Source: Médecins Sans Frontières

Basic Healthcare [ID 18859]

"Link collection for information on basic healthcare in China"

Document(s): Open document

Source: World Health Organization

Online database on mortality and burden of disease, health service coverage, risk factors, health system inputs, differentials in health outcome and coverage and basic socio-demographic statistics [ID 22333]

Document(s): Open document

Source: World Health Organization

Standardized data and statistics for infectious diseases [ID 22334]

Document(s): Open document

Source: World Health Organization

Report on disease outbreaks, mortality, health services and health systems [ID 22335]

Document(s): Open document

10.10.2007 - Source: Congressional-Executive Commission on China

Urban Healthcare ("Annual Report 2007") [ID 21415]

"The government established a public health insurance program for employed urban residents in 1998, and by the end of 2006, approximately 160 million out of the country's 500 million urban residents received coverage.70 In July 2007, Premier Wen Jiabao announced plans to establish a national health insurance program to cover all urban residents, including children, the elderly, and the uninsured, over the next three years. The central government has selected 79 cities to launch pilot programs by the end of September 2007.71 In order to improve community-level medical services in urban areas, large city hospitals will provide facility and staff support to community health clinics, and a data-sharing system will be established."

Document(s): Open document

10.10.2007 - Source: Congressional-Executive Commission on China

Rural Healthcare ("Annual Report 2007") [ID 21416]

"Under China's Rural Cooperative Medical System (RCMS), a farmer and each family member that participates in the system pays an average premium of 10 yuan (US$1.25) each year into a personal medical care account, with governments at all levels subsidizing an additional 40 yuan (US$5) on average.73 Participants may have up to 65 percent of their healthcare costs reimbursed, but are required to first pay such costs out of pocket.74 The scope of the RCMS's coverage, and government spending on healthcare, has increased in recent years. The government reported that the number of counties covered by the RCMS increased from 687 pilot counties in 2005 to 1,451 counties (50.7 percent of China's rural areas) at the end of 2006.75 Prior to implementation of the RCMS, the percentage of rural residents with health insurance coverage reportedly reached a low of 7 percent in 2002.76 After the RCMS was introduced in 2003, the government reported that coverage had increased to 51 percent by February 2007.77 The amount of money the central government has announced it plans to spend on rural healthcare also increased from 2.073 billion yuan (US$252 million) in 2004 to 5.8 billion yuan (US$750 million) in 2006, and reportedly to 10.1 billion yuan (US$1.33 billion) in 2007.78 Since the establishment of the RCMS, some areas have reported increases in the number of hospitalized patients and in the amount of revenue for local clinics."

Document(s): Open document

10.10.2007 - Source: Congressional-Executive Commission on China

50 percent of farmers who fall ill do not seek healthcare for economic reasons, and half of all children who die in rural areas had not received medical treatment ("Annual Report 2007") [ID 21417]

"Some senior Chinese officials and scholars have questioned the fairness and efficiency of the medical and healthcare system. The poorest residents in rural areas frequently do not enroll in the cooperatives because they cannot afford the required fee. As many as 50 percent of farmers who fall ill do not seek healthcare for economic reasons, and half of all children who die in rural areas had not received medical treatment.80 For rural participants especially, the reimbursement level remains inadequate. The average reimbursement rate is 27.5 percent, determined in part by the specific disease and the local government's budget.81 Many counties and townships do not have the financial resources to supply their portion of the fund. In addition, rural clinics are poorly funded and lack adequate medical personnel and equipment."

Document(s): Open document

06.03.2007 - Source: US Department of State

Transparency in the health sector improved ("Country Report on Human Rights Practices 2006") [ID 19086]

"Transparency in the health sector improved compared with the government's cover up of the initial Severe Acute Respiratory Syndrome (SARS) outbreak in 2003. Central government officials pledged to promptly report cases of avian influenza but acknowledged that local authorities did not do so in some cases. International observers acknowledged that transparency had improved with regard to avian influenza but expressed concern about delays in reporting some human and animal cases. Hong Kong media reported that the Guangzhou Bureau of Health told hospitals to submit detailed interview outlines and questions for approval two days before any media interview. Some academics were unable to publish results of independent research into contagious disease cases."

