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[[File:China Healthcare Security (CHS) Logo.svg|thumb|269x269px|China Healthcare Security (CHS)
'''Healthcare in China''' has undergone basic changes over the twentieth century and twenty-first century, using both [[Publicly funded health care|public]] and private medical institutions and [[Health insurance|insurance]] programs. As of 2020, about 95% of the population has at least basic [[health insurance]] coverage.<ref name=":8" />
'''Healthcare in China''' has undergone basic changes over the twentieth century and twenty-first centuries, using both public and private medical institutions and insurance programs. As of 2020, about 95% of the population has at least basic health insurance coverage.<ref name=":8" /> Basic medical insurance includes two systems: employee medical insurance and resident medical insurance. The former covers the urban employed population, and the latter covers the urban non-employed population and the rural population. A total of 25% of the people covered by the basic medical insurance participated in the employee medical insurance, a total of 344 million people; 75% participated in the residents' medical insurance, a total of 1.017 billion people.<ref name=":8">{{Cite web |title=国家医疗保障局 政策解读 "十四五"全民医疗保障规划一问一答 |url=http://www.nhsa.gov.cn/art/2021/9/30/art_38_6144.html |url-status=live |archive-url=https://web.archive.org/web/20220126030020/http://www.nhsa.gov.cn/art/2021/9/30/art_38_6144.html |archive-date=2022-01-26 |access-date=2022-01-26 |website=www.nhsa.gov.cn}}</ref> Medical assistance has subsidized 78 million poor people to participate in basic medical insurance, and the coverage of poor people has stabilized at over 99.9%.<ref name=":8" /> Despite this, public health insurance generally only covers about half of medical costs, with the proportion lower for serious or chronic illnesses. Under the "Healthy China 2020" initiative, China has undertaken an effort to cut healthcare costs, requiring insurance to cover 70% of costs by the end of 2018.<ref>{{cite web |title=Xinhua Insight: China's rural residents enjoy better healthcare - Xinhua | English.news.cn |url=http://news.xinhuanet.com/english/2016-02/26/c_135131604.htm |url-status=dead |archive-url=https://web.archive.org/web/20160226150724/http://news.xinhuanet.com/english/2016-02/26/c_135131604.htm |archive-date=26 February 2016 |access-date=9 August 2022 |website=news.xinhuanet.com}}</ref><ref name="nytimes.com">{{Cite web |title=China's Health Care Reform: Far from Sufficient |url=https://www.nytimes.com/roomfordebate/2011/11/01/is-china-facing-a-health-care-crisis/chinas-health-care-reform-far-from-sufficient |website=[[The New York Times]]}}</ref> In addition, there are policies such as [[critical illness insurance]] and medical assistance. China's commercial health insurance is also proliferating. In 2020, the country's commercial health insurance premium income amounted to 817.3 billion yuan, with an average annual growth rate of 20%. China's coverage of maternity insurance has continued to expand, by the end of 2020, 235.673 million people were insured under maternity insurance.<ref name=":8" />▼
Basic medical insurance includes two systems: employee medical insurance and resident medical insurance. The former covers the urban employed population, and the latter covers the urban non-employed population and the rural population. A total of 25% of the people covered by the basic medical insurance participated in the employee medical insurance, a total of 344 million people; 75% participated in the residents' medical insurance, a total of 1.017 billion people.<ref name=":8">{{Cite web |title=国家医疗保障局 政策解读 "十四五"全民医疗保障规划一问一答 |url=http://www.nhsa.gov.cn/art/2021/9/30/art_38_6144.html |url-status=live |archive-url=https://web.archive.org/web/20220126030020/http://www.nhsa.gov.cn/art/2021/9/30/art_38_6144.html |archive-date=2022-01-26 |access-date=2022-01-26 |website=www.nhsa.gov.cn}}</ref> Medical assistance has subsidized 78 million poor people to participate in basic medical insurance, and the coverage of poor people has stabilized at over 99.9%.<ref name=":8" />
The country maintains two parallel medical systems, one for modern or Western medicine, and one for [[Traditional Chinese medicine]] (TCM). Some Chinese consider TCM backward and ineffective, others consider it inexpensive, effective, and culturally appropriate. China has also become a major market for health-related multinational companies. Companies such as [[AstraZeneca]], [[GlaxoSmithKline]], [[Eli Lilly and Company|Eli Lilly]], and [[Merck KGaA|Merck]] entered the Chinese market and have experienced explosive growth. China has also become a growing hub for healthcare research and development.<ref name="McKinsey" /> According to [[Sam Radwan]] of [[ENHANCE International]], China's projected healthcare spending in 2050 may exceed Germany's entire 2020 [[gross domestic product]].<ref name="Enhance">{{Cite web |date=January 21, 2020 |title=Opportunities in Chinese healthcare - Top1000funds.com |url=https://www.top1000funds.com/2020/01/opportunities-in-chinese-healthcare/}}</ref>▼
▲
The above only applies to [[Mainland China]]. The [[special administrative regions of China|special administrative regions]] of [[Hong Kong]] and [[Macau]] maintain their own separate universal healthcare systems.<ref>{{Cite book |last1=Yang |first1=jinghui |title=港澳基本法比较研究 |last2=Li |first2=xiangqin |date=September 2017 |publisher=BEIJING BOOK CO. INC. |isbn=9787301287415 |trans-title=A Comparative Study of the Basic Law of Hong Kong and Macao}}</ref> [[Healthcare in Taiwan]] is administered by the [[Republic of China]]'s [[Ministry of Health and Welfare (Taiwan)|Ministry of Health and Welfare]].▼
