Health of the Nation…

From guest blogger Martyn…

The failed Chinese healthcare system finally receives government attention.

When Chinaโ€™s government healthcare system was abandoned to market forces from 1978, it effectively shifted the costs of healthcare onto the patients and their beleaguered families. To this day, one of the biggest financial burdens that can befall a Chinese family is that a relative should fall ill and require costly medical treatment. The greedy, cash-strapped hospitals that hand out expensive but โ€œessentialโ€ medicine and advise mums-to-be to have costly Caesarean births, because the government legally restricts the price of natural births to affordable prices, is truly shocking. Also, the return of fatal diseases like tuberculosis, largely eradicated before 1978, is yet another result of the change. If you only read one single China-related article this week, please let it be this one:

China’s authoritarian government is coming under an unusually strong and public attack for the collapse of the country’s universal health care system and the rise of profit-oriented state-owned hospitals.

The public’s access to health care in China has been steadily declining for more than two decades. But the system’s chronic problems are now emerging as a political issue. As a consequence, Beijing is under mounting pressure, and at senior levels, to re-examine its role in the system.

A hard-hitting report issued earlier this month by the Development Research Center, one of the government’s top advisory bodies, concluded that the switch to a user-pays health system has been a failure.

It noted “to our shame” that the WHO ranked the Chinese health system as one of the most unfair in the world. “Most of the medical needs of society cannot be met because of economic reasons,” the report said. “Poor people cannot even enjoy the most basic health care.”

However, credit where creditโ€™s due. Amazingly, the government chose to publish the damning report, co-sponsored by the WHO:

The government ordinarily discourages open criticism of its policies. In this respect, political analysts and health care experts regard publication of the report from the body that advises China’s cabinet, the State Council, as an unusual and surprising step.

It was not immediately clear why Beijing chose to publish the report. But experts in the field suggested that it may indicate a recognition among government officials that the crisis has become so acute as to require an urgent change in policy.

As always, greed, as well as the financial pressures such as the operating costs of cash-strapped hospitals has resulted in these horrific statistics:

Li Ling, an economics professor at Beijing University’s China Center for Economic Research said one measure of medical overservicing revealed in her research was that an average of 50 percent of babies born in Chinese hospitals were delivered by Caesarean section. In some hospitals, that figure was as high as 70 percent.

The main reason for this was that hospitals could only charge a relatively low fee set by the government for live births, but Caesarean sections could be billed at a much higher rate, as surgical procedures. And these procedures allowed hospitals and doctors to manage their time more efficiently than natural births.

“This is a case of the supplier inducing the demand,” Li said. “If a doctor says, ‘I think it is better to have it,’ nobody has the courage to say no.” Before 1978, only 10 percent of births were by Caesarean section.

The Discussion: 23 Comments

read the 4th section of this article (in chinese):

August 21, 2005 @ 2:06 am | Comment

The report was published because Hu/Wen are trying to convince the Central Committee that China should spend more on healthcare (and not just healthcare, but education, and social security too). Try telling the Shanghai gang they can’t have more image projects but have to spend money on doctors to treat the urban and rural poor. Its proving a hard sell!

August 21, 2005 @ 2:09 am | Comment

Boy, the Shanghai Gang sounds like some American politicians I know…

August 21, 2005 @ 2:13 am | Comment


August 21, 2005 @ 2:20 am | Comment

I’m just sayin…

August 21, 2005 @ 2:32 am | Comment

China is a great place to buy medicine if you know what you want. Antiobiotics? Don’t worry about a prescription, buy them over the counter at any pharmacist. If you feel better before the entire course is finished, not to worry, there are people who will buy them off you and sell them in the countryside. Of course there is the danger that China may breed an antibiotic-resistant plague, but don’t worry, they handled SARS and that Bird Flu thing OK didn’t they?

August 21, 2005 @ 2:43 am | Comment

Publish guidelines that hospitals should advise mothers to have natural births, unless their medical condition requires a Casesarean. If doctors are found to consistently break these guidlines, they get struck off permanently.

