Healthcare delivery in CHINA.pptx
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The document provides information on healthcare delivery in China. It begins with definitions of healthcare delivery systems and their components. It then provides demographic profiles of China and India, comparing various metrics like population size, density, health outcomes, expenditures, and common health problems. The profile sections of China and India are quite extensive. It also provides historical background on China's healthcare system, from the pre-revolutionary era to the establishment of the basic health insurance system in recent decades. It describes the key reforms to China's healthcare system over time that aimed to decentralize control and increase coverage. It outlines China's current universal healthcare system, which utilizes a mix of public health programs, primary care facilities, hospitals, and basic medical insurance schemes to cover
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Healthcare delivery in CHINA.pptx
- 1. Healthcare delivery in CHINA Dr. Jenifer Florence Mary J, Postgraduate Department of Community Medicine Sri Manakula Vinayagar Medical College and Hospital Pondicherry, India.
- 2. Healthcare delivery system: It consists of all organizations, people and actions whose primary intent is to promote, restore or maintain the health and includes efforts to influence determinants of health as well as more direct health - improving activities. It is more than the pyramid of publicly owned facilities that deliver personal health services. It includes inter-sectorial action by health staff e.g., encouraging the Ministry of education to promote female education, a well-known determinants of better health. (WHO)
- 3. Demographic profile of CHINA and INDIA Profile China India Politics Socialist consultative democracy – Chinese Communist Party Parliamentary secular democratic republic Country name People’s Republic of China Republic of India Politics Socialist consultative democracy – Chinese Communist Party Parliamentary secular democratic republic Government type Communist Party led state Federal parliamentary republic Administrative divisions 23 provinces, 5 autonomous regions and 4 municipalities 29 states and 7 union territory
- 4. Profile China India Total land area (km2) 9,388,211 (3,624,807 sq. mi) 2,973,190 (1,147,955 sq. mi) Population density (per km2) 153 (397 people per mi2) 464 per (1,202 people per mi2) Climate Extremely diverse; tropical in south to subarctic in north Varies from tropical monsoon in south to temperate in north Population ranking 1 2 Total population 1,441,736,995 (Dec 7, 2020) 1,385,863,914 (Dec 7, 2020) Urban population (% of total pop) 60.8 (875,075,919 people in 2020) 35.0 (483,098,640 people in 2020) Rural population (% of total pop) 39.0 (564,247,857 people in 2020) 65.0 (896,905,745 people in 2020)
- 5. PROFILE CHINA INDIA Population ages 65 and above (% of total pop) (2019) 11.5 6.4 Human Development Index (2018)* 0.758 (+7 – 2013-2018) 0.647 (+1 – 2013-2018) Poverty index (2018)* 0.016 0.123 Illiteracy rate (15 +)** (2018) 97 74 Life expectancy at birth total (yrs.) 77.5 70.4 Life expectancy at birth male(yrs.) 75.4 69.2 Life expectancy at birth female (yrs.) 79.7 71.8 Median age (years) 38.4 28.4 GDP public health expenditure (%) (2019) 2.9 1.29
- 6. Profile China India Under 5 mortality rate (per 1000 live birth) 9.8 32.9 GDP / capita growth (annual %) 6.90 6.68 Household expenditure on health greater than 10% of total household expenditure or income (%)$ 19.72 (2013) 17.33 (2011) Infant mortality rate (deaths per 1,000 live births) 8.4 26.6 Maternal mortality ratio (per 1,00,000 live births) (2017) 29 145 Total fertility rate (live births / woman) 1.7 2.2 Contraception prevalence of women aged 15-49 years (%) (2015) 84.5 53.5 Unmet need for contraception of married women ages 15-49 (%) 2.3 (2001) 13 (2016)
- 7. Profile China India Common health problems! 1. Stroke 2. Ischemic heart disease 3. COPD 4. Lung cancer 5. Alzheimer’s disease 6. Liver cancer 7. Stomach cancer 8. Hypertensive heart disease 9. Road injuries 10. Esophageal cancer 1. Heart disease 2. COPD 3. Stroke 4. Diarrheal diseases 5. Lower respiratory infection 6. Tuberculosis 7. Neonatal disorders 8. Asthma 9. Diabetes 10. Chronic kidney disease
