Chinas Healthcare SystemKatelyn J. LutzAlvernia University

ABSTRACTWhen it comes to a population of 1.34 billion, what kind of health care system is China supposed to have when it comes to its citizens who are in need of care, sick, or injured? This paper is going to critically examine the paths China is taking to reform its health care system in relation to the countrys economics and its society as a whole from the era of Mao to the transition of the more modern progression of Chinas health system in relation to the social and political aspects to the performance, problems and solutions.

Mao-EraSince the birth of the Peoples Republic of China in 1949, the Chinese Communist Party took over all power and the newly formed government came up with a health care system that was very much similar to communist states like the Soviet Union. This government operated and owned all of the health care facilities in the country and also employed the workforce for it. It was such a convenience that during this time no health insurance was needed due to the fact that services given were basically free. (Lessons from the East - China's Rapidly Evolving Health Care System). Help from the barefoot doctors was what made this phase of the health care system successful because they provided basic personal and public medical health services like immunizations, although these doctors did not have much schooling and only received a few months of training after being enrolled in a secondary school. This type of work-unit-based health insurance was put into action through the Government Insurance System or the Labor Insurance System. During this time, between the years of 1952 and 1982, the infant mortality rate increasingly fell from 200 to 34 per 1,000 live births which just so happens to be the most rapid increase in history, and old-age diseases like schistosomiasis was decreased. (Lessons from the East - China's Rapidly Evolving Health Care System). The Chinese population during the Mao era which lasted from the 1950s to the 1970s, there was only half a billion people populating the country compared to the 1.34 billion in todays society, but when it comes to rates according to country and its population, there were 36% of citizens that were under the age of 15, approximately 80% lived in rural areas, 33% were illiterate and lived a state of absolute poverty. (Health Affairs). The mortality rate of China as of 2014 was 7.44 deaths per 1,000 people. When it comes to the morbidity rate the prevalence of tuberculosis as of 2007 was 194 per 100,000 population and the prevalence of HIV of adults older than the age of 15 was 65 per 100,000 people. In the U.S., the mortality rate as of 2013 was 821.5 deaths per 100,000 population and the infant mortality rate was 5.96 deaths per 1,000 live births. The morbidity rate of heart disease is the leading cause of death in the United States. China ranks 144th in the World Health Organization Ranking; The Worlds Health Systems and United States ranks 37th. (World Health Organization's Ranking of the World's Health Systems).Barefoot DoctorsDue to this significant improvement and stability after years and years of war, there was widespread better nutrition and health interventions and even an abundant increase in the level of education. Barefoot doctors became fee-for-service private providers and the majority of the countrys population did not have any form of health insurance for twenty years between 1980 and 2000. (Falling Through the Cracks of China's Health-Care System.). The urban areas used the implementation of user fess since public funding had started to vastly decline and insurance coverage in rural areas dropped by up to 7% because of the radicalism that was in correlation to the Cultural Revolution. (Chinas Healthcare Reform: How Far Has It Come?). Less than 10% of provider expenses was covered because of supply-side subsidies, and the rest was payment earned from uninsured patients through the fee-for-services. (Chinas Healthcare Reform: How Far Has It Come?). Phase IThe year, 1984 started a new phase of Chinas health system that was led by Deng Xiaoping, a Communist Party leader. During this time, China changed to a market economy and also lessened government role in social and economic matters like health care. Therefore, leading to the funding of hospitals by government dropping and barefoot doctors losing public subsidy, turning the health care system in china, upside-down. The market was much unregulated and the government still owned hospitals, but had close to no control over the health care organizations which mostly seemed like they were for-profit. This lead to doctors earning very large bonuses due to the increase in profits the hospitals were making and health care workers were becoming their own private business partners causing there to be decrease in medical professionalism and tradition. (Chinas Healthcare Reform: How Far Has It Come?). Phase IITo make Chinas health care more dramatic with the introduction of the free market, along with the new reform, most of the population of the country lost health insurance because the government stopped providing it and there was not private insurance companies that existed. As of the year 1999, citizens living in rural areas were not covered with any health insurance, only 7% of the 900,000,000 had any types of insurance, in contrast to citizens living in urban areas of the country