China’s Move to Improve Health Care

China’s economy has developed significantly in the last three decades, lifting millions of people out of poverty and improving their health. One of the consequences of the country’s economic progress has been an increase in life expectancy at birth from 69 years in 1990 to nearly 75 years in 2010. Also notable have been the decreases in the infant mortality rate, which declined from 37 per 1,000 live births in 1990 to 17 in 2009, and the under-five mortality rate, which declined from 46 per 1,000 live births in 1990 to 19 in 2009.

Despite this progress, however, many health issues remain unresolved. While the wealthier portion of the Chinese population has benefited from advanced health technologies, many among the poor do not have adequate access to even the most essential services. It is estimated that approximately 80% of the health and medical care services are concentrated in cities, while timely medical care is not available to more than 100 million people in rural areas.

Although some progress has been made in the underdeveloped rural areas, these areas are still afflicted by a lack of safe water and sanitation, undernutrition, vitamin and mineral deficiencies and indoor air pollution. It has been estimated that 80% of rural households have no access to a sanitary lavatory, and 20% of rural households lack safe drinking water.

According to the OECD, almost half of China’s doctors have no better than a high school degree — and many rural doctors have less experience and education than their urban counterparts. The education of rural healthcare workers needs to be upgraded, creating economic incentives so that their salaries can be on a more equal basis with urban doctors.

Beyond these problems, there are several other challenges the Chinese government will need to address — including the need to improve quality of services, to make the healthcare system more equitable and to reduce costs by improving the efficiency of the healthcare system. It will also be necessary to regulate the healthcare system by eliminating unnecessary tests and prescriptions. The government has to make sure that the healthcare needs of the great number of migrants and the older population are properly addressed.

Large disparities continue to persist between affluent and poor Chinese in terms of access to healthcare services, as well as the quality of care provided. Many among the poor limit their use of medical services for purely financial reasons, since the costs of treating serious illness can wipe out a family’s life savings. New measures proposed by the State Council of China will increase insurance payments to cover a significant portion of medical costs, which will help lower the impact of high out-of-pocket payments.

A great part of medical costs is due to unnecessary tests and prescriptions. Chinese hospitals’ reliance on revenues from the sale of drugs has led to overprescribing unnecessary medications to increase their profitability. Some pharmaceutical companies offer under-the-table inducements for prescribing drugs. The resulting high costs of treatment have caused many patients to avoid going to hospitals for vital treatment.

Special attention will also have to be paid to the health needs of migrants and China’s aging population. China has a highly mobile population, with as many as 167 million people having migrated from rural to urban areas — a number that will undoubtedly increase in coming decades. These migrants have special health needs that will need to be adequately addressed, particularly since they usually do not qualify for public medical insurance.

By some estimates, 25% of China’s population will be aged 60 or older by 2035, compared to just 10% in 2001. Medical costs can increase dramatically with age. At the same time, as the population ages, the share of individuals of working age contributing to government revenues will decline. In order to meet these twin challenges, China will need to find ways to improve the health of its aging population and to limit the overall costs of care.

Although the government has admitted that building a “safe, effective, convenient and affordable” health service will not be easy, these are commendable goals. The government should prioritize the promotion of healthy lifestyles and the prevention of chronic noncommunicable diseases.

With the assistance of the World Health Organization and other international agencies, the Chinese government has improved the health of its population. Although millions of people have benefited, millions are still lagging behind. The great challenge for China is to strengthen its healthcare system to reduce disparities and improve the quality of health care for the population at large.