- 8. Profile China India Major infectious disease! Food or waterborne disease: Bacterial diarrhea, hepatitis A and typhoid fever Vector borne: Crimean-Congo hemorrhagic fever, JE Soil contact disease: Hanta viral hemorrhagic fever with renal syndrome Food or waterborne diseases: Bacterial diarrhea, hepatitis A and E, typhoid fever Vector borne disease: Dengue, JE, malaria Water contact diseases: Leptospirosis Sources: Elaboration of data by United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects: The 2019 Revision. World Development Indicators 2020. *Human development report office 2019 ** Population Census of the People’s Republic of China. Beijing: China Statistics Press. #The global health observatory data repository and OCED 2019 data $World Bank, 2019 !GBD compare 2018
- 9. Historical background • Pre-revolutionary China / Pre-Mao era Traditional Chinese Medicine Peking Union Medical College • Mao-era Centrally planned and managed managed health services Soviet model
- 10. China Soviet model Bureaucratic Economy managed by bureaucratic and reports No health insurance Health care was affordable and accessible to all Collectivization of agriculture Innovation difficult No reward for taking risk and creating something new Inefficient firms practiced Firms not allowed to fail Restriction of geographic motility Hukou Co-operative controlled price Ownership of industry by government Centrally planned economy
- 11. First national health congress (Aug 1950) Medicine should serve the workers, peasants & soldiers Preventive medicine to be emphasized over curative services Integration of traditional medical practices with western medicine Health related works to be combined with mass movements, in controlling infectious diseases
- 12. 1950-1957 •Three-pronged healthcare insurance system 1950 •Epidemic prevention station 1951 •Labor insurance regulation 1953-58 •First five-year plan – Agriculture dependence 1955 •Cooperative medical scheme (CMS) 1957 •Three-tier of rural health care system 1959 - 61 •The Great Leap forward / Second 5-year plan 1966 - 75 •Cultural revolution 1976 •Barefoot doctors 1979 •One-child policy •Surveillance system 1978 - 2000 •Economic reforms >2000 •Health reforms
- 13. Early health system reforms • China managed to build a basic health system between 1949- 1979 despite low economic development and limited resources (1.2%) • Emphasis on grassroots care: 90% of all counties had medical institution by 1952 Every village had at least 1 barefoot doctor • Free services to control communicable diseases: smallpox • Centralized control: service cost, drug markups • Initial medical security system: rural cooperative, government and employee insurances Centralized control Communicable disease reduction Rural and primary health care development Barefoot doctors Basic medical security system established
- 14. Initial reforms 1985 • Decentralization of financial and decision-making for public hospitals 1989 • Central role of user charges in financing emphasized 1992 • Greater autonomy for public hospitals, increasing user charger reliance 1994 • Combined risk pooling government, employer/employee expenditure 1997 • Decision on re-establishment of rural CMS, UEBMI deepening 1998 • Implementing the UEBMI scheme nationally 2002 • Launch of NRCMS
- 15. 2003 • Shift to developmental aims including person-centered health care 2004 • China – Centre for Disease Control and Prevention (CDC) 2006 • Aim to establish basic health system for all 2006 • NRCMS refinement and planned expansion 2007 • URBMI established (National coverage of basic health insurance system achieved) 2009 • Aim of achieving UHC by 2020 set 2011 • Guidelines for establishing GP system 2012 • Deepening health reform during 12th five-year plan 2013 • Essential medicine system reform, service industry 2015 • Health reforms for achieving UHC 2016 • Two-child policy Recent health reforms
- 16. Healthy China 2030 • HC 2030, which is the Chinese • vision of health care, is built on four core principles. • The first is health priority. • The second core principle is innovation. • The third principle is scientific development. • The fourth principle is fairness and justice.
