Chinese Medicine: Traditional and Western. Chinese medicine and healthcare Prices for medical services in China
Everyone knows that China is a country of victorious communism. Surely it should have good and free medicine. Those who have been to the Great and Beautiful may have noticed one oddity: there are practically no pharmacies in China, and you are unlikely to meet an ambulance on the street. Why is that? Let's see how people are treated in China and whether it's worth it to get sick there...
All of you have heard about Chinese traditional medicine - massages, acupuncture, qigong and miraculous herbs. The Chinese have been treated with all this for many centuries, and their average life expectancy was 35 years. In the 1950s, the communists came to power, and Mao Zedong said that Chinese medicine is, of course, good, but it would be time to adopt Western medicine. He ordered the construction of normal hospitals throughout China and the training of qualified medical personnel.
Until the 1970s, Chinese medicine was doing well. It developed rapidly, people received high-quality free treatment and vaccinations, their life expectancy increased dramatically. But then it became clear that if the state treats everyone at its own expense, then it simply does not have enough money. The country carried out economic reforms, the authorities greatly reduced the cost of medicine, and treatment in China became paid. The logic is this: if you earn, then pay yourself, and if you are completely poor, then we will help a little.
Since then, the pace of development of Chinese medicine for some reason has slowed down a lot. Everything is more or less good in large city hospitals and private clinics, they have modern equipment and even good understanding doctors. And the situation in the outback, especially in terms of the attitude of staff towards patients, strongly resembles the Russian one.
The article uses photographs of a modern Chinese hospital that I took in Nanjing. My Chinese friends say that this is rather an exception. But I didn’t get to another hospital) So the photos do not accurately illustrate the text;)
01. Interesting fact: no matter how big a Chinese hospital is, it will almost always be packed with patients. 
I came to the hospital on a quiet day, but just so you know, sometimes it happens like this. This is the registration... 
02. Inside the Chinese hospital, you can find Starbucks. In general, in China, patients are not fed, so they have to get their own food during treatment. 
03. Large hospitals are well equipped and look very decent. So if you think that China in terms of medicine is a third world country, then everything is far from it. Even if you visit some hospital in the outback, there is still a high probability that there will be a set of all the necessary equipment. But the doctors there will be such that they most likely will not want to be treated by them) 
04. In any Chinese hospital, you will encounter long queues. In recent years, many hospitals have introduced the possibility of electronic appointments, but the Chinese themselves have not yet got used to this. 
This is what happens when the influx of patients is especially large. 
05. In hospitals where there is no modern equipment, people are treated in the old ways. For example, operations on the abdominal cavity are still performed there using a huge incision, although laparoscopy has long been performed throughout the civilized world (this is when instruments are inserted into the abdominal cavity through several small incisions). If suddenly you find yourself in such a hospital, then none of the doctors will recommend that you go to a place where they are treated with more modern methods. 
06. With the introduction of electronic queues in large and well-equipped Chinese hospitals, things have become more or less civilized. But in general, an appointment with a Chinese doctor looks rather strange. The Chinese are afraid that they might miss their turn or that someone will slip ahead of them, so they like to rush to the doctor's office in a crowd, even if there is already an appointment. They become a circle around the doctor's table and impatiently wait for the current patient to finally finish complaining and free the coveted chair. They can watch with interest how the doctor examines you, and often give good and not very good advice. 
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09. There are quite a few good specialists in Chinese hospitals. It takes hard work to find a good doctor. Judging by the reviews, most doctors are amorphous apathetic people who do not care about patients. The flow of patients in China is very large, so hospital workers begin to perceive their duties as an annoying routine. 
10. But the profession of a doctor in China is quite prestigious. Professionals have a good social package, which depends on their category. They also have a work plan, for the implementation of which they are given additional bonuses. The salary of good doctors in large cities of China is 10-12 thousand yuan (90-110 thousand rubles) plus various additional payments and benefits. Well, there are certainly leftist earnings too. 
11. The most beautiful thing about a Chinese hospital is that you can arrive there with terrible injuries and near death, but no one will treat you or even give you first aid until you pay for the doctor's appointment. 
Joke from the Chinese Internet: doctors are waiting for a dying patient to pay for treatment) 
12. There were stories that after fights in clubs, guys with stab wounds and severe injuries came to hospitals, and they were not treated because they had to pay a deposit of several thousand yuan. Even in China, there is no concept of ambulance. If it's not about resuscitation, then the ambulance that you call to your house is just a taxi. They will put you in a car and take you to the hospital, and only there they will begin to examine and treat you. It is much faster and cheaper to immediately call a regular taxi and get to the doctors on it yourself. 
13. The amount of the deposit that must be paid before starting treatment depends on the hospital and the length of stay. It can be 10 thousand yuan (about 90 thousand rubles). This amount, as I said, does not include food. Usually hospital patients are fed by relatives or paid nurses. 
14. Chinese doctors are very fond of prescribing different medicines. The fact is that in China, pharmacies are located mainly in hospitals, so doctors are interested in selling as many medicines to patients as possible. It often happens that the drugs needed for treatment are prescribed in double or even triple volume. 
15. In general, the availability of drugs in a pharmacy depends on the level of the hospital. The larger and more modern it is, the greater the chance of finding imported drugs that are used in the West. And in hospitals, it’s easier to sell medicines only made in China. 
16. But on the other hand, in Chinese hospitals, any tests and studies can be done in a short time. People don't have to wait months to get some kind of ultrasound or MRI. There is a lot of equipment in hospitals, it is used to the full, but all this, of course, is paid. Ultrasound costs around 2 thousand rubles, MRI - 4-5 thousand rubles, blood test - 150-500 rubles. If you don’t have the money to pay for all this, then no one will help you. 
17. The Chinese are terribly jealous of the fact that medicine is free in Russia. But at the same time, when they get to the Russian hospital, they have a shock. Firstly, on the type of hospitals, and secondly, on the fact that the results of the tests here have to wait a week and that MRI is done only in the regional hospital. 
