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ZT: health care in China (For IV preparation)
作者:USMedEdu
发表时间:2008-10-18
更新时间:2008-10-18
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发信人: HorseArmour (as stupid does), 信区: MedicalCareer
标 题: ZT: health care in China (For IV preparation)
发信站: BBS 未名空间站 (Sat Oct 18 19:52:39 2008)

Healthcare in China

By Michael J Moreton, MD


I have been an obstetrician at the Beijing United Family Hospital, in
Beijing for five years. My former colleagues in North America often ask me
about the Chinese healthcare system. Unfortunately, asking about healthcare
in China is rather like asking about healthcare in Europe. China is huge.
Huge in geographical size (slightly smaller than the US) and in population (
1.3 billion). It is also extremely diverse: Beijing in the east and Xin
Jiang in the west are as different as Poland and Portugal.

Q: How is the healthcare system organized?

A: A healthcare system tends to reflect the general social and economic mood
of a country. At present, the mood in China is one of change. Time has been
lost. China has fallen behind the West and is working hard to take up what
it feels is its rightful position in the world. The effort to change and
modernize is reflected in business, industry, and healthcare. For 50 years
the communist government – run according to Chinese Marxist lines – took
care of the health needs of the country. It dictated what was necessary and
paid for it. The central, provincial, and local governments funded hospitals
, and medical care was provided at either no charge or very little charge to
patients.

Q: How is healthcare funded?

A: Now that China has moved into a more capitalistic, entrepreneurial era,
hospitals have been told that they have to finance some of their own costs.
This is not an easy process for hospitals or for patients. Patients are now
being asked to pay for some of their care. There is currently no system of
private health insurance, although many firms are looking to start such
programs.

Q: How is healthcare delivered?

A: The alarming thing in China is the almost total absence of primary care.
Even in cities, there are no independent doctors' offices or neighborhood
clinics, so people have to go to the hospital for every healthcare need.
Since there is little in the way of appointment systems, crowding and
confusion occur. An enormous amount of resolve and money would be needed to
correct this problem. The math is staggering. In a country of 1.3 billion
people, it would require an additional half-million family doctors to
provide the services that are available in many Western countries.

Hospital structures are vastly different from place to place. Large cities
like Beijing are well served with both general and specialist hospitals.
Specialist hospitals, which are equivalent to tertiary care referral centers
in the West, have excellent equipment and technology: they routinely
perform cardiac surgery, angioplasty, and transplant surgery. In many rural
areas, there is a structured system of local and county hospitals with
increasing levels of expertise as you go up through the system. However,
there are areas of extreme poverty where the level of care leaves much to be
desired. In the provinces furthest from Beijing, hospitals have little in
the way of modern equipment, or even modern plumbing.

Despite the absence of an official private healthcare system, patients can
pay an additional amount of money to see a physician of their choice, at a
more convenient time, or to receive individualized care. Some of these
payments are official and are set by the hospital, but other payments are of
the unofficial variety. The newly affluent Chinese are demanding a better
level of service in all areas of life, including healthcare, and hospitals
are responding to their demands by building units with comfortable private
rooms and special nursing care.

The Beijing United Family Hospital, where I work as an obstetrician, has
been open for five years, and is currently the only Western-owned hospital
in the country. Initially, the patients were almost exclusively Western
expatriates and Chinese who had been living abroad, but recently we have
seen an increasing number of local Chinese patients looking for more
personal care. Foreign patients who are concerned about the lack of
cleanliness in provincial hospitals now fly here from all over the country,
even for minor problems. Beijing also has an eye hospital, which was started
by a local ophthalmologist who trained in the United States.

Another element of the system is Traditional Chinese Medicine (TCM) – see A
Prickly Issue. Many of my Chinese colleagues who practice medicine in a
style similar to that in the West use a few TCM techniques and medications,
but for the most part the two systems run separately along side each other.
There is less antagonism between the two systems than there is in the West.
On questioning my Chinese patients, I find that they are often taking
traditional medicine in addition to the medication that I have given them. (
Playing it both ways!)

Q: What are the current concerns among healthcare workers in the country?

A: Doctors and nurses are very poorly paid, and their level of training
varies greatly. Training for doctors ranges from a two-year course to
programs that are equivalent to those offered by Western medical schools.
Specialists are generally well-trained, but there is no national body that
sets standards and assesses competency, such as the American Boards or a
Royal College.

Although doctors and nurses have social status similar to their counterparts
in the West, many of the younger doctors are discontented. Promotion in the
system is very slow. Moving from city to city, or even from hospital to
hospital, is rarely an option, in part because it has never been a feature
of Chinese life. I have met many former doctors who have given up medicine
for better paying jobs. One young woman works as a ticket agent for a
Western airline company, another as an office manager for an import company.
They feel that the financial and personal rewards are much greater in these
areas.

Q: What are the current concerns among patients?

A: The patients are, for the most part, quite content with the system. The
Chinese are enormously patient. To wait for hours to buy a train ticket or
to see a doctor is accepted as a normal way of doing things. (Although like
many things in China, that is changing.) Privacy is not a great
preoccupation. Crowded clinics and hospitals are accepted more easily than
they would be in the West. This is a very crowded country.

--

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发信人: acne (麦地米虫), 信区: MedicalCareer
标 题: Re: ZT: health care in China (For IV preparation)
发信站: BBS 未名空间站 (Sat Oct 18 19:54:41 2008)

这个要顶。我面试的时候很多faculty对中国的情况很感兴趣。今年大选universal
health care 又是焦点问题。大家多下点功夫因该有意想不到的收获。

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