that 49% did receive some sort of health insurance. (Chinas Healthcare Reform: How Far Has It Come?). The government then was still somewhat involved and made a stand on the pricing of insurance to for people to be able to receive the basic care and to not be over-charged for times of services spent with nurses and doctors. In contrast, there was a higher cost for prescriptions other services done like x-rays and procedures. Therefore, the hospitals and health care centers took advantage of that and increased those prices of care while being able to reduce an amount of access to citizens who didnt have any form of health insurance, while promoting quality of care. (Health Affairs). This did not fare well with the citizens of China as the public knew what was happening to their health care network, causing much hatred towards any healthcare center and the workers and eventually cause public protests and an increase in the social instability of the country and its politics.Phase IIIIt wasnt over, in 2003 was the start of a third portion of the health care dilemma. The government of China looked to help rural residents by bringing about a new health insurance plan to cover some expenses of going to the hospital since the services of the hospital were so expensive that it drove many, many citizen to live in extreme poverty. Due to this change, a financial burden was aroused due to more expensive types of services from the hospital and in the end, was not a solution to the reform that was supposed to work in favor for China. (Chinas Healthcare Reform: How Far Has It Come?).Final PhaseAs of 2008, there was major moves in Chinas delivery system as well as with health insurance, causing the fourth and final, ongoing phase of the health care reform of the country. The free-market economy along with its experiments were slowly fading away as a good thing and more-so started focusing on a health system that could be available to citizens to receive health care that was much more affordable by the year 2020. (Health Affairs). Four years later, in 2012, a new insurance system was implemented to 95% of Chinas population as a whole that was government-subsidized. (Health Affairs). In addition to this new reform action, there was also an implementation to create a new system for primary care as well as to create clinics as networks. Current Reform in ActionEven now in 2015, the 2008 reform is still in action and it has exponentially gotten better except for the tertiary care from hospitals because they were against the newest reform which successfully showed and reflected upon how much power certain types of hospitals had and had a direct effect on the political system causing the country to seek out the market economy again. (Lessons from the East - China's Rapidly Evolving Health Care System). By 2015, 20% of the hospitals in China where to be owned by private sectors which is actually more than double the pre-existing rate. (What Does 2015 Have in Store for Chinas Healthcare Economy?). The problem still in the country is the inequality of care that is available between citizens living in rural areas versus citizens living in bigger cities which sends problems of trying to create a trusted, professional health care work facilities that emphasize high quality care since it known in China that doctors seem to care more about the economic success rather than the best interest and care for their patients. As I said before, this health care system is still evolving and changing rapidly and the country is learning once again that the barefoot doctors have a direct effect on being able to change the health system again for the better especially in the low-income areas of high population. One thing that the country is aware that needs to change is relying on the market forces to provide funding for the services of care because it creates too much risk. This is causing problems regarding the access to healthcare as well as high costs that was experienced by the citizens of China back in the second phase that I recently talked about. The health care system really can make or break the success of the country and as we know and it can be caused by many negative outlooks like bad communication between patients and physicians or any health care provider because of the miscommunication of what is best for each certain patient. This causes it to be a hard decision for Chinas citizens to be able to make good decisions for their health care because there isnt enough education or knowledge about what is out there and what is available and the costs of care too scare many people away. Therefore, patients usually tend to not get health care which leads to them not going to the doctor since being uninsured and it causes a sense of resentment and untrustworthy feelings when it comes to health care and providers. (Chinas Healthcare Reform: How Far Has It Come?).Lack of ProfessionalismChina is making an attempt to change to a more modern way of professionalism when it comes to doctors having a more effective way of providing care after a wave of period of time that they felt underappreciated. The norms are to be altered in a way that will be in favor of the patients being able to seek a professional who truly cares about the quality of care given to the patients versus the bad streak of providers and patients complications and misunderstandings. The country is learning that they can really make an