18. The Chinese have a smartphone app where you can get free medical advice. This is very convenient, for example, during the holidays, when half of the doctors are not working. There you need to describe your complaints and symptoms, you can even attach photos. Any doctor on call in the country connected to the app can stumble upon your problem and tell you what to do about it. 
19. The application connects most of the hospitals across China. In it, you can choose your city, a specific hospital, department, or even a doctor. You can also see reviews there.
And this is a device for paying for the services of a doctor) 
That's it. How do you like Chinese hospitals?
Your Excellencies, Honorable Minister Li Bin, provincial leaders, director generals of provincial health and planned birth committees, ladies and gentlemen,
In the eyes of the world, China is increasingly seen as a development model on many levels.
The world's second largest economy has shown rapid and, at the same time, steady growth. China opened its markets to free trade only when its economy was mature enough to participate in international competition. Fragile economies should consider China as an example when considering joining trade agreements.
The world's most populous country has used its robust economic growth to lift millions of its citizens out of poverty. Achieving the Millennium Development Goal on poverty reduction was largely determined by China's achievements.
When it comes to reducing threats to public health, China has been able to make impressive progress.
With the help of professional doctors, community health workers, traditional Chinese medicine specialists, health inspectors and factory health workers, this vast and densely populated country was able to eradicate smallpox two decades ahead of the rest of the world. In the three years preceding the last case of the disease, more than 500 million people were vaccinated against smallpox in China.
In the face of this achievement, there was a confidence in the WHO that continues to this day: if China decides to do something, it will do it.
Within a decade, China has made significant leaps: in 2003, when the SARS outbreak broke out, China's measures were the subject of serious criticism; For several years, China has taken the highest class measures in the face of the H7N9 avian influenza outbreak, which has won the gratitude of the international community.
China has built the world's largest real-time electronic surveillance system, showing how transparent and comprehensive epidemiological information can be transmitted instantly. Your scientists and epidemiologists have promptly published their reports in the most prestigious medical journals, demonstrating China's world-class scientific potential.
The measures taken by the Chinese government in response to the Shandong vaccine scandal were no less prompt and effective. The scale of the scandal was colossal: 2 million doses of improperly stored vaccines were administered to children and adults.
Within a month of the scandal erupting, the Vaccine Trafficking and Immunization Law was amended by China's State Council to address both the immediate and underlying causes of the scandal. Health authorities have also taken action to restore public confidence in the safety of vaccines and the importance of the lifelong protection against disease that comes from vaccination.
In China, social stability is highly valued and there is an understanding that inclusive social services, including health care, contribute to social cohesion and stability.
Over the past decade, China has embarked on the largest health care reform in human history to ensure that health services are available to people outside of prosperous metropolitan areas.
At the beginning of this century, less than one-third of China's population had access to health insurance. Today, almost 100% of the population is covered by health insurance. Such equality in access to health services is an essential condition for social harmony.
In essence, China has provided its colossal population with social safety nets that protect people from being impoverished by the high cost of health care. This is a colossal contribution to building a just and prosperous society.
Ladies and Gentlemen,
In the development of international health care, China has a special status. Due to China's success at home, its solutions enjoy special prestige when exporting to other countries.
For most developing countries, China is a fellow traveler who has recently faced and overcome similar development challenges. This shared experience gives these countries a special relationship with China that not every wealthy development partner can boast.
Centuries ago, the Silk Road was a conduit for the transmission of knowledge about traditional Chinese medicine, which spread along the trade routes from China to India, the Middle East and Europe. Today, the Belt and Road Initiative is a continuation of this tradition and a modern tool for economic diplomacy.
This initiative, which is a new type of development strategy, aims to promote international cooperation in the spirit of "peace and cooperation, openness and inclusiveness, mutual learning and mutual benefit" inherent in the Silk Road.
In the area of health, in my view, the initiative has great potential and can be expanded from today's health security issues to broader collaborations, especially on diseases such as heart disease, diabetes and cancer, which trade solutions address. and economic policies can have a major impact.
As early as 1963, the activities of Chinese medical teams in Africa had become a model program for international health development assistance, including the construction and donation of hundreds of hospitals and clinics that today dot the map of sub-Saharan Africa.
Although some critics believe that the aid was mainly intended to guarantee the supply of natural resources badly needed by the Chinese economy, independent studies have not found any relationship between the amount of aid to individual countries and the flow of natural resources.
In 1978, an approach based on training local staff in basic health care skills inspired the primary health care movement that began with the Declaration of Alma-Ata and became the trademark for much of what WHO does.
China's contribution to global health security gained international attention during the Ebola outbreak in West Africa, when dedicated Chinese medical teams were among the first to respond to my call for medical support on the ground despite having to work in very dangerous conditions.
China has provided well-trained and self-sufficient medical teams, drawing on decades of experience in sub-Saharan Africa, where medical teams independently procure the equipment, supplies and medicines they need.
Most recently, WHO conducted a proficiency test for an emergency medical team from Shanghai East Hospital, which was awarded a certificate of compliance with international proficiency standards as a result of the test.
The Shanghai medical team is now on the WHO list and can be called in when the next outbreak of a regional or global scale occurs.
Building on these achievements and successes at home, China has twice taken center stage in the global development arena in the past year.
At the September 2015 session of the United Nations General Assembly, President Xi Jinping announced the establishment of a fund that will start at $2 million and increase to $12 million by 2030 to support the least developed countries in the context of the 2030 Agenda for Sustainable Development.
The chairman also announced that China would cancel the debts of the poorest countries and launch 600 concrete projects to reduce poverty, improve education and promote better health care.
As many pointed out, China's leadership was a critical element in reaching an agreement during the Paris Climate Change Conference last December.
Air pollution in China is one of the biggest public health hazards. The country still produces more than 60% of its energy from coal, especially in the country's most industrialized areas, and is the world's largest emitter of carbon dioxide. China's commitment to reducing these emissions has greatly facilitated the negotiation process.
The government has taken a number of steps, including the establishment of an automatic real-time air pollution monitoring system equipped with an alert and warning system, and has allocated large funds for the transition to nuclear, solar and wind energy in accordance with the commitments made under the Paris Agreement.
