Perhaps the longest and best recorded history of medicine can be found in China. Chinese traditional medicine and practices have been in place and developing for about 2000 years. The introduction western practice and medical theory took place in the 19th and twentieth century through the missionaries from the west. The Rockefeller foundation in conjunction with the missionaries built the Peking Union Medical College. Currently, traditional Chinese medicine is still practiced alongside the western conventional medicine (Robert et al.1987).
The Chinese medicine was promoted by the leaders of China thus it remained an important component of the system, however; as the 70’s and 80’s came to pass western medicine gained popularity and acceptance. Traditional Chinese medicine depends on the use of acupuncture, herbs, moxibustion, acupressure and the “cupping” of skin using hot bamboo. At times traditional methods combined with conventional medicine practices. The Chinese healthcare system has experienced tremendous improvements since the early 1940’s however; the system is has not attained efficiency.
Healthcare provision has largely been neglected by the government and this has shifted away from the state-owned enterprises. Successful rural healthcare programs such the “barefoot doctors” were dismantled with no alternative provided. As a result, the development of China’s healthcare is far behind compared to the economic development in the country (Robert et al.1987).
The review of major health indicators clearly shows the necessity for change and infant mortality and life expectancy show that despite the early improvements attained there is been some substantial slow down. Mortality rate and reported incidences caused by infectious diseases in recent years have been so high.
The key indicators show that there is problem in efficiently and effectively meeting the needs of the people of China with regard to health matters and therefore, there is a need for improvement.The Ministry of Public Health took over full responsibility for healthcare matters and it was responsible for supervising and establishing every part of the healthcare policies. The ministry regulated all local, provincial and national health facilities as well as state and industrial enterprise facilities. During 1981 the additional group of facilities offered urban and rural healthcare via a tiered system.
The ‘barefoot’ doctors working in the villages offered healthcare at the village health centers, by offering primary care and preventive services and the rates of doctors to people stood at 2 doctors for every 1000 people. The second tier constituted of health center in the townships, these worked as outpatient centers for an estimated 10000-30000 each. The most qualified practitioners in these centers were assistant doctors. The two lower tiers served the rural health system. The upper tier constituted of doctors from 5 year medical schools that served the county hospitals and these could serve 200000 to 60000 citizens (Robert et al.1987).
Paramedical personnel offered care in the factories and in health stations within neighborhoods. Serious cases could be referred to the district hospitals and most serious problems were referred to municipal centers. A number o government agencies and state enterprises referred their patients to municipal and district hospitals and thus circumvented barefoot and paramedical practitioners (Books LLC, 2010). “Patriotic health campaigns” were initiated to help improve environmental sanitation and hygiene so as to lessen some cases of poor health. Particular focus was laid on water sanitation and waste treatment as well as pest elimination.
As a result, of preventive measures epidemic diseases such as plague, typhoid, scarlet fever and cholera were almost eradicated. The mobilization of masses was successful in fighting condition such as syphilis. Reportedly the condition was eliminated in 1960’s. Other parasitic and infectious conditions were significantly reduced and put under control. After the sixties some anti-epidemic and sanitation programs were relaxed and as a result some incidences of disease increased (Books LLC, 2010). In the 80’s this relaxation of waste treatment led to an increase in diseases such as schistosomiasis and hookworm.
Some problematic diseases such as dysentery, hepatitis, tuberculosis and malaria still persisted. Improved sanitation and health education was still required in the 80’s however; the brigade system had broken down making it difficult to carry out the health campaign (Robert et al.1987). In the 80’s China recognized AIDS as a serious threat, but it was least affected by the condition.
During the 80’s heart diseases, cerebrovascular diseases and cancer were the leading causes of death. This trend was similar to that observed in most developing nations. Prevalent and fatal cancer forms included colon-rectum, lung, liver, stomach, esophagus and liver cancer cases.
Mortality due to these diseases was highest in high income areas, and these were more prevalent in men than women.In order to deal with rising health concerns the country increased quality and the number of personnel to offer medical care, this increase however did not suffice because in 1986 there were still some great shortages in some areas.
