China ‘can show the world the way’
China is a global economic power and wants to contribute more, which shows it is taking up its responsibilities as a global power.”
China can be a role model for the world in extending the coverage of healthcare, and making it more equitable, said Lincoln Chen, president of the China Medical Board.
The country’s healthcare insurance is becoming increasingly universal, and as the world integrates economically, China is well placed to pass on its expertise in healthcare to developing countries, Chen told China Daily.
“China started in the 1950s by sending medical teams to developing countries, and China’s health teams now cover almost 50 countries. China is also intellectually engaged in global health issues,” he said.
China dispatched 55 medical teams with 3,600 workers to nearly 120 medical centers in recipient countries between 2010 and 2012, according to the Chinese government. They trained tens of thousands of local medical staff, which has relieved to some extent the shortage of medical services in recipient countries.
Over the same period, China spent 200 million yuan ($30.7 million) to provide antimalaria medicines, H1N1 influenza vaccines and cholera vaccines free to other developing countries. It also held training in the prevention of infectious diseases.
“China is a global economic power and wants to contribute more, which shows it is taking up its responsibilities as a global power,” Chen said.
Moreover, medical aid is relevant for China’s leadership in regional integration projects such as the Belt and Road Initiative, through which China hopes to facilitate trade and investment exchanges between Europe and Asia through infrastructure investment.
“You cannot construct a highspeed road without seeing the health implications, whether it’s patients’ migration, epidemic disease control or penetration into backward regions,” he said.
Chen, who trained as a doctor at Harvard Medical School, spent his early career working in hospitals and on healthcare projects around the world before becoming president of the New York-based China Medical Board 10 years ago.
The board, established in 1914 with funding from the Rockefeller Foundation, works with many Chinese medical schools to pass on expertise, and provide training and scholarship. It is the key organization that finances Peking Union Medical College in Beijing.
Chen said China’s current budget aid to developing countries, is biased toward building hospitals and providing medical teams, but the training of doctors and building expertise are equally valuable.
For example, when visiting dental and optician vocational training centers in rural Sichuan province, he realized such a model of training could be useful to other developing countries, and should be “more widely propagated”.
Compared with developed countries, where dentists and opticians receive college degrees, the vocational training model in Sichuan recognizes that not all dentists and opticians have to be as highly educated as university graduates, as long as the vocational training gives them essential skills to perform their jobs.
China “will be looked to as a world leader in the meeting of the Sustainable Development Goals”, Chen said. The 17 goals were established by the United Nations Sustainable Development Summit on Sept 25 last year.
Of the 17 goals outlined, the first six deal with health disparities, primarily in developing countries. They are poverty reduction, hunger and food security, health, education, gender equality, and water and sanitation.
Perhaps this is of no surprise considering that China has made significant contributions to the UN Millennium Development Goals adopted in 2000, the forerunner of the Sustainable Development Goals, which mainly focused on growth and reducing poverty.
“I think the most important aspect of achieving efficiency and equity in healthcare coverage is to allow people to drive forward the agenda of their own countries,” Chen said.
“China respects the sovereignty of other countries, so the next step would be investing in the capacity of talented leaders in other countries.”
On top of providing aid and developing talent in other economies, China would also create many benefits if it can facilitate public health discussions among developing countries and use its influence to make developing countries’ key concerns heard.
One such example of concern could be the health implications of the US-led Trans-Pacific Partnership agreement on developing economies, as TPP has a conservative stance on intellectual property protection that could lead to protective measures that reduce the accessibility of drugs to developing countries, he said.
Chen said he is hopeful about changes to healthcare in China, believing they can lead to increasingly more equitable universal coverage.
“The current healthcare reform began in the ’90s, covering such areas as insurance protection, primary healthcare, public health, pharmaceuticals, and reforms of major hospitals. The reforms are making some progress because the government gives priority to healthcare,” he said.
In more recent years, the Chinese government’s proposed healthcare reform agenda has focused on increasing insurance coverage, improving primary care and encouraging private sector provision of healthcare to complement public provision, all of which are focus points of China’s 13th Five-Year Plan (2016-20).
Chen said he sees one key challenge for China’s reforms being the building of the primary care system.
There is a shortage of qualified general practitioners, and the pay incentives in this sector are insufficient, especially to motivate general practitioners to move to grassroots rural clinics.
“The big hospitals are flooded with patients, most of whom could have their conditions taken care of at lower levels. Primary care and big hospitals are two sides of the same coin that need to be smoothed out over the coming years.”
Talking to doctors at hospitals has made him realize that they are often under heavy stress from the patient load, which can be as high as 50 patients in half a day.
“There are too many patients, with limited time for examinations and diagnosis, and doctor-patient communication can be poor. This then leads from the patients’ perspective to lacking trust in doctors and hospitals. This is especially the case when they feel they are getting overcharged and have long wait times.”
Chen sees China’s increasing insurance coverage as encouraging, especially the government’s efforts to focus on extending coverage to rural citizens, ethnic groups and other lowincome communities.
The Chinese government’s method for channeling funding into primary healthcare by making insurance reimbursement for certain treatments available only at the primary level is also encouraging, Chen said.
The policy means patients who bypass primary level clinics and receive treatment at big hospitals will need to pay more.
Another key change that could dramatically lead to China’s healthcare improving is the development of a multidisciplinary approach to healthcare education, he said.
“Today China’s medical schools focus strictly on the technicalities of diseases, but education needs to recognize that other factors like food, education and environment also affect public health.”
This is particularly true as China is experiencing fewer risks in infectious diseases and more problems with illnesses that predominate in developed economies such as obesity, diabetes and cancer.
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