Any good?

August 21, 2005 @ 4:06 am | Comment

this is absolutely disgusting, and imoral. what the hell is wrong with doctors in china? my wife and i were thinking about having a baby, but i sure wont let it be delivered here. what a nightmare. i cant believe people take this without massive protesting. all those poor women that were sliced up for no other reason than to make an extra 20 bucks. im going to be sick.

August 21, 2005 @ 8:08 am | Comment

the article doesnt’ even mention the ‘red pocket/envelopes’ most (if not all)chinese surgeons expect before undergoing surgery on a family member…who knows what might happen if you don’t pay up..?? truly disgusting.

it’s funny, in canada where we have universal healthcare (not a perfect system by any means…) doctors try to kick you out of the hospital as soon as you are better. in china, you have a tooth ache and they’ll advise you stay in the hospital a few days…geez

August 21, 2005 @ 10:21 am | Comment

The healthcare system in China is in a very sad state of affairs. Many of the urban poor in China can only make a few hundred RMB per month and many farmers make even less. Even a simple infection can result in medical bills that exceed several months’ income. It seems that the party of the workers and peasants is really a party of the rich.

August 21, 2005 @ 11:53 am | Comment

dylan writes:
“The report was published because Hu/Wen are trying to convince the Central Committee that China should spend more on healthcare.”

That’s my take as well. Making the report public is one way of shaming the disparate govt factions into toeing the line.

Raj, I don’t think the govt can afford to have doctors struck off en masse nor do I think that such a policy would be possible to implement. Still, at least you have ideas, I don’t.

August 21, 2005 @ 12:07 pm | Comment

Of course, similar “market forces” were pushing way too many women in the US into having Caesarians as well…this has been corrected I believe – but I really do feel that many aspects of “for-profit” healthcare are very problematic.

August 21, 2005 @ 12:26 pm | Comment

dezza, you’re absolutely right, in Chinese hospitals (usually when the medical condition of the patient is serious and the treatment required is substantial) it is normal for the family of the patient hand over some kind of “tip” or “gift” to the doctor/surgeon to ensure that they will give their full attention and make their best efforts.

I stand to be corrected, but I would stress that this is normally done for very serious medical cases rather than routine matters. However, it is standard practice in China and has been for as long as I’ve been here.

Jerome Cole: agreed.

August 21, 2005 @ 12:31 pm | Comment

Btw, re Caesarians, in Hong Kong it’s a fact that many women request this procedure because…how can I put it…they (wrongly!) believe that a natural birth will increase their size ‘down there’.

I agonised over that last setence for a good 5 minutes.

August 21, 2005 @ 12:37 pm | Comment

pls allow me to re-post this one from the teahouse – “public opinions and the health care reform”:

china’s health care reform caused a lot of controversies and, in a recent report released by a state advisory body, the market-oriented reform was accused of “a failure” and was blamed for creating one of the most unfair health care systems in the world.

political factors aside, the single most significant factor that makes the government re-think the current health care reform is public opinions that strongly oppose a market-oriented approach.

Top government advisers, scholars and the state-controlled media are openly criticizing the ruling Communist Party for failing to avert a growing crisis in public health care. These critics allege that paying patients are treated as cash cows while the poor are denied access to proper medical care.

i must also point out that in all chinese media, stories of the poor mistreated by money-hungry doctors are always a hot hot topic that attracts many eyeballs and arouses a lot of echoes among the readers. this carries big weight in the policy making because the government hopes to build a “harmonious society”.

as i understand, the purpose of marketization is to stimulate the amount of service supply, and anyone who followed the reform will admit that numbers of hospitals, especially private ones, are increasing quickly and their service ranges are expanding too.

the problems of the marketization, such as overcharge, unevenness, etc. are the same ones of any industry going privatized, and they will diminish over time as the industry has more money and players in and services become more competitive. even health care sector has its uniqueness, the therapy for the misplaced reform is to further advance the marketization but not to halt it.

the public, mostly don’t have that knowledge and vision, are proposing to draw back to the safe and cozy position of government-take-care-of-all, and with the help of mass media, their voices are without doubt reach the ears of top policy-makers. in my view, the public opinons are an indispensable part of the policy-making process but they are just counter-productive in the health care reform.