Provincial leaders have an important role to play in moving coal-fired thermal power plants and cement plants outside the city limits.
If every country were so serious and determined about its commitment to climate change mitigation, we could indeed save the planet and its climate.
This year marked another significant milestone in the history of health care reform. In August, health issues were declared an official national policy priority following the Central Committee's approval of the "Healthy China 2030" plan.
President Xi Jinping, in his speech at the National Health Conference, emphasized that without ensuring health for all people, it is impossible to build a prosperous society. He placed the issue of health at the center of the entire policy-making system in the country. As a result, the systematic inclusion of health issues in all decision-making has become official government policy.
In his speech, President Xi also stressed the need to establish a system for assessing the health impact of all plans and policies in the field of economic and social development, as well as major projects.
This official recognition of the political role of health issues is unique in its own right and will guarantee China's leadership role both at home and abroad.
However, in China, as in all regions of the world, new, most serious threats are emerging. The difficulties associated with them and their consequences for human health and society are so great that they can slow down or even reverse the achievements of recent years. This applies to both China and all other countries.
Ladies and Gentlemen,
All of humanity today is facing changes of unprecedented speed that threaten human health and cause concern. Globally, 800 million people continue to suffer from chronic malnutrition. At the same time, there are countries where more than 70% of the adult population suffers from obesity or overweight.
Despite the fact that obesity is becoming more widespread everywhere, the epidemiological characteristics of the problem depend on the duration of this epidemic. In North America and Europe, the prevalence of obesity is highest among low-income populations, often living in urban food deserts densely packed with kiosks and fast food restaurants.
In countries with relatively recent obesity epidemics, such as those in the Asia-Pacific region, obesity tends to affect wealthy urban dwellers first, and only then the poor in rural areas and suburban slums.
In China, as decades of poor nutrition were replaced by abundance, the prevalence of obesity and overweight increased and more than doubled in the last decades of the 20th century. Thus, in less than a generation, the country jumped from hunger to feast and abundance.
The population-wide increase in body weight is a wake-up call that warns us of big problems to come. They will not appear immediately, but inevitably, and appear as a wave of lifestyle-related chronic diseases, including heart disease, diabetes, and some diet-related cancers.
Economic growth and modernization, once associated with improved public health, is now opening the door to the globalization of advertising and trade in unhealthy products such as tobacco, alcohol, highly processed foods, and sugar-sweetened beverages.
Although the rapid migration of people from rural to urban areas has a number of positive effects, it also accelerates the transition from an active lifestyle to a sedentary one.
For the first time in history, rapid growth in wealth is leading to a deterioration in the health of many yesterday's poor. This happens in countries where the health system does not have sufficient resources and human capacity to take timely action. If current trends continue, diabetes, which accompanies the obesity epidemic and requires such expensive treatment, could undo all the benefits of economic development.
The Asia-Pacific region is considered to be the epicenter of the diabetes crisis. In this region, the disease develops earlier, is more severe, and leads to death faster than in wealthier countries.
In some of Asia's most populous countries, including China and India, a generation of people who grew up in poor rural areas where food was always scarce and work was physically demanding now lives in city blocks of flats, works in an office, moves little, drives affordable all cars and eats cheap food from fast food establishments.
Partly as a result of these changes, millions of people who have lifted themselves out of poverty and become part of a rapidly growing middle class are now trapped in the suffering associated with chronic diseases and their costly complications. Today, China has the world's largest epidemic of diabetes: it affects 12% of the adult population, and this figure continues to grow at an alarming rate.
WHO data show that the prevalence of diabetes, heart disease and cancer among the Chinese population has risen more than ninefold in a single generation, far outpacing the rest of the world.
This worrying situation is largely a consequence of the shift from a traditional diet to a Western-style diet rich in fat, sugar and salt, an aging population and rising consumption of alcohol and tobacco.
The rise in the prevalence of non-communicable diseases has very far-reaching consequences. This is a veritable tectonic shift that requires a fundamental shift in public health policy.
In most developing countries, health systems were designed to deal with short-lived events such as childbirth or acute infections. These systems were not conceived for the long-term management of patients with chronic pathologies and their serious complications requiring expensive drugs and hospital care.
Public health must shift its focus from treatment to prevention, from short-term to long-term case management, from delivery, vaccination and antibiotic prescribing to behavior change, from working alone to coordinated action with multiple sectors and partners.
One of the most far-sighted ways to ensure this transition is to build a pool of well-trained and motivated general practitioners. They both treat and prevent. They are also better than others at detecting the disease in the early stages before complications that require expensive treatment and long hospital stays occur.
General practitioners are the guards at the entrance to the healthcare system, whose task is to ensure that patients with relatively minor complaints do not overload emergency departments. General practitioners know that illness has not only medical but also social causes, which gives them a great advantage in terms of primary prevention and increased patient satisfaction with services. They are the ones who can provide truly people-centred services.
Many outside observers of China's ambitious reform agenda have pointed out that the lack of well-trained medical practitioners is a major obstacle to reducing the overuse of hospital care.
Provincial health leaders have a key role to play and direct resources in the right direction. Investments in primary health care will bring more results and be more cost-effective than investments in the construction of new hospitals and clinics.
The costs of treating these lifestyle-related diseases are shocking. Prevention is no doubt a more effective way to solve the problem, but the organization of prevention is a very difficult task for at least two reasons.
First, the underlying causes of chronic disease lie outside the health sector. The health sector bears the burden of these diseases but has little leverage over risk factors. Second, the activities of powerful economic actors such as tobacco, alcohol, food and soft drink manufacturers are leading to the globalization of unhealthy lifestyles.
Using the WHO Framework Convention on Tobacco Control as a legal instrument, governments, including at the regional level, can enact legislation that will significantly reduce tobacco use. We are confident in this, we have a lot of proof of this.
Tobacco control measures in Beijing are among the most stringent in the world. Shanghai recently banned smoking in all airport buildings and railway stations in the city. The Shanghai Legislative Assembly is considering taking even tougher measures to ban smoking in all public buildings.
If Beijing and Shanghai can do it, with broad support from the people, every health leader in every province can do it.