▲The country maintains two parallel medical systems, one for modern or Western medicine, and one for [[Traditional Chinese medicine]] (TCM). Some Chinese consider TCM backward and ineffective, others consider it inexpensive, effective, and culturally appropriate. China has also become a major market for health-related multinational companies. Companies such as [[AstraZeneca]], [[GlaxoSmithKline]], [[Eli Lilly and Company|Eli Lilly]], and [[Merck KGaA|Merck]] entered the Chinese market and have experienced explosive growth. China has also become a growing hub for healthcare research and development.<ref name="McKinsey" /> According to [[Sam Radwan]] of [[ENHANCE International]], China's projected healthcare spending in 2050 may exceed Germany's entire 2020
▲The above only applies to [[Mainland China]]. The [[special administrative regions of China|special administrative regions]] of
== History ==
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=== Mao era ===
Free medical treatment was practiced in areas controlled by the CCP before 1949. In February 1951, the industrial and mining departments began to try out labor insurance regulations and solve workers' medical problems. In the same year, free medical treatment was also tried in northern [[Shaanxi]] and some ethnic minority areas. On June 27, 1952, the Instructions of the Administration Council on the Practice of Free Medical Treatment and Prevention for State Functionaries of People's Governments at all levels, parties,<ref>{{Cite book |last=Compiled by China Working Committee on Aging Office |title=Compilation of laws and regulations on Aging in China |date=2010 |publisher=Unknown |isbn=978-7801787316}}</ref> organizations and affiliated Institutions were issued. After that, the CCP government gradually communized the medical and health system and modernized it in imitation of the [[Soviet Union]]. During the period of planned economy, a tertiary hospital structure was established: a tertiary medical service and epidemic prevention system consisting of municipal and district hospitals and outpatients from sub-districts,
Before the [[Cultural Revolution]], the [[Ministry of Health (China)|Ministry of Health]] focused on the delivery of health care in urban hospitals.<ref name=":05">{{Cite book |last=Lampton |first=David M. |title=Living U.S.-China Relations: From Cold War to Cold War |date=2024 |publisher=[[Rowman & Littlefield]] |isbn=978-1-5381-8725-8 |location=Lanham, MD |pages= |author-link=David M. Lampton}}</ref>{{Rp|page=304}} [[Mao Zedong|Mao]] criticized Minister of Health [[Qian Xinzhong]] for promoting this health care model, arguing that an urban hospital-focused health care model failed to treat peasants and focused on cure rather than preventative medicine.<ref name=":05" />{{Rp|page=304}} Mao also described the Ministry itself as the Ministry "of urban overlords."<ref name=":05" />{{Rp|page=105}}
The Cultural Revolution brought a greater focus on rural health care. In his June 26 Directive, Mao prioritized healthcare and medicine for rural people throughout the country.<ref name=":22">{{Cite book |last1=Xu |first1=Youwei |title=Everyday Lives in China's Cold War Military Industrial Complex: Voices from the Shanghai Small Third Front,
=== Deng's economic reform ===
However, beginning with [[Chinese economic reform|economic reforms]] in 1978, health standards in China began to diverge significantly between urban and rural areas and coastal and interior provinces.
The barefoot doctor system was put in free fall in 1981, as the "commune" system was shut down.<ref name=":18">{{cite journal |vauthors=Dong Z, Phillips MR |title=Evolution of China's health-care system |language=English |journal=Lancet |volume=372 |issue=9651 |pages=1715–6 |date=November 2008 |pmid=18930524 |doi=10.1016/S0140-6736(08)61351-3 |s2cid=44564705}}</ref><ref name="mcconnell">{{cite journal | last = McConnell | first = John | title = Barefoot No More | journal = The Lancet | year = 1993 | volume = 341 | issue = 8855 | page = 1275 | doi = 10.1016/0140-6736(93)91175-l | s2cid = 54379134}}</ref> By 1984,
Urban residents also faced healthcare privatization as they were laid off from state-owned enterprises and lost much of their social security and health benefits. As a result, the majority of urban residents paid almost all health costs out-of-pocket beginning in the 1990s, and most rural residents simply could not afford to pay for healthcare in urban hospitals.<ref name=":22"/>
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In 1989, the Chinese government decided to try and reverse the fall of rural healthcare coverage, but they were not very successful: coverage was only up to 10% by 1993.<ref name="carrin"/> In 1994, the government decided to fund a revival of the co-operative system,<ref name="carrin"/> though they would not be successful until the 2005 NRCMCS project.<ref name="reform"/>
Despite the consequences of privatization, the economic reforms did bring in money and new technology for building new hospital infrastructure. Modern hospital infrastructure expanded significantly in China beginning in the 1990s.<ref name=":53">{{Cite book |last=Santos |first=Gonçalo |title=Chinese Village Life Today: Building Families in an Age of Transition |date=2021 |publisher=[[University of Washington Press]] |isbn=978-0-295-74738-5 |location=Seattle |pages=}}</ref>{{Rp|page=101}}
=== 21st century ===
