The healthcare time bomb is ticking away:
Equitable society, not GDP growth, is what Beijing should focus on
China''s embrace of market reforms has transformed its economy, raised living standards and enabled the development of an awe-instilling infrastructure. It has, however, also led to the dismantling of social security nets and drastic reductions in spending on public health. With health experts warning that China may likely become the epicentre of a potential global bird flu pandemic, the consequences of the mainland''s ailing public health care system are no longer confined to within the country''s borders. The SARS epidemic in 2003 exposed the serious failings of healthcare in China. Since then the World Heath Organisation (WHO) says that the surveillance system for monitoring infectious diseases in China has improved. However, access for the average Chinese citizen to affordable healthcare is actually declining.
The government''s share in national health spending has plunged from close to 100% in the heyday of the communist revolution to about 15% today. Less than 10% of China''s rural population and 50% of its urban residents have medical insurance. Even state-owned hospitals must generate their own funds, leading to a chaotic, mad dash to make ends meet, in which more often than not it''s the sick and poor that are the losers. "Its shameful but our public health system is in tatters. If you don''t have money you cannot get treatment" says Professor Li Ling of Peking University''s China Centre for Economic Research.
According to China''s 2003 national health survey, 64%. of people in cities who needed hospital treatment said they chose not to be treated because of the cost. In the countryside, this figure was 75%.
On the surface it may look as if condemnations of China''s public health situation are too harsh. According to the World Bank''s World Development Report in 2000, average life expectancy in China was 71, compared to an average of 69 for middle-income countries. India''s life expectancy is only 63. Similarly, on other health parameters, like infant mortality and maternal mortality, China does much better than the world average.
But as Henk Bekedam, WHO head in Beijing points out, the majority of China''s significant health gains were all achieved before the economic reform process started in the late 1970s. Between 1949 and 1978 life expectancy in China doubled from 35 to 68 years. Despite a dramatic increase in prosperity since then, average life expectancy in the mainland has increased by only 3.5 years, about half the gains in longevity in Japan and Korea.
Today infant mortality is actually increasing in some parts of China and certain diseases like snail fever and tuberculosis which had been more or less been eradicated under Mao, have returned in parts of the countryside.
For three decades after the communist revolution in 1949, China relied on a socialised healthcare system under which collective farms and factory communities took the responsibility. In the countryside, barefoot doctors, although only lightly qualified, provided medical services for all. It was a basic system, but functional and largely egalitarian.
Since embarking on economic reforms, the communist party has systematically unbraided its own healthcare structure so that China today has one of the most unequal public health systems in the world. In 2000, the WHO ranked China 144th amongst 191 countries on the basis of fairness of access to healthcare and fairness of individual contributions to cost. Even India, with half of China''s per capita GDP, ranked ahead of the mainland at 112th place.
Explains Professor Li Ling: "In China, the government looked to the market as a solution for everything, including health." As a result hospitals were "reformed" along the lines of other state-owned enterprises. The government funds less than 10% of the operating costs of state-owned hospitals in cities today. As a result, profit maximisaton has become the driving force behind their operations. This routinely leads to the over-prescription of costly medical tests and medicines.
Moreover, big cities in China consume 80%. of the country''s medical resources although only a third of the Chinese population live there. Similarly, resources are disproportionately allocated by hospitals towards fancy, high-tech equipment. For example, there are more CAT scanners in Beijing alone than in all of the UK. This leads to a colossal mismatch between the needs of patients and where the resources are actually being invested.
According to a ministry of health survey, while average incomes in urban areas over the last five years increased by 8.9%, annual medical zoomed up by 13.5%. In rural areas, incomes only went up by 2.4% but medical costs increased by 11.8%. In the absence of effective medical insurance, nearly 60% of total expenditure on health in China today comes straight out of people's pockets. In contrast, in 1980 only 20% of health spending came directly from individuals.
There is a growing realisation on the part of China''s government that the public health situation is reaching crisis point. A report brought out by a Chinese State Council think tank in August concluded that "medical reforms" in China had been a "failure". The new 11th Plan, drafted in October, also places much emphasis on developing an equitable society rather than focussing solely on GDP growth. Given that China currently has 320 million smokers, a looming HIV crisis (the UN predicts 10 million HIV carriers by 2010) and a high probability of becoming the centre of a bird flu epidemic, it's high time that those in power do sit up and take notice.
http://www.financialexpress.com/fe_full_story.php?content_id=107699
