and outpatient visits (Huang et al, 2011). In other words, people’s ability to afford health care services has increased. Nevertheless, there are also certain obstacles and difficulties on NRCMCS’ way: funding isn’t adequate enough, there’s shortage of proper equipment and qualified medical staff (Wagstaff et al., 2009). Moreover, opportunity to receive treatment for free covers mainly only inpatient treatment and costs, whereas people still have to cover outpatient expenses themselves (hence affordability of treatment remains low). Still, visiting local-level hospitals and clinics, Chinese rural residents get up to 80 per cent of their healthcare bills covered by NRCMCS. On the other hand, as the person goes further to county- or city-level hospitals and modern health centers, the share covered by the described scheme decreases. Healthy China 2020 Despite all the difficulties, Chinese authorities are rather decisive in their intentions to improve healthcare system and provide access to it for all the citizens. The healthcare program that has been declared recently is called Healthy China 2020. The program is aimed at establishing universal healthcare access for all residents of China regardless of rural or urban areas by 2020. Healthy China 2020 incorporates several areas related to public health that are to be reorganized and improved: for instance, quality of nutrition, agricultural sector and social marketing (Hu et al.,2011). Generally, the lion’s share of the program is focused on preventive measures, seeking to prevent spreading of chronic diseases. In other words, the government has chosen to focus much on improvement of the general lifestyle among the population, encouraging healthier food habits, physical activity and well-balanced diet. Healthy China 2020 attaches even more importance to improvement of the situation in overpopulated urban areas that are subject to string influence of modernity and globalization. Among the multiple goals of the program, there is a goal to improve average life expectancy in China – in 2008, it reached 73 years (Chen, 2008). According to this program, healthcare should be made affordable for everyone and fair. Special programs intended to change price setting system for medicinal drugs are also a part of Health China 2020. Moreover, quality of medical services is expected to rise due to professional training extension and quality inspection of hospitals, medicine and doctors’ work. Summing up the goals of the program, one could say that Healthy China is a rather ambitious and promising healthcare reforming program combining implementation of preventive measures, control over quality of healthcare, and affordability of the latter. Currently, healthcare expenses in China are 3% of GDP higher, and about two thirds of these financial resources are used for dealing with healthcare and insurance issues in rural areas and among the most vulnerable categories of citizens like unemployed and retired people, students and immigrant workers living in urban areas. Although it’s too early to speak about the outcomes of Healthy China Program, it is clear that the government attaches much importance to it in terms of healthcare improvement, and these challenges are to be overcome in a way that would reduce state budget difficulties. Chinese vs. American Healthcare Healthcare peculiarities and challenges look very similar in the U.S. and in China. First of all, the characteristic of both systems is corruption. Although low prices for medical items are kept by the government, it produces negative impact on the well-being of hospitals, that charge higher prices for their service, offering more costly procedures, drugs, equipment and ways of treatment (Wharton School, 2013). Moreover, doctors and hospitals receive so-called kickbacks from pharmaceutical and equipment-producing companies for promoting their products. On the other hand, American healthcare system is corrupt, too, nut this corruption doesn’t reach this extent, at least because the system is monitored and controlled better, with hospitals executives going to prison for giving kickbacks to doctors (Wharton School, 2013). The disappointing common feature in healthcare policies of both states is dissonance between healthcare insurance coverage and actual opportunities in getting medical aid promised by the insurance. Similar to China, the U.S. also expanded insurance coverage, but – again, people still experience difficulties in finding a doctor and receiving even primary care. As Chinese healthcare reforms that took place earlier proved to be inadequate to some extent, America can learn from China’s mistakes. And the most important lesson is that health insurance isn’t equal to actual access to healthcare services or coverage of costs (Wen, 2013). Thus, the system needs to be improved. Conclusion Healthcare system in the People’s Republic of China is an integral part of social welfare and general well-being of the most populous nation in the world. Despite vigorous economic growth, issues of health are becoming more and more itching for many citizens. Lifestyle of the nation and general life conditions only add to this problem, making it one of the most acute social problems in China. However, the government is still trying to solve the problem, deploying various approaches and learning on its own mistakes. Though the system is still far from being completely satisfying, hopefully, policy of this successful socialistic state will be able to cope with the challenge decently. References: Adetunji, Jo. (2013) First world problems: China’s lifestyle contributes to ill health. Retrieved November 15 from: http://theconversation.com/first-world-problems-chinas-lifestyle-contributes-to-ill-health-15041 Chen, S. (2008) China unveils healthcare scheme, BBC News. Retrieved November 15 from: http://news.bbc.co.uk/2/hi/asia-pacific/7175501.stm Deiaco, E. (2013) China’s Healthcare System – Overview and Quality Improvements. Retrieved November 15 from: http://www.tillvaxtanalys.se/download/18.5f097bc113eacc3d6d513e/1369033621751/direct_response_2013_03.pdf Dib, Hassan H., Pan, Xilong, and Zhang, Han. (2008) Evaluation of the new rural cooperative medical system in China: is it working or not? International Journal for Equity of Health, 7-17. Hu, F. B., Liu, Y., and Willett, W.C. (2011) Preventing chronic diseases by promoting healthy diet and lifestyle: public policy implications for China. Obesity Reviews, 7, 552-559. Huang, X., Aurore Pelissier A., Audibert M., Matonnat J. (2011) The Impact of the New Rural Cooperative Medical Scheme on Activities and Financing of Township Hospitals in Weifang, China. Retrieved November 15 from: http://www.cerdi.org/uploads/sfCmsContent/html/333/PelissierHuang.pdf Kan, Haidong. (2009) Environment and Health in China: Challenges and Opportunities. Retrieved November 15 from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2799473/ Liu, Yuanli, Hsiao, William C., and Eggleston, Karen. (1999) Equity in health and health care: the Chinese experience. Social Science & Medicine, 10, 1349-1356. Nordqvist, J. (2013) China Developing Health Problems Seen In Rich Nations. Retrieved November 15 from: http://www.medicalnewstoday.com/articles/261668.php Office of WHO Representative in China. (2005) China: Health, Poverty and Economic Development. Retrieved November 15 from: http://www.who.int/macrohealth/action/CMH_China.pdf Sandel, M. (2010) What Money Cant Buy: The Moral Limits of Markets, Allen Lane. Wagstaff, Adam, Magnus, Jun, Gao, Ling, Xu, and Juncheng, Qian. (2009) Extending health insurance to the rural population: An impact evaluation of Chinas new cooperative medical scheme. Journal of Health Economics, 1, 1-19. Wen, L. (2013) What the US Can Learn From Chinas Health Care Reform. Retrieved November 15 from: http://www.huffingtonpost.com/leana-wen-md/china-health-care_b_2850243.html Wharton School. (2013) ‘Ticking Time Bombs’: China’s Health Care System Faces Issues of Access, Quality and Cost. Knowledge Wharton. Retrieved November 15 from: http://knowledge.wharton.upenn.edu/article/ticking-time-bombs-chinas-health-care-system-faces-issues-of-access-quality-and-cost/ World Health Organization. Blindness as a public health problem in China. Retrieved November 15 from: http://www.who.int/mediacentre/factsheets/fs230/en/ Read More