The [[2002–2004 SARS outbreak|2003 SARS epidemic]] resulted in substantial public criticism, prompted government statements that privatizing health care in rural China had been a failure, and brought rural reform to the top of the policy agenda.<ref name=":423">{{Cite book |last=Heilmann |first=Sebastian |title=Red Swan: How Unorthodox Policy-Making Facilitated China's Rise |date=2018 |publisher=[[The Chinese University of Hong Kong Press]] |isbn=978-962-996-827-4 |doi=10.2307/j.ctv2n7q6b |jstor=j.ctv2n7q6b |s2cid=158420253 |author-link=Sebastian Heilmann}}</ref>{{Rp|pages=104–105}} The government launched the New Rural Co-operative Medical Care System (NRCMCS) in 2005 in an overhaul of the healthcare system, particularly intended to make it more affordable for the rural poor. Under the NRCMCS, some 800 million rural residents gained basic, tiered medical coverage, with the central and provincial governments covering between 30 and 80% of regular medical expenses.<ref name="reform">{{Cite journal |last1=Carrin |first1=G. |last2=Ron |first2=A. |last3=Hui |first3=Y. |last4=Hong |first4=W. |last5=Tuohong |first5=Z. |last6=Licheng |first6=Z. |last7=Shuo |first7=Z. |last8=Yide |first8=Y. |last9=Jiaying |first9=C. |last10=Qicheng |first10=J. |last11=Zhaoyang |first11=Z. |last12=Jun |first12=Y. |last13=Xuesheng |first13=L. |date=1999 |title=The reform of the rural cooperative medical system in the People's Republic of China: interim experience in 14 pilot counties |journal=Social Science & Medicine |volume=48 |issue=7 |pages=961–972 |doi=10.1016/S0277-9536(98)00396-7 |pmid=10192562}}</ref>
Since 2009, China has been undertaking [[Healthcare system reform in China|the most significant healthcare reforms]] since the [[Mao era]].<ref>{{Cite journal |last1=Chen |first1=Jiang |last2=Lin |first2=Zhuochen |last3=Li |first3=Li-an |last4=Li |first4=Jing |last5=Wang |first5=Yuyao |last6=Pan |first6=Yu |last7=Yang |first7=Jie |last8=Xu |first8=Chuncong |last9=Zeng |first9=Xiaojing |last10=Xie |first10=Xiaoxu |last11=Xiao |first11=Liangcheng |date=2021-12-13 |title=Ten years of China's new healthcare reform: a longitudinal study on changes in health resources |journal=BMC Public Health |volume=21 |issue=1 |pages=2272 |doi=10.1186/s12889-021-12248-9 |issn=1471-2458 |pmc=8670033 |pmid=34903184 |doi-access=free }}</ref> The availability of medical insurance has increased in urban areas as well. By 2011 more than 95% of the total population of China had basic health insurance, though out-of-pocket costs and the quality of care varied significantly,<ref name="McKinsey">{{cite web |last1=Frank Le Deu |display-authors=etal |title=Health care in China: Entering 'uncharted waters' |url=https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/health-care-in-china-entering-uncharted-waters |access-date=April 13, 2016 |publisher=McKinsey & Company}}</ref> particularly when it came to serious illnesses among children.<ref>{{cite journal |author=Huaqing Liu |author2=Dongni Su |author3=Xubei Guo |author4=Yunhong Dai |author5=Xingqiang Dong |author6=Qiujiao Zhu |author7=Zhenjiang Bai |author8=Ying Li |author9=Shuiyan Wu |date=August 12, 2020 |title=Withdrawal of treatment in a pediatric intensive care unit at a Children's Hospital in China: a 10-year retrospective study |journal=BMC Med Ethics |language=English |volume=21 |issue=1 |page=71 |doi=10.1186/s12910-020-00517-y |oclc=8644440795 |pmc=7425042 |pmid=32787834 |doi-access=free }}</ref>
== Current healthcare system ==
{{Further|Health in China|Medicine in China|Healthcare system reform in the People's Republic of China}}
[[File:Life expectancy by WBG -China -diff.png|thumb|[[Life expectancy]] in China]]
The Chinese healthcare system maintains [[Traditional Chinese medicine|traditional Chinese medicine (TCM)]] and modern medicine as two parallel medical systems. The government invests in TCM research and administration, but TCM is challenged by having too few professionals with knowledge and skills and rising public awareness of modern or western models.{{sfnb|Xu|Yang|2009|p=133}}
The Chinese healthcare system maintains [[Traditional Chinese medicine|traditional Chinese medicine (TCM)]] and modern medicine as two parallel medical systems. The government invests in TCM research and administration, but TCM is challenged by having too few professionals with knowledge and skills and rising public awareness of modern or western models.{{sfnb|Xu|Yang|2009|p=133}} Major cities have hospitals specializing in different fields and are equipped with some modern facilities. Public hospitals and clinics are available in cities. Their quality varies by location; the best treatment can usually be found in public city-level hospitals, followed by smaller district-level clinics. Many public hospitals in major cities have so-called V.I.P. wards or {{transliteration|zh|gāogàn bìngfáng}} ({{zh|c=高干病房}}). These feature reasonably up-to-date medical technology and skilled staff. Most V.I.P. wards also provide medical services to foreigners and have English-speaking doctors and nurses. V.I.P. wards typically charge higher prices than other hospital facilities, but are still often cheap by Western standards. In addition to modern care, traditional Chinese medicine is also widely used, and there are Chinese medicine hospitals and treatment facilities located throughout the country. Dental care, cosmetic surgery, and other health-related services at Western standards are widely available in urban areas, though costs vary. Historically, in rural areas, most [[Health in China|healthcare]] was available in clinics providing rudimentary care, with poorly trained medical personnel and little medical equipment or medications, though certain rural areas had far higher-quality medical care than others. However, the quality of rural health services has improved dramatically since 2009. In an increasing trend, healthcare for residents of rural areas unable to travel long distances to reach an urban hospital is provided by family doctors who travel to the homes of patients, which is covered by the government.<ref>{{cite web |title=Health Information - Beijing, China - Embassy of the United States |url=http://beijing.usembassy-china.org.cn/acs_health.html |url-status=dead |archive-url=https://web.archive.org/web/20080426180827/http://beijing.usembassy-china.org.cn/acs_health.html |archive-date=2008-04-26 |work=usembassy-china.org.cn}}</ref><ref>{{cite web |title=Accessing Medical Services and Hospitals |url=https://www.angloinfo.com/beijing/how-to/page/beijing-healthcare-health-system-medical-services |access-date=15 June 2016 |publisher=[[Angloinfo]]}}</ref><ref>{{cite web |title=China Guide: Health care in China, Doctors, clinics and hospitals: Health care is widely available in China |url=http://www.justlanded.com/english/China/China-Guide/Health/Health-care-in-China |work=Just Landed}}</ref><ref>{{cite news |title=China: Doctors on Wheels Bring Quality Care to Rural Residents |work=worldbank.org |url=http://www.worldbank.org/en/news/feature/2013/04/04/china-bringing-quality-health-services-to-rural-residents}}</ref><ref>{{Cite web |title=China's rural residents enjoy better healthcare - China - Chinadaily.com.cn |url=http://www.chinadaily.com.cn/china/2016-02/26/content_23657044.htm |website=www.chinadaily.com.cn}}</ref>▼
