Health system of the PRC

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Jinin People's Hospital , Jilin Province (2017)

The Chinese health system includes public hospitals, non-profit hospitals, primary health facilities, and specialized facilities. After the PR China had a relatively exemplary health care system in the 1970s, which was mainly known for the barefoot doctors , only about 5% of the rural population had access to the health system by the end of the 1990s due to the reforms. This undesirable development should now be remedied by 2020 and the entire population should have access to rudimentary health care. On December 28, 2019, a Basic Health Care and Health Promotion Act was passed by the Standing Committee of the National People's Congress. The COVID-19 pandemic that broke out in the Chinese city of Wuhan shows how urgent reforms are in the health sector.

statistical data

In 2016, the Chinese Communist Party and the State Council published the Healthy China 2030 Plan . According to this plan, life expectancy for 2015 is estimated at 76.34 years; it should increase to 79 years of age by 2030. Infant mortality fell to 0.81% per 100,000 live births by 2015 and is expected to decrease to 0.5% by 2030. According to the Healthy China 2030 plan , these indicators show that China is no longer a developing country; By 2020, the People's Republic of China intends to catch up with the indicators for countries with middle and higher incomes. Diseases of affluence, which have increased dramatically, are a hindrance to this goal.

organization

Ambulance vehicles in Beijing (2013)

At the national level, the State Commission for Health and Family Planning was responsible for the health system until March 2018, which was located under the State Council and was considered a ministry. With the reform of the state organs in March 2018, responsibility for health care was transferred to the National Health Commission ( Chinese  国家 卫生 健康 委员会 , Pinyin Guójiā wèishēng jiànkāng wěiyuánhuì ), which is also part of the State Council as a ministry. In addition, there is now a National Office for Medical Care ( Chinese  国家 医疗 保障 局 , Pinyin Guójiā yīliáo bǎozhàng jú ), which is directly under the State Council.

In the PRC, 90% of medical treatment is carried out in hospitals, so that there are almost no free doctors, ie the hospital is visited for every minor illness. In 2016 there were around 29,140 hospitals across the country, around 4,000 clinics for traditional Chinese medicine, 36,795 health stations, 34,327 local health stations and 216,187 ambulances. Overall, the People's Republic of China had 7 million hospital beds in 2016.

The Chinese hospitals are divided into three classes. The hospitals of care level one are found in cities and municipalities with simple equipment and have up to 100 beds. They offer basic services. Care level two hospitals are on a supraregional level. These hospitals are equipped to perform sophisticated operations. They have 100 to 500 beds. Care level three hospitals are located in large cities. They are superbly equipped - often with international devices - and offer space for more than 500 patients.

financing

From 1978 to 2015, the percentage of total government spending on health spending doubled from 3% to around 6%. In 2017, the state paid 4,097.465 billion yuan to the health system.

Healthcare providers in China receive payments from three sources: drug sales, private payments from patients, health insurance payments, and direct government funding.

Diagnosis-related case groups

Since the beginning of this century, the People's Republic of China has been experimenting with a system of diagnosis- related case groups . Beijing has been experimenting with the DRG system since 2008. The introduction of DRG systems means that the most financially sensible categorization is in the foreground of medical treatment. A communication dated January 10, 2017 stipulates that 100 diseases nationwide are to be billed via the DRG system and that in future 320 diseases are to be billed via DRGs. In addition, upper price limits are set for the individual DRGs.

For the development of a mature DRG system with Chinese characteristics, there are currently no databases on patient information at the national level that provide information on the patient's gender, age and degree of physical impairment, for example. Furthermore, there is a lack of information systems about the diagnosis, complications, operations and their duration as well as the length of the hospital stay, etc.

German experience should be used when introducing a nationwide DRG system.

Paying the hospital doctors

The salary of Chinese doctors consists of a basic salary, bonuses and other perks. The basic salary consists of position salary, age allowance, performance allowance and state allowance. The latter surcharges are set by the State Commission on Health and Family Planning, the Ministry of Finance and the Bureau of Labor Authorities. A national salary survey conducted by the State Commission on Health and Family Planning in Second and Third Tier City Hospitals shows that the base salary is only 13-14% of the total salary of medical staff in public hospitals. 14% are provided for benefits and grants. For performance-related wages and salaries as well as bonuses that are linked to hospital services, the figure is as much as 74%. The problem is that hospitals autonomously set additional payments for which there are no national standards.

Violence against doctors

The salary system needs to be reformed because it invites corruption. Anyone who spends a lot of money on treatment has high expectations with regard to the treatment results. Failure to comply with these leads to violent arguments between patients and medical staff. In the Agenda Healthy China 2030 , the improvement of the salary system for medical staff was included and violence against doctors was explicitly defined as a problem that needs to be remedied. One solution should be a salary system based on international standards. In the Act on Basic Health Care and Promotion of Health , violence against doctors is once again explicitly punished, but whether these legal regulations alone help is questionable. Above all, the health system itself and communication between patients and doctors must be improved.

Lack of doctors in the country

Regardless of an increase in salary, medical students are drawn to the big cities after graduation, similar to those in western countries. In April 2015, the Chinese government passed a law that regulates the income and pensions of rural doctors. In addition, a funding program came into force to counteract the shortage of doctors in structurally weak regions. Among other things, free training courses for medical workers in rural areas are offered; School leavers from rural areas can also study medicine for free if they commit to work in their local clinic after graduation.