Unfortunately, the tobacco industry is trying its best to undermine the passage of these much needed laws. Their goal is to weaken China's national tobacco control legislation, which is currently being drafted.
Don't let industry known for its unscrupulous behavior undo these advances in China's public health. The interests of public health must come before protecting the profits of private companies. Every tobacco-related death is a preventable tragedy.
Ladies and Gentlemen,
In a world with so many uncertainties, economic, trade and industrial considerations can take precedence over national and international concerns and take precedence over public health interests.
Another trend requires close attention. Economic growth and rising prosperity are almost always accompanied by increased demand for meat and dairy products.
The world food system, over the last decades of the last century, has made the transition to industrial food production. As a result, huge livestock complexes have appeared, where thousands of pigs, cattle and poultry are kept in cramped and unsanitary conditions.
Thus, gigantic livestock enterprises have been built in China, capable of producing more than a million heads of pigs a year. The system of mass stall keeping of livestock makes it possible to meet the demand of the population for cheap meat, but at a very high price.
This system is not environmentally sustainable. These livestock farms are highly polluting the environment with animal feces and chemical waste, as well as methane, which contributes to climate change.
Growing a huge number of animals in cramped conditions requires the use of a huge amount of antibiotics. In some countries, more antibiotics are used for food production than for human treatment.
The research in China best demonstrates the direct link between the use of antibiotics in food production and the detection of drug-resistant pathogens in food, animals and humans.
Worldwide, more and more first and second line antibiotics, vital to humanity, are being rendered useless by the emergence of antibiotic resistance, clearly linked to the abuse of these valuable drugs.
With so few replacement drugs currently in development, the world is moving towards an era of life without antibiotics, when many common infectious diseases will once again become deadly.
As host of the G20 summit in September, China included the issue of antimicrobial resistance on the agenda and final communiqué of the event.
China is very fortunate to have a Chairman who has put health at the center of all government activities. All measures taken by all departments must be accompanied by a health impact assessment.
This can help China to ensure that the rapid modernization and economic progress of the population does not lose, but strengthens their health.
As we move forward with the Belt and Road Initiative, I would like to ask you not to forget that there are so many economic and trade factors that could undo decades of sustained progress in public health.
Recognizing and adjusting these factors is another way to promote peace and cooperation, openness and inclusiveness, mutual learning and mutual benefit.
A world in which such imbalances exist in income levels, opportunities, access to health care, and levels of health is neither stable nor secure.
Thank you.
The Chinese government has begun to improve the health care system and pension provision of the population of the most populous country in the world. Many have been affected by the global financial crisis. Banks went bankrupt. Market development has slowed down. A recession has come. However, in the midst of this chaos, one potentially positive development has taken place: China has begun to take concerted action to strengthen the social safety net. With the global economy in crisis, and demand for Chinese goods declined, especially in developed countries, the Chinese government turned its attention to domestic sources of demand. A large-scale program of increased budgetary spending was launched, which placed great importance on infrastructure spending.
However, policies aimed at improving China's pension system and creating a better and more efficient health care system designed to cover the entire population of China have also been of no small importance. China's recent moves were just the beginning of this renewed process of building a social safety net that to some extent smoothes income inequality and improves the living standards of more than a billion people. China's reforms are coming at a time when advanced economies, including the United States, as well as many in Europe, are grappling with the long-term costs of pensions and health care.
Reducing the need for savings in China
In China, almost everyone saves money. Corporate savings rates are high. The government is a net saver. The population also saves money; moreover, the savings rate is highest among the young and the elderly, who in developed countries, on the contrary, are less inclined to save money than other groups of the population. Much of the high savings rate among older Chinese is motivated by preventive considerations, as people are concerned that, given the high life expectancy of the average Chinese, either the rising cost of living or rising health care costs may lead to spending all funds, and in old age they may become indigent. Even younger families are at risk for costly catastrophic or chronic illness.
Since the market for private health insurance and private annuities is underdeveloped, it is very difficult for a Chinese citizen to insure himself against individual risks. Therefore, the population has a strong incentive to save more than they really need in order to insure themselves. A stronger social insurance system can reduce the need for this kind of preventive saving and thus boost private consumption. The rise in consumption is in many ways a beneficial by-product of reforms that are worthwhile in their own right because they protect the poor and improve the standard of living of the population. Moreover, they have a positive effect on the rest of the world: part of the growth in consumption in China will come from increased imports, which will help reduce global imbalances.
Improving the pension system
For years, China has been unable to solve the problem of a fragmented and complex pension system, which does not cover a significant part of the population and does not provide sufficient protection for those covered by this system. There are notable differences between the pension systems operating in different provinces, as well as differences in the provision of pensions to the rural population, migrants and urban populations, and even members of different professions. The transition from this tangled tangle to a more coherent system has long been one of the challenges. However, significant progress has been made in recent years.
Most importantly, in the midst of the global crisis, the government introduced a new rural pension system, which already has more than 55 million participants, and by the end of this year, the system will cover about 23 percent of the population of rural counties. Under this program, a basic pension of 60 to 300 yuan is paid, depending on the region and the size of the individual account. Participation in the system is voluntary, and each of the participants is required to annually deduct from 100 to 500 yuan. Additional funds come from the central government, provincial governments and local governments, but in the western and inland provinces with lower incomes, the central government covers the bulk of the costs. This reform will boost consumption by reducing preventive savings and, more directly, by raising the incomes of those who join the new system: more than 16 million people have already started receiving benefits.
Along with the increase in the coverage of basic pensions, measures are being taken to improve the existing system of pensions for the urban population. The government has introduced a system whereby pensions can be transferred from one province to another, and contributions made in one province are credited to the pension fund even if the worker subsequently moves to another province. These reforms should help increase labor mobility. In addition, many provinces are trying to pool risk by aggregating pension fund receipts and expenditures across the province.