Major cities have hospitals specializing in different fields and are equipped with some modern facilities. Public hospitals and clinics are available in cities. Their quality varies by location; the best treatment can usually be found in public city-level hospitals, followed by smaller district-level clinics. Many public hospitals in major cities have so-called V.I.P. wards or {{transliteration|zh|gāogàn bìngfáng}} ({{zh|c=高干病房|link=no}}). These feature reasonably up-to-date medical technology and skilled staff. Most [[V.I.P]]. wards also provide medical services to foreigners and have English-speaking doctors and nurses. [[V.I.P.]] wards typically charge higher prices than other hospital facilities, but are still often cheap by Western standards.
Reform of the health care system in urban areas of China has prompted concerns about the demand and utilization of Community Health Services Centers; a 2012 study, however, found that insured patients are less likely to use private clinics and more likely to use the centers.<ref>{{cite journal |last1=Qian |first1=D |display-authors=etal |year=2010 |title=Determinants of the Use of Different Types of Health Care Provider in Urban China: A racer illness study of URTI |url=https://pubmed.ncbi.nlm.nih.gov/20650539/ |journal=Health Policy |volume=98 |issue=2–3 |pages=227–35 |doi=10.1016/j.healthpol.2010.06.014 |pmid=20650539 |access-date=26 May 2012}}</ref>▼
▲
▲Reform of the health care system in urban areas of China has prompted concerns about the demand and
A cross-sectional study between 2003 and 2011 showed remarkable increases in health insurance coverage and inpatient reimbursement accompanied by increased use and coverage. The increases in service use are particularly important in rural areas and at hospitals. Major advances have been made in achieving equal access to insurance coverage, inpatient reimbursement, and basic health services, most notably for hospital delivery, and use of outpatient and inpatient care.<ref>{{cite journal |last1=Meng |first1=Qun |last2=Xu |first2=Ling |last3=Zhang |first3=Yaoguang |last4=Qian |first4=Juncheng |last5=Cai |first5=Min |last6=Xin |first6=Ying |last7=Gao |first7=Jun |last8=Xu |first8=Ke |last9=Boerma |first9=J Ties |last10=Barber |first10=Sarah L |date=3–9 March 2012 |title=Trends in access to health services and financial protection in China between 2003 and 2011: a cross-sectional study |journal=The Lancet |volume=379 |issue=9818 |pages=805–814 |doi=10.1016/s0140-6736(12)60278-5 |pmid=22386034 |s2cid=19744259}}</ref>
A 2016 report from the [[World Bank Group]], the [[World Health Organization]], the [[Ministry of Finance (China)|Ministry of Finance]], the [[National Health and Family Planning Commission]], and the [[Ministry of Human Resources and Social Security]] of China recommended health care reforms to reduce healthcare spending in China by shifting away from a hospital-centric model towards a system that focuses more on primary care, health service equality, and cost-efficient health services.<ref name=":9" /> The report found that the greatest health threat to the Chinese population is from [[Non-communicable disease|non-communicable]] diseases which replaced infectious diseases as most common threat. The threat from non-communicable disease is worsened by behaviors like sedentary lifestyles, high alcohol consumption, and smoking as well as air pollution. The report suggests that without health care reforms the spending on health care in China will increase to 9% of China's GDP by 2035 which is an increase from the 5.6% of China's GDP in 2014.<ref name=":9">{{Cite web |title=Report Recommends Deeper Healthcare Reforms in China |url=https://www.worldbank.org/en/news/press-release/2016/07/22/report-recommends-deeper-healthcare-reforms-in-china |access-date=2023-10-13 |website=World Bank |language=en |archive-date=2023-09-20 |archive-url=https://web.archive.org/web/20230920022355/https://www.worldbank.org/en/news/press-release/2016/07/22/report-recommends-deeper-healthcare-reforms-in-china |url-status=live }}</ref>
With substantial urbanization, attention to health care has changed. Urbanization offers opportunities for improvements in population health in China (such as access to improved health care and basic infrastructure) and substantial health risks including air pollution, occupational and traffic hazards, and the risks conferred by changing diets and activity.<ref name=":10" /> [[Communicable disease|Communicable]] infections should also be re-focused on.<ref name=":10">{{cite journal |last1=Gong |first1=Peng |last2=Liang |first2=Song |last3=Carlton |first3=Elizabeth J |last4=Jiang |first4=Qingwu |last5=Wu |first5=Jianyong |last6=Wang |first6=Lei |last7=Remais |first7=Justin V |date=3–9 March 2012 |title=Urbanisation and health in China |journal=The Lancet |volume=379 |issue=9818 |pages=843–852 |doi=10.1016/s0140-6736(11)61878-3 |pmc=3733467 |pmid=22386037}}</ref> In 2022, the [[BBC]]'s chief international correspondent [[Lyse Doucet]] said China had a very good healthcare system including at the provincial level.<ref name=bbcr4-20221230>{{cite news |url=https://www.bbc.co.uk/sounds/play/m001gjtz |title=Correspondents' Look Ahead |last=Doucet |first=Lyse |publisher=BBC Radio 4 |time=30m30s |quote=China does have a very good healthcare system right down to the provincial level |date=30 December 2022 |access-date=2 January 2023 |archive-date=2 January 2023 |archive-url=https://web.archive.org/web/20230102213253/https://www.bbc.co.uk/sounds/play/m001gjtz |url-status=live }}</ref>
