Academic journal article China Perspectives

Evolution of the Health System: Inefficiency, Violence, and Digital Healthcare

Academic journal article China Perspectives

Evolution of the Health System: Inefficiency, Violence, and Digital Healthcare

Article excerpt


Today, China's public hospitals manage 90% of consultations for what English-speakers would call ambulatory care or outpatient care, and 90% of hospital inpatient admissions. (1) As such, public hospitals deal with demands for treatment by consultation just as they must deal with treatment for inpatients.

China is in the midst of a paradox. There has been a spectacular upward surge in health indicators, matching the similar increase in economic indicators. It is also a colossal market, with healthcare expenditures reaching $511.3 billion in 2013. (2) That is equivalent to 5.6% of GDP. (3)On the other hand, the health system has officially been described as inefficient, and there is a toxic atmosphere between medical staffand patients.

Before we examine the healthcare system in all its various permutations, we will first offer a brief overview of the current state of China's health and healthcare. In 2015, mainland China had a natural population growth of 5.21 per thousand, with a crude birth rate of 12.37[per thousand] and a crude death rate of 7.16[per thousand]. Urban residents now account for 54.8% of the total population (or 1.4 billion people). The population is 51.2% male and 48.8% female. (4) Life expectancy has improved considerably over the years: while in 1990 it was 67 years for men and 70 for women, by 2010 it had risen to 72.5 for men and 76.8 for women. Likewise, the mortality rate for children under five and the maternal mortality rate have seen distinct improvements. However, it is also apparent that medication (especially antibiotics) is currently being over-consumed. It is acknowledged that 70% of prescription medicines contain antibiotics. (5)One consequence of this inappropriate medication use is an increase in morbidity and mortality. Lianping Yang et alii (6) estimate that each year, 2.5 million patients are admitted to hospital suffering from unwelcome medicinal side-effects. (7)

On the economic front, gross domestic product (GDP) is not far behind that of the United States. (8)While the growth rate appears to be slowing down, (9) it is nonetheless expected to reach 6.9% for the year 2016. (10) Overall, the general level of wealth among the population is on the rise. In 1990 the per capita GDP was 1,644 RMB, whereas by 2012 it had reached 38,420 RMB.

As a result, the Chinese healthcare system has been forced to adapt, not only to demographic changes but also to a demand for new treatments: from dealing with a low-income population with a high birth rate and high death rate, primarily requiring basic care, it has moved to looking after a comparatively older population with a low birth rate and higher income, demanding ever-more-effective healthcare treatment. Since the economic reforms, the expected level of treatment quality has risen considerably, which de facto reduces the number of establishments able to meet these expectations to only the very best urban hospitals, thus creating high demand and low supply for said treatment, while less reliable healthcare establishments have found themselves in a situation where there is too much supply, but insufficient demand.

This demand for healthcare provided by "trained and qualified" medical staffhas led to a decrease in the supply available to meet the demand, and therefore to ever-longer waiting times and ever-shorter consultations. Treatment prices have shot up, which can be explained in part by the lack of qualified staffon offer, but also by the state's withdrawal of funding from public hospitals. Moreover, doctors with a financial stake in the profitability of their establishment tend to over-prescribe and overdiagnose, and the cost of medication has shot up, all against a backdrop of corruption.

The doctor-patient relationship has therefore been transformed into a dynamic of conflict in the face of exorbitant treatment costs, extremely long waiting times, ever-shorter consultation appointments, and the increasingly widespread practice of bribery. …

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