The number of nurses and physicians increased from 33000 and 363000 to 637000 and 1.4 million respectively. Approximately 436000 physician assistants underwent training and had two years of medical education. The number of paramedics also rose from 485400 to 853400 between 1975 and 1982 (Myron & Gail, 1982). The number of medical students also rose from 100000 to 160000 within the same period.
The government made an initiative to increase and expand medical facilities and the bed capacity in hospitals increased from 1.7 to 2.2 million between 1976 and 1984. Hospitals also increased from 63000 to 67000 within the same time frame (Robert et al.1987).The quality and availability of healthcare was very different in level in the cities and the countryside.
Data colleted in 1982 showed that the crude rate of death was 1.6 for every thousand people, which was higher than in urban areas and life expectancy was low by four years (Myron & Gail, 1982). The physician-patient rate per thousand citizens was approximately 10 times higher in urban areas compared to rural areas.
Expenditure on medical care was higher in urban areas compared to rural areas. The bed capacity in urban areas was also twice that in many local rural areas, however; some rural areas were better off than others. The transformation that eliminated collectivization in 1987 also reduced support on most rural medical facilities which depended on collectivization.
The cooperative system then only covered 40-45% of the rural people compared to the 80-90% in the 70’s. As finances for the cooperatives died resources declined and so did the ‘barefoot doctors.’ As a result, primary care and education suffered a great blow, sanitation checks on water sources and sanitation systems also declined (Books LLC, 2010).
The lack of funds from cooperatives also meant no funds to support ‘barefoot doctor’ education programs and therefore, provision of primary curative and preventive services declined. The costs of medical care shot up and locked out some patients in need of care. When patients failed to pay the debt became the responsibility of the hospital and this led to very huge debts.
As post-Mao modernization happened barefoot doctors went into private practice, where they provided services for a fee. The change of the government system made farmers richer and they were able to seek their services directly from county hospitals, and this reduced business for the barefoot doctors.
As a result, barefoot doctors and brigade leaders went into farming as it turned out to be lucrative. Cooperative medical programs collapsed totally. Healthcare in China developed positively up to the mid 80’s, however; it exacerbated overpopulation problems, and by 1987 China had a population which was four times larger than that of the U.S (IBM Business consulting Services, 2006).
However, birth control programs put in place in the 1970’s managed to reduce the birth rate.The post 1990 period saw new changes and turns in the healthcare system. Western styled health facilities having international medical practitioners are now available in Guangzhou, Shanghai and Beijing as well as other large cities.
Other facilities in major cities have V.I.P wards also known as gaogan bingfang. These facilities have modern facilities styled in the western way and they have skilled and knowledgeable practitioners. There are still emerging public health challenges such as pollution, a growing HIV aids epidemic, millions of smokers and rising obesity.
The HIV epidemic was worsened by unsanitary practices of blood collection in the rural communities. The tobacco problem is worsened by the fact that the sales are directly under the government in a monopolistic control. The fact that the government greatly benefits from tobacco revenue makes it hesitant to control smoking.
Hepatitis still poses a great problem in the mainland, where approximately 10% of the people have the disease. The disease has also been linked to a lower female birth according to research. This may be the explanation to gender imbalance in China if the research conclusively establishes the link. In response to the problem the Chinese government started a vaccination program for every newborn child within China’s mainland in order to combat hepatitis (Books LLC, 2010). The outbreaks of various avian flu cases in the recent past have raised great concern in the Chinese healthcare system. These viruses are animal-human transmissible and there have been very few cases of human-human transmission.
However, there are greater challenges and if the virus morphs and attains human to human transmission capability. There was also concern in the 2005 outbreak of the bacteria Streptococcus suis which was transmitted from pigs to humans and killed 38 people in the Sichuan province. This was of great concern in China because the virus exists in other pig rearing nations but there have been no reported cases of pig to human transmission. As of 2004 the government gave an advisory for drinking bottled in less developed regions because cholera and other diseases were spread by water (Books LLC, 2010).