As of 2022, enrollment in China's nationwide healthcare system is almost universal. However, these plans generally provide low levels of benefits.<ref>{{Cite book |last=Roach |first=Stephen S. |url= |title=Accidental Conflict: America, China, and the Clash of False Narratives |date=2022 |publisher=[[Yale University Press]] |isbn=978-0-300-26901-7 |location=New Haven |oclc=1347023475 |author-link=Stephen S. Roach}}</ref>{{Rp|page=202}} In 2022, there were 1.34 billion people enrolled in state-subsidized basic health insurance, which was 17 million fewer people compared to 2021.<ref>{{Cite web |date=2023-12-14 |title=Millions of Chinese People Drop Out of State Health Insurance |url=https://www.voanews.com/a/millions-of-chinese-people-drop-out-of-state-health-insurance/7399107.html |access-date=2024-07-12 |website=Voice of America |language=en |archive-date=2024-07-12 |archive-url=https://web.archive.org/web/20240712122508/https://www.voanews.com/a/millions-of-chinese-people-drop-out-of-state-health-insurance/7399107.html |url-status=live }}</ref> The drop may be attributable to steadily rising premiums, reduced benefits as well as rising co-payments and other changing policies.<ref>{{Cite web |date=2023-12-14 |title=Millions of Chinese People Drop Out of State Health Insurance |url=https://www.voanews.com/a/millions-of-chinese-people-drop-out-of-state-health-insurance/7399107.html |access-date=2024-07-12 |website=Voice of America |language=en |archive-date=2024-07-12 |archive-url=https://web.archive.org/web/20240712122508/https://www.voanews.com/a/millions-of-chinese-people-drop-out-of-state-health-insurance/7399107.html |url-status=live }}</ref>
The National Healthcare Security Administration published in 2024 a statistical report on the development of the country's medical insurance industry, which reported that China had 198,000 medical institutions and 352,400 pharmacies 550,000 medical and medicine institutions in the national medical insurance network.<ref>{{Cite web |title=Report shows steady improvement of China's medical insurance system-Xinhua |url=https://english.news.cn/20240726/a3dfb1e375cd4e40a792ad0342bf8cb8/c.html |access-date=2024-07-26 |website=english.news.cn}}</ref> The statistical report also noted that in 2023 centralized bulk drug procurement reduced medical expenses for 80 drugs and an average price cut of 57%.
== Resources ==
In 2005 China had about 1,938,000 physicians (1.5 per 1,000 persons) and about 3,074,000 hospital beds (2.4 per 1,000 persons).<ref>{{Cite web |title=National Bureau of Statistics's Database |url=http://www.stats.gov.cn/english/ |access-date=2016-04-13 |archive-date=2014-09-15 |archive-url=https://web.archive.org/web/20140915155232/http://www.stats.gov.cn/english/ |url-status=live }}</ref> Health expenditures on a [[purchasing power parity]] (PPP) basis were US$224 per capita in 2001 or 5.5 percent of the gross domestic product.<ref>{{Cite web |title=按购买力平价 (PPP)计算的人均
There is a shortage of doctors and nurses in China. More doctors are being trained, but most aim to leave the countryside in favor of the cities, leaving significant shortages in rural areas.<ref name="China Medical Board">{{cite web |title=China Medical Board |url=http://www.chinamedicalboard.org/ |access-date=21 January 2013 |archive-date=4 April 2015 |archive-url=https://web.archive.org/web/20150404064529/http://www.chinamedicalboard.org/ |url-status=live }}</ref>
In 2016 it was reported that [[ticket resale]] was widely practiced at [[Beijing Tongren Hospital]] and Peking University First Hospital. Advance tickets for outpatient consultation are sold by the hospitals for 200 yuan but sold for as much as 3,000 yuan. An eye doctor commented that the appointment fees did not reflect the economic value of doctors' skills and experience and that the scalpers were selling the doctor's appointment at a price the market is prepared to pay.<ref>{{cite news |date=12 April 2016 |title=Scalped: At China's creaking hospitals, illegal ticket touts defy crackdown |publisher=Reuters |url=https://www.reuters.com/article/us-china-healthcare-scalpers-idUSKCN0X82O1 |access-date=13 April 2016 |archive-date=10 December 2020 |archive-url=https://web.archive.org/web/20201210234335/https://www.reuters.com/article/us-china-healthcare-scalpers-idUSKCN0X82O1 |url-status=live }}</ref>
== Medical training ==
In 1956, in the midst of China's education reform modeling Soviet practices, the Ministry of Hygiene embarked on standardizing medical education and organizing medical colleges in China. Taking an April, 1955 Soviet curriculum as reference, the resulting curriculum would offer a tertiary higher medical education at a maximum of 12 years. By 1958, traditional Chinese medicine was included in the curriculum. Beginning in 1962, a six-year course for medical education and a five-year course in pharmacology came into effect. Despite these early standardizations, the Cultural Revolution saw a halt in higher medical education and a preference for "barefoot doctors" with little to none formal medical education. Higher medical education was revived in 1977 on orders of the Ministry of Education and the State Department to resume higher education; starting February, 1978, students are enrolled in a five-year course for medical school and a four-year course for pharmacology at the undergraduate level.