Corruption in Health Care

The Chinese health system is corrupt in many areas. Doctors are prone to bribery because of their low pay. Pharmaceutical companies also try to gain advantage through corruption. This also applies to foreign companies.

Telemedicine

In the city of Shenzhen, there are first attempts to digitize doctor's visits. For this purpose, there are red cells, comparable to telephone booths, into which the patient goes, can be identified by facial recognition and is asked about his complaints by an artificial intelligence. An initial diagnosis is made before a human doctor intervenes.

See also

further reading

  • Burns, Lawton Robert / Liu, Gordon G., China's Healthcare System and Reform, Cambridge University Press, 2017.
  • Meng, Qingyue / Yang, Hongwei /, Chen, Wen / Sun, Qiang / Liu, Xiaoyun, People's Republic of China. Health System Review, World Health Organization, 2015.
  • Reisach, Ulricke (Ed.), The Health Service in China. Structures, actors, practical tips, 2017.
  • World Bank Group / World Health Organization / Ministry of Finance / National Health and Family Planning Commission / Ministry of Human Resources and Social Security: Deeping Health Reform in China. Building High-Quality and Value-Based Service Delivery. (PDF) 2016, accessed on February 14, 2019 .

Individual evidence

  1. ↑ 全国 医疗 卫生 服务 体系 规划 纲要 (2015-2020). State Council , March 6, 2015, accessed February 17, 2019 (Chinese).
  2. ^ Wong, Linda, Marginalization and Social Welfare in China , London, 1998, ISBN 978-0-415-13312-8 , p. 194.
  3. ↑ a b c Healthy China 2030健康 中国 2030 ”规划 纲要. Chinese Communist Party / State Council , October 25, 2016, accessed February 14, 2019 .
  4. ↑ 基本 医疗 卫生 与 健康 促进 法 出台 ： 为 全民 健康 保驾 护航. Standing Committee of the National People's Congress , December 28, 2019, accessed January 31, 2020 (Chinese).
  5. ↑ 中共中央 印发 《深化 党 和 国家 机构 改革 方案》. Chinese Communist Party , March 21, 2018, accessed February 14, 2019 (Chinese).
  6. ↑ Florian Albert: Hospitals in China: Gigantic. Exotic. Inspiring. Bibliomed-Medizinische Verlagsgesellschaft mbH, 2017, p. 1082 f., Accessed on January 30, 2018.
  7. ↑ chat Frankowski, Patricia / Reisach, Ulrike / Bosch, Claudia: hospital types, range and instrumentation . In: Reisach, Ulricke (ed.): The health system in China. Structures, actors, practical tips . 2017, ISBN 978-3-95466-303-3 , pp. 44 (297 pp.).
  8. ↑ National Bureau of Statistics of China: China Statistical Yearbook 2017 . China Statistics Press, Beijing 2017, ISBN 978-7-5037-8253-4 , p. 726.
  9. ↑ Darimont, Barbara / Margraf, Louis: Analysis of quality assurance in the hospital sector of the People's Republic of China . In: J Glob Health Rep . No. 2 , 2018, p. 1127–1135 , doi : 10.29392 / joghr.2.e2018038 ( joghr.org [PDF; accessed February 16, 2019]).
  10. ↑ a b Wang, Yan: 疾病 诊断 相关 分组 (DRGs) 的 研究 与 进展 ， 以及 DRGs 发展 历. 2017, Retrieved February 14, 2019 (Chinese).
  11. ↑ 关于 推进 按 病 种 收费 工作 的 通知 - 发 改 价格 〔2017〕 68 号. State Development and Reform Commission , 2017, accessed February 17, 2019 (Chinese).
  12. ↑ Florian Albert: Hospitals in China: Gigantic. Exotic. Inspiring. Bibliomed-Medizinische Verlagsgesellschaft mbH, 2017, p. 1082 f., Accessed on January 30, 2018.
  13. ↑ World Bank Group / World Health Organization / Ministry of Finance / National Health and Family Planning Commission / Ministry of Human Resources and Social Security: Deeping Health Reform in China. Building High-Quality and Value-Based Service Delivery. (PDF) 2016, p. 94 , accessed on February 14, 2019 (English).
  14. ^ Liu, Gordon / Huang, Jiefu: Global Hospital Management Survey - China, Management in Healthcare Report. (PDF) 2014, p. 29 , accessed on February 14, 2019 (English).
  15. ↑ Zhang, Xinqing / Sleeboom-Faulkner, Margaret, Tensions between Medical Professionals and Patients in Mainland China, in: Cambridge Quarterly of Healthcare Ethics, Issue 20, 2011, p. 1.
  16. ^ Protecting Chinese doctors . In: The Lancet . No. 395 , 2020, p. 90 ( thelancet.com [accessed January 31, 2020]).
  17. ↑ China takes action against the shortage of doctors in rural areas. CRI, April 2, 2015, accessed January 30, 2018.
  18. ↑ Köckritz, Angela / Kunze, Anne: Never ask the doctor! The Chinese government is investigating western pharmaceutical companies - in its own interest. Zeitonline , August 22, 2013, accessed on February 16, 2019 .
  19. ↑ Wolfgang Hirn: Shenzhen - The world economy of tomorrow . Campus, Frankfurt 2020, p. 100-101 .