The healthcare system in China currently faces a multitude of other problems including the provision of health for women, sex education and contraception. This sector lags behind because of the culture of conservatism. Reportedly, lack of contraception is blamed for the large number of abortions. Severe acute respiratory syndrome (SARS) posed a great challenge in 2002, but it was later overcome after the isolation the virus and development of a vaccine. By 2005 1 million Chinese were HIV positive and according to projections this figure would rise to 10 million by 2010 if nothing was to be done. The republic of China thus faces a great challenge from the epidemic.
Tuberculosis is also another challenge that has been aggravated by the highs smoking habits and the rise of multi-drug-resistant strains of TB. The country is second to India in having the largest TB infected population. The problem of malnutrition is also currently high in China especially, in the western rural areas where poverty levels are higher.For the poor population there is greater need for education on nutrition and possible provision of health supplements by the government. The three main challenges that healthcare currently faces in China include affordability, inefficient usage of resources, lack of quality care for patients.
The expenditure on healthcare has been increasing in a comparative percentage compared to GDP, but the percentage still remains low compared to both developed and other developing nations (French, 2006). As an example China spent 5.8 percent of the national GDP on health in 2002. This is low compared to other nations such as the OECD countries (8%), South Africa a developing nations (8.7%), Brazil (7.9%), and India (6.1) (IBM Business consulting Services, 2006).
Inadequate expenditure forms a bigger part of the problem. Equally troubling is the lack of access to affordable services and high quality services. If no remedial steps are taken approximately 500 million Chinese citizens will find that they cannot afford medical care.
Problems of allocation may also be making other places especially, in the rural areas to be marginalized, and as such re-allocation is necessary to ensure that equality (French, 2006). A look at the situation implies that the “Xiao Kang” objectives have not been met, in these objectives all Chinese people are required to be moderately well off.
The Chinese health situation and development does not match the economic development and the people are getting little health services and care from the government in relation to the revenues they generate for the economy and there is a need for improvement of healthcare to match its economic development and improve the living standards of its people among which healthcare should be a top priority (IBM Business consulting Services, 2006).
Drastic changes starting with the stakeholders should be initiated in china in order to realize improved health standards. The health insurance sector is also very much behind and it requires greater changes and improvement to attain better standards as articulate by the heath minister Gao Qiang: “The gap between the need for healthcare services and the capabilities of current Chinese health insurance and delivery system is still immense…Development of the healthcare sector should depend on the government as well as the market… (IBM Business consulting Services, 2006).” the government needs to embrace some remedial changes such as establishing information networks, applying modern technology and make use of clinical solutions that are innovative.
Conclusively, the healthcare industry in China is marred by inequalities in both accessibility and distributions of government expenditure. The affordability rate low and many patients are locked out due to excessively expensive costs of medical care. The quality of care is also low despite the achievements attained there is a need for improvements as the populations expand each year. Additionally, the government is seemingly neglecting the healthcare sector by giving inadequate funding to the sector. Therefore, there is a need for a change of policy at the government level and cooperation of the private sector.
References
Books LLC (2010),. Healthcare in China, General Books LLC Publishers
French, W. H. (2006),. Wealth Grows, but healthcare withers in China, The New York Times, retrievable from http://www.nytimes.com/2006/01/14/international/asia/14health.html?_r
IBM Business consulting Services (2006),. Healthcare in China: Towards greater access, efficiency and equality, IBM Corporation
Myron, S. C. and Gail, E. H. (1982),. Healthcare in the People’s Republic of China: A view from inside the system: American Journal of public health, volume number 72, issue number 11 p. 1238. Retrievable from http://ehis.ebscohost.com/ehost/detail?vid=14&hid=103&sid=bb0a9177-fcab-44a5-83d7-da6a3d03b53f%40sessionmgr113&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=bth&AN=4949091
Robert L. Worden, R. L. Savada, M. A. and Dolan, E. R. (1987),. China: A Country Study. Washington: GPO-Library of Congress. Retrieved on 26th March, 2011 from http://countrystudies.us/china/38.htm