In 2012, the [[Ministry of Education (China)|Chinese Ministry of Education]] proposed again to standardize medical education in China into "5+3" programs: five years of undergraduate medical school training and three years of residency. Meanwhile, the same proposal also suggested a "3+2" program for graduates of higher vocational colleges: a three-year vocational medical degree and two years residency. <ref>{{Cite web|title=教育部 卫生部关于实施卓越医生教育培养计划的意见|url=http://www.moe.gov.cn/srcsite/A08/moe_740/s7952/201205/t20120507_166950.html |access-date=2 December 2023}}</ref> The indetermination of this departmental opinion displayed how various tracks of higher medical education coexist in contemporary China. Previously, a 1998 State Department regulation established professional clinical medicine degrees
of [[Master of Medicine|Master of Medicine (M.M)]] and [[Doctor of Medicine|Doctor of Medicine (M.D)]]. Applicants to these degrees require three years of experience as resident physicians as well as supervised training of at least six months; a M.M holder may advance to M.D with three years of further residency, bring the potential length of the most advanced medical degree in China to 11 years.
By 2019, Chinese medical education features tracks of three-year (vocational or no degree), five-year (Bachelor of Medicine), "5+3" (
The National Health Commission of the People's Republic of China certifies
has obtained a bachelor's degree or above in a medicine-related major from an institution of higher education and has completed at least one year of medical work practice at a medical and healthcare institution under the guidance of a practicing doctor.(Article 9, subsection 1)
has obtained a junior college degree in a medicine-related major from an institution of higher education, and has practiced with a medical and healthcare institution for at least two years after obtaining a practicing certificate of practicing assistant doctors.(Article 9, subsection 2)
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== Traditional and modern Chinese medicine ==
{{See also|Medicine in China|Traditional Chinese medicine|Medical missions in China|Pharmacy in China|Pharmaceutical industry in China}}
Although the practice of traditional Chinese medicine was strongly promoted by the Chinese leadership and remained a major component of health care, Western medicine gained increasing acceptance in the 1970s and 1980s. For example, the number of physicians and
In practice, however, this combination has not always worked smoothly. In many respects, physicians trained in traditional medicine and those trained in Western medicine constitute separate groups with different interests. For instance, physicians trained in Western medicine have been somewhat reluctant to accept unscientific traditional practices, and traditional practitioners have sought to preserve authority in their own re. Although Chinese medical schools that provided training in Western medicine also provided some instruction in traditional medicine, relatively few physicians were regarded as competent in both areas in the mid-1980s.<ref>{{Cite book |last=Zhang |first=Yawei |title=Encyclopedia of Global Health |date=9 January 2008 |publisher=SAGE Publications, Inc. |isbn=9781412941860 |doi=}}</ref>
The extent to which traditional and Western treatment methods were combined and integrated into the monitor hospitals variety they monitor hospitals and medical schools of purely traditional medicine was established. In most urban hospitals, the pattern seemed to be to establish separate departments for traditional and Western treatment. In the county hospitals, however, traditional medicine received greater emphasis.<ref>{{Cite web |title=China Health Care |url=https://photius.com/countries/china/society/china_society_health_care.html |access-date=2022-11-21 |archive-date=2021-05-17 |archive-url=https://web.archive.org/web/20210517034501/https://www.photius.com/countries/china/society/china_society_health_care.html |url-status=live }}</ref>
[[File:
Traditional medicine depends on [[Chinese herbology|herbal treatments]], [[acupuncture]], [[acupressure]], [[moxibustion]] (burning of herbs over acupuncture points), "[[Fire cupping|cupping]]" (local suction of skin), qigong (coordinated movement, breathing, and awareness), [[tui na]] (massage), and other culturally unique practices. Such approaches are believed to be most effective in treating minor and chronic diseases, in part because of milder side effects. Traditional treatments may be used for more serious conditions as well, particularly for such acute abdominal conditions as [[appendicitis]], [[pancreatitis]], and [[gallstone]]s; sometimes traditional treatments are used in combination with Western treatments. A traditional method of [[Orthopedics|orthopedic]] treatment, involving less immobilization than Western methods, continued to be widely used in the 1980s.<ref>{{Cite web |title=Health in China |url=https://www.best-country.com/en/asia/china/medicine |website=best country |access-date=2022-10-31 |archive-date=2022-10-31 |archive-url=https://web.archive.org/web/20221031063750/https://www.best-country.com/en/asia/china/medicine |url-status=live }}</ref>
== Employment insurance regulations ==
In 1951, the State Council issued the Regulations of the [[China|People's Republic of China]] on Labour Insurance, which is a sole proprietorship that stipulates the main recipient of the insurance medical treatment labor insurance medical treatment, and that reference could be made to workers of collectively owned enterprises in towns above the county level.<ref name=":6">https://www.ide.go.jp/library/English/Publish/Reports/Als/pdf/22.pdf Labour Disputes Settlement System in China: Past and Perspective Authors: Wang zhenqi