Document(s): Open document

03.2007 - Source: US Social Security Administration

Report on social security system (old age, disability and survivors; sickness and maternity; work injury; unemployment; family allowances) ("Social Security Programs Throughout the World") [ID 22337]

Document(s): Open document

12.2006 - Source: Health Action International

Shanghai Province: Report on availability, prices and affordability of medicines in the private and public sector ("A Survey of Medicine Prices, Availability and Affordability in Shanghai, China using the WHO/HAI Methodology") [ID 21746]

Document(s): Open document

20.09.2006 - Source: Congressional-Executive Commission on China

Public Health ("Annual Report 2006") [ID 17390]

see report for further details - Chapter V(g)

"• The central government strengthened its commitment during the past year to address the severe shortage of affordable health care in rural China. Since the collapse of the rural public health infrastructure in the 1980s, the disparity in the availability and affordability of health care between urban and rural areas has increased. As a result, the medical needs of China’s rural poor, including the diagnosis and treatment of infectious diseases, often go unaddressed. The government, however, has pledged to accelerate the establishment of rural health cooperatives and invest more than 20 billion yuan (US$2.5 billion) over the next five years to modernize hospitals, clinics, and medical equipment at the village, township, and county levels. [...]

• Chinese public health officials have shown increased commitment and responsiveness in their efforts to prevent and control the spread of avian flu, and have taken steps to improve government transparency following the mishandling of the SARS epidemic in 2003. International health experts, however, still consider China to be among the most likely incubators of a potential human influenza pandemic. Central government cooperation in sharing information and virus samples with international health organizations has been inconsistent, and international health organizations and central government officials continue to express concern about the speed and accuracy of local reporting on outbreaks among both humans and poultry."

Document(s): Open document

2006 - Source: World Health Organization

Profile of health situation and national health priorities ("Country Health Information Profile") [ID 21745]

Document(s): Open document

11.10.2005 - Source: Congressional-Executive Commission on China

Public Health ("Annual Report 2005") [#37506],  [ID 4467]

see report for further details - chapter III(h)

"The two greatest public health challenges facing China today are infectious diseases and rural poverty. The central government is taking steps to improve the public health infrastructure in rural areas, but China’s poorest citizens lack preventive healthcare, and weak implementation of laws that provide for free vaccinations leave many adults and children unprotected.
Central government efforts to address China’s HIV/AIDS epidemic continue to expand and deepen, but local governments often harass Chinese activists who work on HIV/AIDS issues.
Government controls inhibit the flow of health-related information to the public, potentially affecting public health in China as well as international disease monitoring and response efforts."

Document(s): Open document

04.2005 - Source: UK Home Office

Country Report April 2005 - Medical Services Overview ("Country Report - April 2005") [#31975],  [ID 4468]

"5.101 According to the World Health Organization (Regional Office for the Western Pacific, Manila, Philippines) in their Country Profile for China – available via their website:

“By the end of 2003, there were 305 000 health care institutions in China, including 64 000 hospitals and health care stations, 3058 maternal and child health care institutions, and 1811 specialized health institutions or stations. Hospitals and health care institutions in China had a total capacity of 2.9 million beds. There were 4.24 million health workers in China, including 1.83 million practising doctors and assistant doctors and 1.24 million registered nurses.” [8a] (p 55)

5.102 As documented by Europa publications (2005), health expenditure as a percentage of GDP was 5.5 in 2001. The same source also noted that life expectancy was 72.7 for women and 69.6 for men in 2002. [1a] (p 202)

5.103 As reported by the BBC on 15 April 2003, “Until about twenty years ago, virtually all Chinese were given low-cost or free medical care by government hospitals. Today, only officials and state enterprise employees get government medical care. Everybody else must fend for themselves.” [9ae]

5.104 On 31 August 2004 the Epoch Times reported, “Dishonest medical practices are a serious problem in China. Lack of medical expertise in cosmetic surgery can cause severe disfigurement. Also, hospitals have been known to manufacture illegal medicine leading patients with minor illnesses to become seriously ill or die from lack of correct treatment plans. Many complain about the high fees hospitals charge.” [19ac]

5.105 According to a nationwide survey carried out in 2003 and reported by the official news agency Xinhua on 22 November 2004, “36% of Chinese patients in cities and 39% in the countryside did not go and see a doctor because they could not afford the medical treatment.” The same source noted, “Doctors are inclined to give patients expensive prescriptions, because Chinese hospitals depend too much on the income from medicines instead of service.” [13p]

5.106 As reported by Asia Times on 2 October 2004, more than 310 million Chinese or 30% of the population over the age of 15 were smokers. The tax rate was relatively light at 46% (compared to 60-90% in developed countries) and each year 750,000 Chinese died from smoking related illnesses. [15cc]"

Document(s): Open document

2005 - Source: UN Development Programme

Report on human development and poverty reduction campaign (equitable distribution of benefits among regions and people) ("Human Development Report 2005 - Towards Human Development with Equity") [ID 22338]

Document(s): Open document

31.08.2004 - Source: Human Rights Watch

The new law was passed, that bans discrimination against people living with infectious diseases ("China: Law Bans HIV-Related Discrimination") [#26659],  [ID 4470]

Document(s): Open document

10.2003 - Source: UK Home Office

Country Assessment - October 2003 - Medical Services ("Country Report - October 2003") [#49232],  [ID 4471]

"General Information

5.57. China spends 5.3 per cent of its GDP on health care = per capita expenditure of US$205. The child mortality rate m / f (per 1000) is 34 / 40 respectively. Life expectancy at birth m / f (per 1000) is 69.8 / 72.7.