While the changes introduced in response to the global crisis have played an important role in improving the current system, much remains to be done. In particular, measures can be taken to make pension plans more uniform across the country, to make it easier to transfer pensions from one province to another and to ensure equality between different geographical regions. In addition, it makes sense to simplify the existing system of regional, national and occupational pensions. The authorities should also strive to achieve the ultimate goal of risk pooling at the national level so that the Chinese pension system becomes a truly efficient social insurance system that provides a minimum living wage for all of China's elderly population while reducing incentives for high levels of preventive saving. At the same time, China has an opportunity to learn from the mistakes of developed countries and prevent short- and long-term fiscal costs of pension reform from spinning out of control.
Expanding health system coverage
In addition to reforming the social security system, the Chinese government has announced a comprehensive three-year health care reform aimed at providing reliable and affordable health care to the entire population by 2020. The main goals of the reforms: To make health care more equitable by significantly developing medical services in rural areas, expanding access to health insurance programs and reducing the share of the population in paying for medical services. For example, 55 per cent of health care costs are reimbursed to rural families, indicating both significant progress in recent years - less than 30 per cent in 2004 - and that there is room for further improvement in the system.
Reduce costs through a range of programs designed to revolutionize the pricing of medicines and health care services and remove incentives that encourage overuse of medical procedures and medicines. Over time, it is planned to abandon the payment for individual medical services and move to one-time payments to service providers, the amount of which depends on the patient's disease.
Expand risk pooling by increasing public participation in the health insurance system and increasing the availability of insurance programs throughout the country. Improve the quality of health care by expanding education and research, raising standards of oversight and regulation, and the quality of physicians, hospitals, and medicines. Strengthen sanitary and epidemiological surveillance, increase the effectiveness of preventive measures, maternal and child health care, and expand access to state-funded medical education.
As a result of this reform, between 2013 and 2015, public health spending will increase by almost 3 percent of GDP. About two-thirds of these additional financial resources will be used to expand health coverage for rural populations, as well as retirees, the unemployed, university students and urban migrant workers. By the end of 2013, the government plans to cover 90 percent of the country's population with some form of health insurance. This will be partly achieved by increasing subsidies for the rural population in connection with participation in health insurance programs. Additional funds will also be allocated so that the population of all rural areas has access to district hospitals, medical centers operating in cities and towns, and local medical posts. To ensure this, the government intends to build 29,000 health centers in cities and towns and 2,000 district hospitals over the next three years. In addition, in order to staff these health facilities, the government is training 1.4 million health professionals.
Although it is too early to evaluate the results, it should be noted that the government attaches great importance to the strengthening of the health system, and these tasks are being pursued in a sustainable manner and in a way that avoids the budgetary problems associated with the increase in health spending that characterizes many developed countries. It is clear that the Chinese government has stepped up efforts to bring universal basic pensions and quality health care to all citizens of the country. This should reduce the risks to older people and, over time, as it becomes clear that the state is capable of providing high-quality and affordable health care, it will help to reduce incentives for high levels of preventive savings.
After the founding of the People's Republic of China, there have been significant improvements in the medical care of the population, as well as in their living conditions. According to the main comprehensive indicator of the health of the population - life expectancy, China during this time has moved out of the category of poor countries and has risen to the level of the lower group of countries with average incomes.
The provision of the population with the assistance of qualified medical personnel also corresponds to these indicators, although access to such assistance varies greatly by place of residence.
However, medical statistics show that the main positive shifts in the health status of the population were achieved in the pre-reform period of the existence of the PRC. Thus, a sharp reduction in child mortality took place immediately after the proclamation of the republic in 1949, and in the 1980s and 1990s this indicator changed little. The economic successes of the reformist course did not so obviously contribute to the development of health care. Growth rates of public spending on health care in 1979-2004 were lower than the rate of economic growth, which led to a decrease in the share of these expenditures in GDP. In 2005, the share of the state in health care expenditures in the PRC was only 38.8%, while in the world as a whole it reaches 56%. Only 1% of the state budget goes to health care in the PRC, and in total in low-income countries of the world, 4.6% of public funds are spent for this purpose. Since the beginning of reforms in 1978, the share of the state and employers in the structure of total health care expenditures has steadily decreased, while the share of individuals has increased. As a result, in 2006 the state accounted for only 18.1% of expenditures, enterprises and social institutions - 32.6%, and the remaining 49.3% of health care expenditures were borne by the citizens themselves.
The per capita costs of citizens for treatment are growing much faster than their incomes. From 1998 to 2006, on average per capita expenditure per year on ambu-
hospital treatment increased by 13%, and hospital treatment - by 11%2. According to sociological surveys, the population in China puts the high cost of medical services in the first place among all social problems3. These services account for an average of 11.8% of the family budget, second only to food and education. In 2003, a farmer's net annual income was 2,622 yuan on average, and the average cost of a hospital stay was 2,236 yuan. Therefore, for most peasants, hospital treatment is beyond their means.
In recent years, the number of hospitals and health centers, as well as the number of qualified medical personnel, have been declining, although the number of hospital beds has been growing. The number of certified medical staff per 10 thousand people in the period from 1978 to 2000 increased by more than one and a half times, from 10.8 to 16.8 people, and then to
2007 decreased to 15.4 people. At the same time, the decline in medical workers is especially noticeable not in cities, where it is not actually observed, but in county centers. It is at the county level that there is an acute shortage of technical personnel. It is also not very clear where the additional beds are located: in annexes to the main hospital buildings or due to compaction. The question of the quality of services in this situation, with the reduction of medical staff, already seems redundant.
Social inequality in access to medical services has increased. According to a study conducted by the Chinese Academy of Social Sciences, 80% of government spending on medicine goes to serve a social group, which is based on 8.5 million government officials and party functionaries. 2 million government and party officials of various ranks enjoy long-term sick leave. Of these, 400,000 spend long periods of time in special hospitals for treatment and recreation, at a cost of 50 billion yuan per year4.