- 17. Framework of the HC 2030 vision
- 19. Health system Mixed health financing / Universal Health Coverage 1. Health legislative system (financing, service delivery and health supervision system) 2. Central Government control and regulation 3. Dominant public hospitals, including traditional medicine hospitals 4. Constitution includes the right of citizens to state assistance for health care including disability and ageing 5. Basic public health equalization programmed • Historical grassroots health facility focus • Growing private sector and NGO involvement • Social health insurance with UHC focus by 2020
- 21. Level of healthcare in CHINA and INDIA
- 22. China’s Healthcare system Healthcare system Public health Prevention centers (dedicated to different areas) Health education on 1. Basic diseases prevention and control 2. Family planning, MCH care 3. Mental health 4. Blood donation 5. Special disease and emergencies Medical services Primary hospitals 1. Basic medical care Rural areas: Township health centers and village clinic 3. Urban areas: Community health centers and community health stations Secondary and tertiary hospitals 1. High quality services and more advanced medical supplies 2. Generally preferred by patients as better qualified doctors and even for less serious treatments 3. Typically located in urban areas Pharmace utical services Pharmacies (afflicted by medical institutions ) Usually locate in a hospitals Supplies prescription medicine Independent pharmacies Located in cities and villages Provides general medicine that is freely available
- 23. Health Financing – Basic medical insurance schemes 3 basic insurance schemes • 95% population coverage • UEBMI (mandatory for urban employed) • URBMI (urban unemployed) • NRCMS (rural) . Financing • UEBMI: employer/employee contributions • URBMI and NRCMS: premiums, government subsidy • Overall decrease in OOP payments from 59% to 34% in 2012 . Breadth • UEBMI: inpatient, outpatient, some pharmacies • URBMI and NRCMS: inpatient and limited catastrophic diseases
- 24. Financial flow Created by Dr. Jenifer J
- 25. Universal healthcare insurance system Urban residence Urban workers and retiring workers Urban workers Children, students, unemployed and urban residence Rural residence Farmers Other healthcare insurance Civil servants and soldier
- 26. Health legislation Chinese government upholds the following principles in health: • Highlight rural areas • Preventive care first • Aligning positions of traditional Chinese medicine and western medicine • Relying on science, technology and education • Encouraging the participation of whole society • Serving for people’s health • Serving for China's socialistic modernization
- 27. Essential drug list • Drug is made by manufacturers • Sold to patients by distributors • Raise the price for drugs in order to gain margin. • Expensive fees for medical services in China • It aims to lower the price by reducing the middleman • Sets ceiling price for drugs in the list which is updated every 3 years • The government tried to extend the zero mark up for drug sales in basic level hospitals with no profit and the lost margin would be reimbursed by the government
- 28. Input and processes outputs outcomes impact Policy changes Insurance Essential drugs Public health Process or implementation Health workers PHC service packages Hospital standards MRs prices Service reorganization Results Coverage Behavior change Result Financial protection Patient satisfaction Financial changes Investments follow New policies Better quality Efficiency in service delivery Health status TIME 2009………………………2010…………………………….2011………………2012………………………………2020
- 29. Challenges in Healthcare system in CHINA • Uneven economic growth • Urban and rural disparities • Technological barriers • Human resources • Overcrowding at tertiary hospitals • Needs for the growing elderly population • Market-oriented financing mechanisms to fund for both curative and preventive care • Services became unaffordable and inaccessible for disadvantaged populations • Rapid rise of medical costs and the inefficiency of state-owned enterprises collapsed rural health insurance and crippled urban health insurance • Lack of coverage provided by the health system and inadequate government support are the main obstacles to universal coverage
- 30. Learning • Continue political support is most important enabling condition for achieving UHC • Increasing health financing is necessary and investment from both government and private sector to be considered • Strong PHC system should be regarded as a core component in realizing UHC • Increase spending on health, especially infrastructure, providers and necessities • Better control of communicable diseases and improvement in maternal and infant mortality • Though, there is no strong and proper evidence for the healthcare system, it is to interrupt
- 31. Reference • Detels R. McEwen J. Beaglehole R. Tanaka H. Oxford textbook of Public health. 4th ed. New York: Oxford University Press; 2004. • WHO. China’s village doctors take great strides. Bulletin of the World Health Organization. 2008 [cited on 2020 Dec 7]; 86 (12) Available from URL: www.who.int/bulletin/volumes/86/12/08-021208/en/ • Qingyue M, Hongwei Y, Wen C, Qiang S, Xiaoyun L. People’s Republic of China Health System Review.2015 [cited on 2020 Dec 8]; 5(7) Available from URL: http://iris.wpro.who.int/bitstream/handle/10665.1/11408/9789290617280_eng.pdf • WHO (World Health Organization) (2020). Universal Coverage of health care in China: Challenges and Opportunities. WHO, Geneva. • H. Yu, “Universal Health Insurance Coverage for 1.3 Billion People: What Accounts for China's Success?” Health Policy 119, no. 9 (Sept. 2015): 1145–52. • The State Council, The State Council’s Suggestion on Merging Urban-Rural Resident Basic Health Insurance (2016), http://www.gov.cn/zhengce/content/2016-01/12/content_10582.htm
- 32. Thank you