A Dream Yet to Come True: Disparity of Healthcare Access in China

Irene J. Su, RN, MSN

Disclosures

Topics in Advanced Practice Nursing eJournal. 2007;7(3) 

In This Article

Toward Better Access to Healthcare

Given the facts as described above, it is not a surprise that the WHO ranked China fourth from the bottom in a health equity league table of 191 countries in the world. The Chinese government is well aware of the disparity in its healthcare delivery. During a visit to the United States on September 8, 2005, the Chinese vice minister of health, Huang Jiefu, delivered an hour-long speech at Harvard Medical School entitled "Healthcare for Tomorrow's China." Huang acknowledged that China was "in the midst of a social transition with negative impacts on healthcare." "Medical resources in China, actually, are inadequate," Huang said.[21]

In December 2006, the Voice of America reported that a 4-year-old boy from Guangan, Sichuan Province died 2 hours after being taken to the hospital.[22] The boy accidentally ingested pesticide earlier that day. The hospital refused to provide gastric lavage because the family of the victim was unable to come up with a treatment fee of 800 yuan (a little over $100). Media coverage of the story produced uproar throughout the country. In March 2007, the Chinese Ministry of Health issued a directive to all healthcare facilities in the country to provide basic life sustaining treatment to patients without demanding advance payments.

While the gesture to address the financial barriers to healthcare has come in due time and is absolutely necessary, a more cohesive framework of the infrastructure needs to be in place before healthcare will be effectually accessible to the poor and vulnerable citizens in China. Without a fundamental reform in the healthcare delivery system, a directive such as this is, at its best, a buck-passing policy and is bound to meet with resistance when being implemented.

It is a well-known fact that Chinese medical facilities are shouldering the burden of a huge financial shortfall ever since the cut back of government funding. State media admitted that hospitals nationwide collectively had an outstanding loan of 35 billion RMB yuan.[23] Current government funding only covered a negligible percentage of the hospitals' operating cost. Hospitals are forced to generate enough revenue in order to survive. This situation has reinforced profit-seeking behaviors of many healthcare facilities and medical providers, including:

  • Prescribing unnecessary medications,

  • High pricing for drugs,

  • Performing redundant lab tests, and

  • Demand for briberies.

Sporadic measures will not fix long-standing problems in the healthcare system. The cost of human life is incalculable; healthcare facilities should be reimbursed for at least the cost of saving a life. The government should set aside a welfare fund to provide assistance to individuals who do not have the ability to pay for medical service in case of an emergency.

A few pilot programs have already proven to be successful. In Zhejiang Province, a public assistance program funded by provincial and local governments has helped to cover 600,000 residents with financial hardship. The fund pays for medical treatment up to 3500 RMB yuan.[24] In addition, since preventive care enhances the health condition of the general population and will save on costs of primary and tertiary care in the long run, preventive measures such as immunizations should be free and accessible for every eligible citizen.

There is no reason why public and private insurance plans cannot be adopted at the same time to provide adequate coverage for the entire population. Third-party payer system as a gatekeeper should be encouraged to curtail cost of healthcare caused by overprescribing and overtreating practices. Hospitals should be made to allow patients to fill prescriptions in other pharmacies to prevent manipulation of drug prices or receiving kickbacks from pharmaceutical manufacturers.

Currently, doctors' consultation fees are ridiculously low, ranging from an equivalence of a few dimes to a few dollars. These fees should be adjusted to reflect fair compensation for medical doctors. Otherwise, policy attempting to ban providers from accepting bribes from clients will always remain wishful thinking.

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