For the urban population in China, there is a health insurance system. However, this system excludes students, persons without permanent employment, the unemployed and rural residents who come to work in the city. Until recently, compulsory health insurance did not apply to employees of non-state enterprises. The new law on labor contracts made it mandatory for employers to provide their employees with health insurance. But many of them evade this obligation by hiring predominantly migrants and not concluding an employment contract with them. According to the “Report on the main results of the 3rd study of public health services”, in 2003, 44.8% of urban residents and 79% of rural residents had no health insurance at all. The share of people without health insurance is especially high among the population with low incomes. At the same time, she constantly grew. In 1993, about 50% of the urban poor had no health insurance, in 1998 - 72, and in 2003 - 76%.
In recent years, work has been carried out in the countryside to create a system of medical care on a cooperative basis. By the end of 2007, it covered 730 million people, or 86% of the rural population. However, the system suffers from a lack of funds and is unable to support villagers in cases of serious illness requiring hospital treatment. The farmer pays an annual contribution of 10 yuan to the rural cooperative insurance fund, and the central and local governments pay another 20 yuan per person. It is planned to expand the coverage of rural areas with this system from year to year and complete its expansion to the entire country, mainly by 2010. So far, 80% of public health spending is directed to the city and only 20% to the countryside. On a per capita basis, these appropriations are 4 times more in the city than in the countryside (38.3 yuan versus 9.9 yuan). Complete or partial loss of working capacity due to the lack of timely and high-quality medical care often causes the plight of a peasant family. The average cost of treating a serious illness is 7,000 yuan (about $1,000), more than three times the average annual income of a farmer.
In China, there is a heated debate about the causes of the poor state of health care and the best ways out of it. Liberal “marketers” are opposed here not so much to ideological “anti-marketers”, but to those who, sharing in principle the orientation of the economy towards market relations, are not ready to give the most sensitive areas for the people completely to the market and place a significant share of responsibility for them on the state .
The liberals blame everything on the former planned economic system and its survivals. The planned system, from their point of view, is responsible for the fact that the service sector in the countryside, like the agricultural sector as a whole, has been sacrificed for decades to the development of heavy industry. Accordingly, the main problem of health care is seen in the fact that it is not sufficiently included in market relations. Formally, everything seems to be going well. The market allocates resources. Any capital is admitted to the field of medical services. The creation of new structures and the direction of services are determined mainly by market demand. But in fact, for more than two decades of reforms, the conditions for the creation of non-state hospitals have not appeared. Prices for medical services and medicines are still controlled by the state. They are not installed by hospitals, but by the relevant government departments. Hospitals can only operate within a certain price range.
As of 2003, 96% of hospital beds, equipment and medical personnel are located in public health facilities. With long-term support from the government, few hospitals have concentrated the best resources and have a monopoly position that non-state medical institutions cannot compete with. This situation is recognized as abnormal. It is argued that in a market economy it is impossible to preserve the reserves of non-market relations, that health care has no choice but to undergo market reform. The weight of this position is reinforced by the fact that behind it are the interests of national and foreign capital, which are ready to invest billions of dollars and yuan in Chinese medicine, considering it as a potentially extremely profitable area for capital investment.
Opponents of the market, on the contrary, see the main troubles of health care in the loss of social significance by state medical institutions, in their excessive pursuit of material gain. It is noted that in state non-profit medical institutions, the salaries and bonuses of employees, as well as the current expenses of institutions, are mainly financed through their own commercial activities, while the share of state funding does not exceed 6%. Hence the desire of doctors to prescribe a lot of expensive drugs to patients, prescribe expensive examinations and procedures. The state controls the prices of approximately 20% of drugs circulating on the pharmaceutical market and has repeatedly reduced prices in recent years. However, market-controlled drug prices are rising, sometimes many times over. In the vast majority of medical institutions, mark-ups on the price of dispensed medicines reach 30-40%, far exceeding the standard of 15% established by the state. According to the World Bank, in 2003 spending on medicines in China accounted for 52% of all health care spending, while in most countries they do not exceed 15-40%. At the same time, from 12 to 37% of appointments are not necessary. According to a single hospital survey conducted in 2000, 80.2% of patients were prescribed antibiotics, including
58% - two or more drugs. The payment for a single course of treatment in a hospital sometimes exceeds the average annual salary. From 1990 to 2004, expenditures on outpatient treatment in general hospitals increased 12 times, and on treatment in hospitals, 10 times. According to China's health statistics yearbooks, during this period, the average annual earnings of doctors increased by 11.6 times in central hospitals, 8.2 times in provincial hospitals, 6.8 times in district hospitals, and 5.5 times in county hospitals.
In the spring of 2005, Deputy Minister of Health Ma Xiaohua voiced the thesis about the need to uphold the leading role of the state when introducing market mechanisms into this area. In essence, this marked the beginning of a revision of the previous basic principles and emphasis of the health care reform carried out over two decades, which made the main emphasis on the introduction of market relations. There was a massive press campaign for the government to take the lead in solving health problems. A joint 2005 report by the Center for Development Research under the State Council of the People's Republic of China and the World Health Organization concluded that market-based health care reform in China has largely failed, primarily due to excessive market orientation and insufficient government role.
The country's leadership again found itself in a dilemma: in which direction should the healthcare reform be carried on - whether in the direction of further denationalization, the sale of medical institutions, or, on the contrary, back, in the direction of the former state medicine. Or try to somehow combine these principles. In essence, such disputes did not stop during the entire period of reforms, but today the hour has come when it is necessary to make a fundamental choice. The serious SARS epidemic in 2003, which exposed all the shortcomings of Chinese health care, made this problem particularly acute.
One of the leading theorists and planners of Chinese economic reforms, Deputy Head of the Development Research Center under the State Council of the People's Republic of China, Professor Li Jiange, who was directly involved in reforming the healthcare system under the previous leadership, points to the objective financial and material difficulties faced by the reforms. Thus, in the United States in 2004, $1.8 trillion was spent on healthcare. In China, the entire GDP amounted to $1.6 trillion in the same year. At the same time, the population of the United States is slightly more than 200 million people, and - over
1.3 billion. If we calculate the cost of treatment and medicines in China, based on only one tenth of the American norm, then the entire Chinese GDP will not be enough for them. In China, health insurance for urban workers and employees averages 2,000 yuan per person per year. If the government took upon itself the task of extending this standard to the entire urban and rural population (and such proposals are being put forward), then this would take the entire expenditure part of all budgets of the central and local governments at all levels.