August 21, 2005 @ 7:28 pm | Comment

I recall the time I was in Shanghai, and ill. The hospital kept trying to convince me to stay in the hospital for a few days. It took some serious resistance on my part before they finally prescribed a course of antibiotics, something for the godawful sore throat I had, and something to deal with the blazing fever I had.

As it turned out, it was just a particularly annoying case of the flu, but to hear the doctors, it was a life threatening disease that, if I wasn’t hospitalized, would render me an invalid or worse. ๐Ÿ™‚

That’s just my personal observation of the medical profession in Shanghai, take it as you will.

August 21, 2005 @ 7:49 pm | Comment


In a perfect world, you’d probably be right (with your point that the Chinese healthcare system would, if given time for market forces to work, eventually settle down and provide adequate healthcare to the nation).

However, all I see happening is that private hospitals would flood the cash-rich cities but the countryside would turn into a healthcare wasteland. City dwellers have money, peasants, largely, do not. The hinterland would offer slim pickings for private health companies and the quality of medical treatment would depend directly on how much cash a family has available to pay.

August 21, 2005 @ 9:57 pm | Comment

Nolan, your experience is consistent with one of the main points of the article (i.e. doctors will, in many cases, insist on perhaps unnecessary treatment and expensive medicine in order to rake in more cash). The fact that you’re a foreigner probably made matters worse.

I remember in Beijing, a secretary at our office would, every winter, develop a slight sniffle. Then one morning she’d arrive late to work lugging a plastic carrier bag stuffed with tonics and antibiotics (a point Peter also raises above) while rubbing her bottom from the injection she’d just received. When I used to comment that all she needed to do was wear an extra jumper and take a bit more care of herself, she’d look at me as if I’d just admitted to boiling babies alive at weekends and eating them. “But what if it gets worse!” she’d squawk.

I reckon private medical care has also turned Hong Kong into a city of hyperchondriacs.

August 21, 2005 @ 10:05 pm | Comment

Well, at least people will go here. As an American man (not *the* American Man) I am conditioned by experience to not go to the hospital unless I am actually leaking internal organs or unconscious and somebody else summons help.

Oddly, the Singaporeans have the same infatuation with Caesarians, as I recall. I think it was seens a convenience. Why go through 20 hours of backbreaking labor when, zap, it can all be over?

My wife and I are still thinking of having a child in Beijing, but I feel an expensive, private hospital bill coming on.

Oh, and Martyn, per your extensively engineered wording above, remember, when you need a PR pro to help you find a euphemism, you know where to come.

August 22, 2005 @ 12:06 am | Comment

Will, I might as well do some shameless blog wh0ring here – check this out…

August 22, 2005 @ 12:56 am | Comment

china economic roundup (viii)

It’s all smiles and handshakes when Hu Jintao and Manmohan Singh meet, but the two emerging powers are competing for influence in South Asia – both diplomatic and economic. Via CDT, Japan Focus has a very in-depth article on

August 22, 2005 @ 1:13 am | Comment

Thanks, Lisa, that was interesting. Actually, the private healthcare in China is OK, I hear, and still cheaper than in the US. A little marketing and they could probably do OK.

Frankly, the US has increasingly less to be proud of on the healthcare front, I think. It’s not like a visit to a US public hospital in a major urban area (the hospitals of last resort) is a charming experience (with apologies to my bro, the 3rd year med student). But still, if you had to have an emergency appendectomy, where would you go?

August 22, 2005 @ 2:12 am | Comment

The problem of healthcare is universal. Everybody wants more, they just don’t want to pay for it. Pricing pressure is distorted everywhere by government intervention including in the US where virtually all procedures are assigned a government price by Medicare and all health insurers work their payments in relation to that government set price/RVU statistic.

August 23, 2005 @ 11:24 am | Comment

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