Healthcare Reform in China: From Violence To Digital Healthcare

256 Pages·2018·3.653 MB·English

by  Carine Milcent (auth.)

HEALTHCARE
REFORM IN
CHINA
From Violence To
Digital Healthcare
Carine Milcent
Healthcare Reform in China
Carine Milcent
Healthcare Reform
in China
From Violence To Digital Healthcare
Carine Milcent
CNRS and Paris School of Economics (PSE)
Paris, France
ISBN 978-3-319-69735-2 ISBN 978-3-319-69736-9 (eBook)
https://doi.org/10.1007/978-3-319-69736-9
Library of Congress Control Number: 2017958008
© The Editor(s) (if applicable) and The Author(s) 2018
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To Béatrice, Johanne, Léonie et Alexandre….
And, to Thomas
A
cknowledgements
I would like to thank Thomas Serrurier for his active involvement in this
book, helping me get results of better quality. I am really grateful to him
for his patience and support in overcoming numerous obstacles I have
been facing through the research and writing.
I would like to thank relatives such as Celia for their feedback, coopera-
tion and of course friendship.
I would like to thank my friends for accepting nothing less than excel-
lence from me. Last but not the least, I would like to thank my family: my
kids and husband for supporting me spiritually throughout writing this
book and my life in general.
Opinions expressed in this book are the author’s.
This book is divided into 10 chapters that can be read separately, even
though knowing the background and overlays of reforms that have built
up current situation is definitely beneficial to understand the current chal-
lenges of the healthcare system and the next round of changes likely to
happen.
This research is supported by the Projet International de Coopération
Scientifique (PICS) research grant No. 263008 to the French National
Center for Scientific Research (CNRS).
vii
c
ontents
1 I ntroduction 1
2 T he Notion of a Health Good in China and Elsewhere 15
3 O rganization of Healthcare in China and its Reforms 35
4 H ospital Institutional Context and Funding 63
5 M edical Staff 91
6 H ealth Insurance in China 125
7 T he Medical Drug Market and its Reforms 153
8 T he Rise of Violence as a Result of Inefficiency
in the Healthcare System 171
ix
x CONTENTS
9 D igital Healthcare 191
10 C onclusion and Discussion 225
Index 243
l f
ist of igures
Fig. 1.1 Ageing population, the demographic shift. The dotted line
indicates the excess male or female population in certain age
groups. The data are in thousands or millions. Source: United
Nations, Department of Economic and Social Affairs, Population
Division (2017). World Population Prospects: The 2017.
https://esa.un.org/unpd/wpp/Graphs/DemographicProfiles/ 4
Fig. 3.1 Medical personnel and number of beds in China in 2011 (per
1000 inhabitants). Source: China Health Statistics Yearbook,
2012 36
Fig. 4.1 Ownership and healthcare services in 2006. Note: Data are
from the 2006 MOH Health Statistical Digest (online)
(Ministry of Health, 2006) and refer to 2005. Estimates
exclude a small number of providers (<1%) that have not yet
been classified. The “non-profit” category mainly consists of
organizations owned by the government and companies
(available data do not permit a disaggregation of the non-
profit category by ownership) 65
Fig. 4.2 Ownership and healthcare services in 2012. Note: Data are
from the 2012 MOH Health Statistical Digest (online)
(Ministry of Health, 2012) and refer to 2011. Estimates
exclude a small number of providers (<1%) that have not yet
been classified. The “non-profit” category mainly consists of
organizations owned by government and companies (available
data do not permit a disaggregation of the non-profit category
by ownership) 65
xi
xii LIST OF FIGURES
Fig. 4.3 Funding sources of public hospitals in China. Out-of-pocket
payment: sum paid by patients and not reimbursed by any
kind of insurance. It includes $6 million from the uninsured
and $26 million in co-payments from the insured. UEBMI:
Urban Employee Basic Medical Insurance. URBMI: Urban
Resident Basic Medical Insurance. NRCMS: New Rural
Cooperative Medical System. “Other” includes private health
insurance (both supplementary and stand-alone); employer
contribution to group private health insurance, which is
around $1 million. Total funding is around $7 million.
Source: Hospital interviews; government statistics 2010,
“Healthcare in China,” A Kieger Report on the Chinese
Healthcare Market 2015. www.mckinsey.com/...service/
healthcare%20systems%20and%20services/health%20
international/hi10_china_healthcare_reform.ashx 72
Fig. 4.4 Hospital ownership by hospital level. Source: NHFPC (2014),
figures from 2012 76
Fig. 4.5 Number of public and private hospitals in China. Source:
NHFPC (2014) 77
Fig. 4.6 Investors with various backgrounds in 2012. Source: Roland
Berger (2014) 82
Fig. 5.1 Number of hospital beds and doctors in cities and counties
1952–2002 (in 10,000). Source: China Statistical Yearbook,
2003, Table 21–36, p. 806. Note 1: Before 1978 statistical
data are questionable—particularly during the period of the
Great Leap Forward and the Cultural Revolution. Note 2:
Doctors include traditional healers, university-trained doctors
and physicians with a university certification. http://www.
china-profile.com/data/fig_health_1.htm. Accessed
September 2017 93
Fig. 5.2 Number of Nurses and Physicians per 1000 in China,
1960–2009. Source: 2010 China Yearbook of Health
Statistics. Qin, X. and Li, L. and Hsieh, C-R (2013)
“Too Few Doctors or Too wages? Labor supply of healthcare
professionals in China” China Economic Review, 24(1) 95
Fig. 5.3 In-hospital admissions and outpatient visits in hospitals,
1993–2012. Source: Chinese Health Statistics Yearbook
2012. Wang et al., “Comparison of Chinese Inpatients with
Different Types of Medical Insurance Before and After the
2009 Healthcare Reform,” BMC Health Services Research,
Vol. 14, 2014, p. 443 109