|Category||Politics and Sociology|
'Ever since the SARS epidemic of 2003 lifted the curtain to reveal the extent of horrors and ineptitude in China’s system outsiders have puzzled over why health has remained an Achilles Heel of the transforming state. Yanzhong Huang is arguably the only expert able to solve this paradox, offering bold and startling insights. This is a must-read for anybody interested in global health, pandemic control, or the future of the Chinese state.' ― Laurie Garrett, Senior Fellow for Global Health, Council on Foreign Relations, USA and author of Betrayal of Trust: The Collapse of Global Public Health
State engagement in health government governance is a relatively recent development in rapidly modernizing China - the government's first health-care moves post-Mao were to withdraw from the sector, acerbating problems of cost, access, and equality; average life expectancy rose by only five years between 1981 and 2009, compared to an increase of almost 33 years during the Mao era (1949-1980). To be fair, its initial improvements (35 to 67.9) came from a much lower base, yet other nations have improved more from a similar base in recent years.
Infant/maternal mortality has made considerable strides recently. Infant mortality in China decreased from 38 deaths/1,000 live births in 1990 to 16 in 2010, and the mortality rate for children under five dropped from 48 per 1,000 live births to 18. The maternal mortality ratio has also fallen, from 110 per 100,000 live births in 1990 to 38 in 2008.
Another substantial improvement - TB cases in 2010 China were estimated at 216 per 100,000, down 45% from 2000.
Chronic non-communicable diseases such as cancer and cardiovascular are the leading causes of death in China - with pollution contributing to at least the cancer death rates. Public opinion surveys in 2009 ranked health care and food and drug safety as among the nation's top three concerns. A major contributor was the introduction of market-oriented reform w/o adequate rule of law.
Industrial pollution is not the only instance of conflict between economic and health goals. China has one-third of the world's smokers and suffers about one million related deaths/year; its cardiovascular disease death exceeds that in the U.S.
Author Huang suggests separating public hospital ownership from management and ceasing the use of drug sales as the main revenue source for hospitals, similar to Taiwan. (Of every $100 spent on U.S. health care, $10-$12 goes for drugs, in China it is $40-$45.) He also suggests replacing fee-for-service with DRG and capitation to give those hospitals incentive to hold down costs and improve accountability. As for food and drug safety, Huang sees weak enforcement as the greatest problem, sometimes based on 'political consideration' (corruption), especially at the local level. This problem is acerbated by the absence of press freedom.
The 'good news' is the incoming president Xi Jinping has pledge to bring higher levels of health care to China's people - Beijing plans to triple its health care spending to $1 trillion by 2020.
Bottom-Line: China spent less than 5% of GDP on health care in 2005, vs. 16% in the U.S. and 10% in Canada. However, China's advantage in purchasing power parity leads author Huang and others to probably overstate the crisis in China's health-care as far as financial commitment is concerned; this is especially likely given that the author's estimates of government spending have been labeled as far too low (Tang, Baris). It also has initiated a program of encouraging Western hospitals to invest in China. A third major initiative - expanding health insurance to universal levels by 2020 (now reportedly at over 94%, though at low benefit levels that focus on in-patient care).