Such arguments, however, do not convince everyone. Opponents point out that over the past century, more than 160 countries of the world, sooner or later, created various social security and health insurance systems. At the same time, neither in England almost 100 years ago, nor in the USA 70 years ago, nor in Japan 68 years ago, economic conditions were hardly better than in today's China. But all of them managed, using the limited financial resources of their time, to provide decent treatment for their citizens. Why is China unable to do this?
In determining the way forward for health care reform, Beijing is looking closely at the experience of other countries with economies in transition, especially Hungary and Poland. The delegation of the Ministry of Health of the People's Republic of China and the State Committee for Development and Reforms, which visited these countries, found a lot of useful things there, especially in the relationship of medical institutions with the state and the market. It is stated that, for all their political and economic orientation towards Europe, these countries approach the spread of market relations and privatization to health care very carefully. While the level of privatization in the economy is very high, there are very few fully privatized hospitals. In Hungary, after a long discussion, they refused to privatize the social insurance fund. The main element of the reform in Poland and Hungary was the creation of independent nationwide health insurance funds. In Poland, such a fund receives funds mainly from the state and enterprises and extends its services to all family members of a person with health insurance. Medical institutions receive funds not directly from the state budget, but under contracts with the health insurance fund, in accordance with the work done. This method, according to the head of the Chinese delegation, is also acceptable for China. The experience of other countries, in particular Spain and Brazil, is also being studied. And here there is a tendency towards an increase in the role of the state, primarily the central budget, in financing health care and medicine, while using various forms of cooperation with private capital. This contributes to the reduction of interregional differences in the provision of the population, especially the elderly, with medical services.
In August 2006, the State Council of the People's Republic of China set up a coordinating group for health care reform, which included representatives of a dozen ministries and state committees. At the end of 2006, most departments approved a project submitted by the Ministry of Health, which provided for the provision of practically free medical services in communal hospitals to almost all urban residents. The total government spending under this option was estimated at 269 billion yuan.
In early 2007, it was decided to involve six independent domestic and foreign research centers in the parallel preparation of reform projects, including Beijing, Fudan, People's Universities, WHO, the World Bank, and the Mackenzie consulting company. Later, Beijing Normal University and Tsinghua University joined them in cooperation with Harvard University.
In March 2007, the Ministry of Finance of the People's Republic of China made public its point of view on health care reform. It boiled down to the fact that medical services should be paid, thereby solidarizing with the market model.
At the end of May 2007, independent projects were jointly considered for the first time at a meeting convened by the State Committee for Development and Reform, with the participation of the ministries of health, finance, labor and social security and other departments. Most of the presented developments focused mainly on the leading role of the state, the smaller part - on the market.
In July 2007, the State Council of the People's Republic of China issued a document titled "Guiding Considerations for the Deployment of Urban Basic Health Insurance Pilot Sites," which called for the number of pilot cities to be increased to 79 this year and to cover the entire country in 2010. This meant that the government intended to use the increase in health care spending primarily to subsidize the covered population rather than increase investment in public health facilities. Thus, a course was proclaimed for the development of the medical services market.
Hu Jintao's report to the 17th CCP Congress in the fall of 2007 emphasized the government's responsibility for health care reform. They spoke about the need to strengthen the generally useful nature of health care, to increase the investment activity of the state. At the meetings held after the congress, it was decided, on the basis of the existing independent developments, to prepare a new consolidated draft of the health care reform "with Chinese characteristics" and submit it to the public. The project was supposed to provide for the creation by 2020 of a system that would guarantee the provision of basic medical services to all residents of the city and village.
The controversy between supporters of predominantly market-oriented and predominantly state-oriented reform in China did not stop. The latter advocated the establishment of a low cost of hospital services, for minimizing differences in the prices of dispensed drugs while maintaining, however, the market sale of patented and innovative drugs. All hospital equipment, from their point of view, should have been centrally purchased by government departments. Hospitals were asked to be allowed to continue to charge for treatment, but to transfer all income to higher health authorities, which are responsible for allocating resources. Opponents of the statist approach characterized it as a return to a planned economy, as a way to further increase corruption.
Against this background, in 2007, the Health Development Program for the 11th Five-Year Plan (2006-2010) was adopted. The document noted certain achievements of the previous five years (2001-2005). The average life expectancy increased to 72 years (by 0.6 years compared to 2000). Decreased neonatal mortality, infant mortality and mortality of children under 5 years of age. Work has intensified on the prevention of AIDS, on the identification and treatment of patients with tuberculosis and a number of other serious diseases. The water supply and sewerage networks in the countryside have expanded significantly. Increased investment in health care. The systems of cooperative medicine in the countryside and the provision of medical services at the communal level in cities have been strengthened.
At the same time, serious unresolved problems were noted. AIDS is beginning to spread from risk groups to the general population. The number of TB patients exceeded
4.5 million people. It is not possible to effectively control the spread of hepatitis. New infectious diseases are constantly emerging. Hundreds of thousands of people suffer from schistosomiasis, diseases associated with iodine deficiency, and fluorosis. The number of people suffering from malignant tumors, diseases of the cardiovascular and respiratory systems, diabetes, injuries and poisonings is about 200 million. 16 million people suffer from mental disorders. The risk of occupational diseases is growing. The level of protection of motherhood and infancy, especially among migrants, is low, and its differences between the city and the countryside are significant. Villagers suffer more from AIDS, tuberculosis, hepatitis, schistosomiasis and local diseases. Only 18.5% of the staff of volost and settlement health centers have higher education.
The program provided guidelines for the development of all subsystems of health care, determined specific guidelines for 2010 to further increase life expectancy and reduce mortality in different age groups.
In the spring of 2008, Premier Wen Jiabao, in a report on the work of the government at the session of the NPC, emphasized the need to carry out health care reform in order to provide everyone with access to basic medical services. The central government announced that it will allocate 82.5 billion yuan (about
11.7 billion dollars), which was 16.7 billion yuan more than the amount allocated for this purpose in 2007, with the bulk of the funds
was intended to strengthen the lower levels of the health care system in the city and countryside.