Current situation

5.58. Since March 2003, the international media has been following the increase in a new infectious disease, Severe Acute Respiratory Syndrome - SARS, which emerged publicly in southern Guangdong province in late February 2003 and may have begun there in November 2002. The emergency has highlighted two themes important within the PRC: the alleged secrecy of the authorities and the inherent inadequacy of the newly privatised health-care system. The crisis has seen the sacking of both the Health minister, Zhang Wenkang, and the Major of Beijing, Meng Xuenong, on 21 April 2003.

5.59. The World Health Organisation (WHO) lifted its travel warning for Beijing on 24 June 2003 and for Hong Kong SAR the day before. One month later the Chinese Ministry of Health reported no new cases or deaths from SARS.

5.60. To date 643 people have died in China (including Hong Kong SAR) as a result of SARS. While the government has been praised internationally for bringing the situation under control SARS has highlighted the importance of having in place a universal health care insurance system covering the whole country.

5.61. Until about twenty years ago most Chinese were given low cost (subsidised) or free medical care of government hospitals, but as economic reform has gathered pace (See Economy) the government has restricted such access. Today only government officials and employees of State Owned Enterprises (SOE's) get government healthcare.

Rural Healthcare

5.62. For many rural Chinese, healthcare is no longer affordable - the average bill for hospitalisation has been estimated to exceed the total annual income of over 50 per cent of the rural population.

5.63. Originally rural areas had a healthcare system based on community financing models, collectively called the rural "Co-operative Medical System". From a high of 90 per cent (coverage) in the 1970s, coverage has fallen to less than 10 per cent by the year 2000. Economic reforms, poor management and demand outstripping resource input have all contributed to the collapse of CMS services.

5.64. The World Health Organisation (WHO) has been running a pilot project since 1994 to cover 8.7 million people in seven provinces with a new form of healthcare coverage, experimenting with trials forms of resuming universal coverage.

Urban Healthcare

5.65. Under the Health Protection System reforms urban residents are now expected to foot the initial healthcare bill themselves and then to claim back reimbursement from provincial healthcare funds up to a locally set ceiling. This is in contrast to the previous system whereby insurance was guaranteed by work units under the Government Insurance Scheme (GIS) and the Labour Insurance Scheme (LIS).

5.66. There are reportedly great disparities existing between rural and urban hospitals. Thus there are no uniform standards for treatments such as emergency cardiac treatment. Doctors are asked to stick to general procedures given in standard textbooks.

Health Insurance

5.67. In 2001 there were only 17 Chinese companies licensed to provide health insurance. With coverage patchy and the SARS crisis prompting a re-evaluation of health care provision the Chinese government has announced that it will now allow foreign health insurance companies to operate in China one-year ahead of the schedule agreed with the WTO (World Trade Organisation)

Pharmaceutical Products

5.68. China Pharmaceuticals Guide, claims to comprehensively cover every aspect of regulation concerning pharmaceuticals, health systems reforms' impact on the pharmaceuticals market and the market sector generally in China. Includes traditional Chinese medicine sector as well.

5.69. The State Development Planning Commission has begun insisting that Chinese pharmaceutical companies pass on savings in production to consumers'. The Ministry of Health has started to crack down on unsafe medical practices, such as recycling syringes revoke licenses for companies founds to be producing “counterfeit” cosmetics.

5.70. In November 2000, the Ministry of Health announced that it was going to crack down on fake and unsafe medical appliances and products, particularly illegally recycled syringes, unsafe and counterfeit cosmetics and inedible oils sold as edible. 49 pharmaceutical manufacturers' licences have been revoked. UK medical commentators have stated that it is difficult to ascertain how to work out what "counterfeit" means as Chinese medical and pharmaceutical literature is highly localised and under-researched in the West.

Medical Profession and Associated Organisations

5.71. Professional representation for healthcare professionals is mainly through the Chinese Medical Association. Originally founded in Shanghai in 1915, the CMA was moved to Beijing in 1950. It employs 300 staff and represents over 400,000 health professionals. The 76 professional subgroups are listed on the CMA website - all registered societies as national societies. http://www.chinamed.org.cn/ Doctors in China take an oath at medical school on ethical standards similar to the Hippocratic Oath"

Document(s): Open document

07.2000 - Source: UK Department for International Development - Health Resource Centre

Report on health indicators, health service provision and financing, current health policies ("Health briefing paper") [ID 22336]

Document(s): Open document