attempt to reform types of health insurance plans that will also help with the delivery systems role. In addition to this, we have learned that the plan of Chinas health care system under certain leaders worked in correlation with how decisions and errors were made and how to fix them by coming up with better solutions. (Falling Through the Cracks of China's Health-Care System.).Now in the current year of 2015, China had moved in a more positive direction and their reform goals include to implement pilot reform of public hospitals, expand infrastructure for grassroots medical networks, broaden basic healthcare coverage, provide equal access to basic public healthcare services, and establish a national essential drug system. (Chinas Healthcare Reform: How Far Has It Come?). Due to the protests and riots in the country because of access that is unaffordable, President Hu Jintao is trying to make it a priority to build up a stronger, more reliable society as health being a top social priority and promised for a bigger government role in public health, with a goal for everyone to enjoy basic health care service to continuously improve their health and well-being. (Lessons from the East - China's Rapidly Evolving Health Care System).Chinas Latest Reform InitiativesChina has come up with a solution to incorporate the rural areas of the country to have a better access of care through the New Cooperative Medical Scheme which is a government-run voluntary insurance program. This is to help abolish the amount of poverty there is in these areas and protect them from the high costs of expenses when it comes to their health. When it comes to primary care, China is to provide and urgency for community health centers in urbanized areas and most importantly, there is a better perception for the countrys government to provide funds for an overall universal basic health service and care. (Health Affairs).Impact on the U.S.China's health care past failures offered many important lessons to the United States when it comes to their way of providing health care in many ways. In China, those with insurance still have to pay 60-70% out of pocket, leaving many without actual health coverage. Taking "personal responsibility" for our health may be important, but we should not price people out of life-saving treatments. (Wen, M.D. Leana ). Secondly, the act of fee-for-services should be done away with and be put in place with a better understanding of a fee-for-diagnosis. With a specific illness billed a fixed amount regardless of the tests and procedures performed. Not only does such "bundled payments" require accurate diagnoses, they reduce cost and the potential for inefficiency and corruption, states Doctor Leana Weng. (Wen, M.D. Leana). America has a once-in-a-generation chance to fix our broken health care system. As policy-makers discuss implementation of the Accountable Care Act, they should learn from China's experience and decide whether they see medical care as a commodity or social provision, and what are the responsibilities of the government to ensure the health and well-being of its citizens. (Wen, M.D. Leana).Affordable Care Act in US on Health CareBefore Obamas Affordable Care Act was implemented, the United States saw an outrageous growth in the numbers of uninsured citizens which led to an exponential increase in the amount of debt and people filing for bankruptcy because of not being able to afford health care as the costs of care and drugs are on the rise. This deficit causes a profit for the growing healthcare corporations, but also growing is the amount of national debt which could be referred to as crisis in health care for the country. To address these problems, the Affordable Care Acts goals are to make sure the people of the United States get a fair treatment by health care providers and help make health insurance more affordable to lower and middle income Americans as well as small business employers. (Health Care Facts: Why We Need Health Care Reform).

ReferencesChinas Healthcare Reform: How Far Has It Come? (n.d.). Retrieved November 12, 2015, from http://www.chinabusinessreview.com/chinas-healthcare-reform-how-far-has-it-come/Health Affairs. (n.d.). Retrieved November 12, 2015, from http://content.healthaffairs.org/content/27/2/460.full.htmlHealth Care Facts: Why We Need Health Care Reform. (n.d.). Retrieved November 12, 2015, from http://obamacarefacts.com/healthcare-facts/Falling Through the Cracks of China's Health-Care System. (n.d.). Retrieved November 12, 2015, from http://www.wsj.com/articles/falling-through-the-cracks-of-chinas-health-care-system-1420420231Lessons from the East - China's Rapidly Evolving Health Care System NEJM. (n.d.). Retrieved November 12, 2015, from http://www.nejm.org/doi/full/10.1056/NEJMp1410425Wen, M.D. Leana. "What the US Can Learn From China's Health Care Reform." The Huffington Post. TheHuffingtonPost.com, n.d. Web. 12 Nov. 2015.What Does 2015 Have in Store for Chinas Healthcare Economy. (n.d.). Retrieved November 12, 2015, from http://www.forbes.com/sites/benjaminshobert/2015/01/14/what-does-2015-have-in-store-chinas-healthcare-economy/World Health Organization's Ranking of the World's Health Systems. (n.d.). Retrieved November 15, 2015, from http://thepatientfactor.com/canadian-health-care-information/world-health-organizations-ranking-of-the-worlds-health-systems/

CHINAS HEALTHCARE SYTEMRunning head: CHINAS HEALTHCARE SYSTEM