The coverage of the Labour Insurance Regulations was further extended in 1953 and 1956 respectively and was eventually introduced in all enterprises that were state-owned in 1956. The Labour Insurance Regulations were also introduced or applied by reference to the larger, better-off, collectively owned enterprises. But even so, the expanded beneficiary population still represents a very small proportion of the sizeable Chinese population. According to statistics for 1957, the urban population accounted for only 15.39% of the country's total population in that year, and the number of people employed in establishments and government departments with regular incomes totaled less than 20% of the urban population.<ref name=":7">{{Cite web |title=中华人民共和国劳动保险条例实施细则修正草案 |trans-title=The People's Republic of China Labor Insurance Regulations Draft Amendment to the Implementing Rules |url=http://www.mohrss.gov.cn/xxgk2020/fdzdgknr/zcfg/gfxwj/shbx/201308/t20130808_109736.html |website=中华人民共和国人力资源和社会保障部 }}{{Dead link|date=July 2024 |bot=InternetArchiveBot |fix-attempted=yes }}</ref>
In the 1950s and early 1960s, employees of enterprises covered by the Labour Insurance Regulations were required to pay for medical treatment, surgery, hospitalization, and general medicine for general illnesses, non-work-related injuries, and disabilities, but the cost of expensive medicine, hospital meals, and travel expenses were borne by the employees themselves.<ref name=":6" /><ref name=":7" /> In the event of illness of an immediate family member supported by the employee, he or she may be treated in the hospital of the enterprise or other special hospitals, and the enterprise shall bear half of the cost of surgery and ordinary medicine.<ref name=":7" />
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In 1966, the Ministry of Labour and the All-China Federation of Trade Unions issued the "Circular on Several Issues Concerning the Improvement of the Labour Insurance Medical System for Enterprise Workers,"<ref name=":7" /> which appropriately lifted the burden of medical treatment on individual workers to prevent phenomena such as "soaking the sick" and "treating small illnesses in a big way."<ref name=":7" />
The source of funding for
== Primary care ==
{{cleanup section|reason=Section confuses two very different eras of primary care in china, pre- and post-1985.|date=January 2024}}
After 1949 the Ministry of Public Health was responsible for all healthcare activities and established and supervised all facets of health policy. Along with a system of national, provincial, and local facilities, the ministry regulated a network of industrial and [[State-Owned Enterprise|state enterprise]] hospitals and other facilities covering the health needs of workers of those enterprises. In 1981 this additional network provided approximately 25 percent of the country's total health services.<ref>{{Cite journal |title=Health Care Reform in China |url=https://www.bpastudies.org/index.php/bpastudies/article/view/89/187 |journal=Business and Public Administration Studies |date=2009 |volume=4 |issue=1 |pages=13 |last1=Qichao |first1=Song |access-date=2022-11-21 |archive-date=2022-11-21 |archive-url=https://web.archive.org/web/20221121125339/https://www.bpastudies.org/index.php/bpastudies/article/view/89/187 |url-status=live }}</ref>
Health care was provided in both rural and urban areas through a three-tiered system. In rural areas, the first tier was made up of barefoot doctors working out of village medical centers. They provided preventive and primary-care services, with an average of two doctors per 1,000 people; given their importance as healthcare providers, particularly in rural areas, the government introduced measures to improve their performance through organized training and an annual licensing exam.<ref name="Policy Brief 8">{{cite journal |last1=Bloom |first1=Gerald |author2=Kate Hawkins |date=June 2009 |title=Lessons from the Chinese Approach to Health System Development |url=https://opendocs.ids.ac.uk/opendocs/bitstream/handle/20.500.12413/3886/Bloom%20-Building%20institutions%20for%20an%20effective%20health%20system-%20Lessons%20from%20China
== Gender and health care in China ==
=== Gender-affirming care ===
Although research on health care and gender in China often employs languages that are strictly gendered, access to gender affirming care in China remains an important issue to be examined. There is currently no national survey on the amount of individuals seeking gender affirming care. It is estimated that there are around 400,000 individuals seeking [[gender-affirming surgery]] in China in 2017.<ref name=":02">{{Cite journal |last1=Zhu |first1=Xuequan |last2=Gao |first2=Yue |last3=Gillespie |first3=Amy |last4=Xin |first4=Ying |last5=Qi |first5=Ji |last6=Ou |first6=Jianjun |last7=Zhong |first7=Shaoling |last8=Peng |first8=Ke |last9=Tan |first9=Tingting |last10=Wang |first10=Chaoyue |last11=Chen |first11=Runsen |date=May 2019 |title=Health care and mental wellbeing in the transgender and gender-diverse Chinese population |url=https://doi.org/10.1016/S2213-8587(19)30079-8 |journal=The Lancet Diabetes & Endocrinology |volume=7 |issue=5 |pages=339–341 |doi=10.1016/s2213-8587(19)30079-8 |pmid=30902476 |s2cid=85455270 |issn=2213-8587}}</ref> It is difficult for transgender and gender non
In recent years, despite the state cracking down on queer content online, progress has been made in regards to gender affirming care. The first medical team specializing in gender affirming care is placed in the [[Peking University Third Hospital]].<ref name=":11">{{Cite web |date=2019-05-10 |title=Transgender people in China risk their lives with dangerous self-surgery |url=https://www.amnesty.org/en/latest/press-release/2019/05/china-transgender-dangerous-self-surgery/ |access-date=2023-11-12 |website=Amnesty International |language=en}}</ref> This is the first of its kind health care institution pioneering gender affirming care for trans people in China.<ref name=":11" /> In 2021, the first clinic providing gender affirming care to transgender children in China opened in Shanghai.<ref name=":15" /> In 2022, the [[National Health Commission]] of China published ''Management Specification on Gender Reassignment Technology''
▲{{See also|transgender people in China}}
== Deficiencies and problems of health care in China ==
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China is a country with the fastest aging population on the largest scale in the world, and the family welfare structure is continuously weakened due to the declining birthrate and aging population. There will be even a greater demand for medical resources in the future.<ref name=":1">{{Cite web |last=Zheng |first=Gongcheng |date=2016-02-17 |title=中国社会保障改革面临四大问题与五大挑战 |trans-title=China's social security reform faces four major problems and five challenges |url=http://www.xinhuanet.com/politics/2016-02/17/c_128726709_2.htm |archive-url=https://web.archive.org/web/20220126051202/http://www.xinhuanet.com/politics/2016-02/17/c_128726709_2.htm |archive-date=2022-01-26 |access-date=2022-01-26 |website=www.xinhuanet.com |publisher=XinHua}}</ref> However, urban and rural residents are still expecting the state to subsidize the personal medical cost of diseases.<ref name=":1" /> At the same time, the growth rate of the national economy has dropped from double digits in the twentieth century to single digits; in 2016, it dropped to about 7%, and the growth rate of fiscal revenue has also dropped from over 20% to single digits.<ref name=":1" /> Therefore, the slowdown in the growth of national fiscal revenue and the rapid growth of national welfare has become a urgent dilemma.<ref name=":1" />
===
In 2010, to prevent the loss of medical insurance funds caused by fraudulent insurance and
In 2020, the Hebei Provincial Medical Security Bureau issued the "Notice on Preventing Medical Insurance Designated Medical Institutions to Prevaricate and Refuse to Accept Insured Persons", requiring medical security departments at all levels to conscientiously do a good job in ensuring the enjoyment of medical security benefits for insured persons during the end of the year, and resolutely put an end to prevarication and refusal of patients who received medicare.<ref>{{Cite news |date=December 9, 2020 |title=河北省医保局
=== Erosion of health insurance funds and excessive medical treatment ===
In 2016, a study reported that a large number of doctors and patients conspired to erode medical insurance funds in China.<ref name=":0">{{Cite web |last=ZHENG |first=Gongcheng |date=2016-02-17 |title=中国社会保障改革面临四大问题与五大挑战 |trans-title=China's social security reform faces four major problems and five challenges |url=http://www.xinhuanet.com/politics/2016-02/17/c_128726709_2.htm |archive-url=https://web.archive.org/web/20220126051202/http://www.xinhuanet.com/politics/2016-02/17/c_128726709_2.htm |archive-date=2022-01-26}}</ref> Several media outlets have disclosed that the ways of eroding the medical insurance fund included farmers being
In response to these problems, various local government agencies have begun to coordinate and supervise medical insurance funds.<ref name=":5" /> They introduced the medical insurance monitoring systems to intelligently review medical insurance funds; they also mandated central purchase of pharmaceutical consumables to save money and increase the proportion of medical labor technology value in fund settlement.<ref name=":4" />
=== Reasons for certain medicines' high price ===
Industry experts in mainland China believed that for a long time, the state medical authorities have not rejected the income-generating behavior of hospitals because medical care was cheap and generous, and they understood it was impossible to require high quality and cheap price at the same time. This is a congenital contradiction. Therefore, relatively high-price/quality medical services and medication were not excluded and hospitals sometimes used them for additional income and to support medical professionals with higher pay; this way, hospitals can retain talents and maybe even for doctors to study abroad and further their expertise. Therefore, in addition to the common phenomenon of hospitals investing in pharmacies, it was also a norm for salesmen of many [[Pharmaceutical industry|pharmaceutical companies]] to travel to doctors' homes to offer dividends. Sometimes there are no standard answers to prescribing medicine for many diseases, and the dosage may also depend on the case. At this time, prescribing a certain drug and the dosage becomes the doctor's discretion.<ref>医院医疗保险管理 荣惠英 <Hospital medical insurance management> Song huiying.p225. {{ISBN|9787117203197}}</ref> Therefore, the salesperson of the pharmaceutical factory and the doctor may have common interests.
Another problem is that the laws and regulations give hospital administrators too much discretion and power. Although all medicines are listed in the medical insurance payment catalog,<ref>DRG医疗支付的国内外实践<Domestic and foreign practice of medical payment>p44.刘芷辰Liu Zhichen.中华工商联合出版社All-China Federation of Industry and Commerce Press.{{ISBN|9787515828961}}</ref> no law stipulates that all medicines in the hospital pharmacy must be purchased in certain quantities. This presents a feasible way for hospitals to make money by instructing patients to purchase medicines in certain pharmacies at their own expense. In the beginning of 2019, the General Office of the State Council issued the document "Opinions on Strengthening the Performance Evaluation of Tertiary Public Hospitals".<ref>{{Cite web |date=2021-01-28 |title=國務院-关于加强三级公立医院绩效考核工作的意见文件 |trans-title=State Council
# Patients or their family members can check the medical insurance drug catalog at any time to identify whether their medication is in the catalog
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== References and further reading ==
* {{cite journal |last1=Xu |first1=Judy |last2=Yang |first2=Yue |date=2009 |title=Traditional Chinese Medicine in the Chinese Health Care System |journal=Health Policy |language= |volume=90 |issue=2 |pages=133–139 |doi=10.1016/j.healthpol.2008.09.003 |issn= |jstor= |pmc=7114631 |pmid=18947898 |authorlink=}}
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== External links ==
* [https://www.chinaeducationaltours.com/guide/culture-chinese-health-care-system.htm An Essential Guide to Chinese Healthcare System]
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