A number of deputies who spoke at sessions of the NPC and the CPPCC, while welcoming the intentions of the government, objected at the same time to the state monopolization of the public health system, in particular, in such its components as protecting the health of women and children, prevention, control of infectious diseases, sanitation of the environment. environment, health promotion, ambulance. The state was not recommended to invest heavily in capital construction and large equipment. In the interests of creating an inexpensive and efficient public health system, the government was offered to buy the services of medical institutions using market competition methods. Instead of directly investing in the health care system, he was charged with the obligation to invest in health insurance institutions, buy insurance for his citizens in order to guarantee patients the freedom to choose a medical institution and ensure equal competition between organizations providing medical services. Without directly participating in the management of medical institutions, the government undertook to promote the development of corporate governance, to stimulate the attraction of both state and non-state capital in the development of domestic healthcare.
In April 2009, two documents aimed at accelerating the development of health care in the coming years were officially published: “Considerations of the CPC Central Committee and the State Council of the PRC on deepening the reform of the health care system” and “Draft implementation in the near future (2009-2011) of key programs in pharmaceutical and healthcare fields. The first paper was submitted for open public comment in September
2008 and caused a large number of responses with comments and suggestions, which were summarized by the relevant departments and proposed as amendments.
For the period 2009-2011. it is planned to cover the entire urban and rural population with a system of basic medical guarantees: the urban population - with basic medical insurance, the rural population - with rural cooperative medicine. By 2010, the standard amount of subsidies for these two systems is raised to 120 yuan per person per year, and individual contributions are slightly increased accordingly. It is planned to start creating a state system of basic provision of medicines. Since 2009, the creation of the National Archive of Population Health Data has begun. It is planned to launch a reform of public medical institutions aimed at improving the management and control of their activities and raising the level of services they provide. It is planned to allocate 850 billion yuan for all this over three years. The burden of medical care costs that the population is forced to bear is lightened.
Thus, in this most important social sphere for the entire population of the country, a framework for interaction between the state and the market is established, with the leading role of the state, which assumes responsibility for the public use of all strata and groups of society with basic medical services, regardless of the thickness of individual wallets. At the same time, the healthcare system remains mixed, which implies an influx of capital of various types of ownership into this system.
Medicine in China is significantly different from European medicine. While the disease and its manifestations are treated in Europe, Eastern healers for thousands of years have considered the human body as a single system in which everything is interconnected. For this reason, Chinese doctors believe that the state of the whole organism should be examined, and not a separate organ. Such an unusual approach gives its results - according to the World Health Organization, the methods of Chinese medicine are recognized as effective and are being actively introduced into the practice of Western doctors.
Secrets of traditional Chinese medicine
Traditional Chinese medicine is one of the oldest systems of treatment in the world, with a history of more than three thousand years. For many centuries, the Chinese sages kept the teachings about the healing of a person. There are several books that outline the basic principles of this teaching and the oldest methods of treatment:
- "Nan Zen"
- "Shang Han Long"
- "Wen Yi Lun"
Without exception, all methods of Chinese medicine are aimed at helping a person without harming him in any way.
Treatment is based on three "pillars": herbal medicine, acupuncture and gymnastics. In addition, Chinese healers actively use baths, compresses, massage.
The most important advantage of Chinese medicine is its preventive focus. The advantages of this approach are obvious: if the disease is detected at an early stage, the patient will be helped to maintain health by simple methods, such as diet, adherence to certain rules of behavior, massage, etc.
It should be noted that the healing process in ancient China could take a very long time. This was explained by the fact that at first the doctor sought to eliminate the main symptoms of the disease, and then, after the person felt much better, he began to eliminate the cause of the disease in order to prevent possible complications in the future. Therefore, a doctor in China is not a specialist in diseases, but a specialist in health.
The Heihe Traditional Medicine Hospital of China is the center of ancient methods of treatment. Here they provide high-quality dental services, conduct effective physiotherapy procedures and massage.
Principles of traditional medicine
Chinese medicine originates from the early teachings of the Taoist monks, and all its methods are to improve the spirit and body and establish a balance between them. According to Chinese doctors, our well-being depends on the circulation of the vital energy Qi, as well as on the balance of the female Yin energy and the male Yang. And if the energy exchange is disturbed, it will certainly result in diseases and ailments. Therefore, it is necessary to treat not the symptom, but the cause, restoring the harmony of the body.
The fundamental principle of Chinese medicine is the treatment of natural remedies. Doctors with special knowledge can return energy to the human body with the help of herbs, acupuncture, massages. One of the most famous Chinese scientists, Gao Zong, described in his treatises a myriad of plants, methods of treatment with the help of stones, minerals, vegetables and fruits.
Key Treatments in Chinese Medicine
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Traditional Chinese medicine has dozens of techniques. The most common of these include:
Fundamentals of disease prevention
Chinese medicine considers massage and diet to be the basis of prevention. Chinese healers are confident that these methods can stop the disease at the very beginning and prevent it from becoming chronic.
In addition, in their opinion, it is necessary to improve the state of the human immune system and eliminate pathogenic factors - the causes that provoke diseases.
A healthy lifestyle is of great importance for the Chinese: giving up bad habits and following certain rules. For example, many city dwellers go to parks in the morning and evening and do qigong exercises. This gymnastics has a lot in common with yoga - it also involves slow, smooth movements and breath control. Qigong helps to harmonize the state of the body and spirit and allows the Qi energy to flow freely. As a result, it significantly improves the supply of oxygen to the brain and all systems and organs of the human body, increases concentration and performance, relieves muscle tension and normalizes blood pressure.
Prices for medical services in China
China is famous for its high level of medical care. In China, there are dozens of world-famous clinics that offer high-quality examination and treatment by highly qualified narrow-profile specialists. 
Paid or free medicine in China - this question is asked by everyone who thinks about treatment in this country. Answering this question, it should be noted that free treatment is possible only for Chinese citizens, for all foreigners, medical care is paid. However, despite the fact that local doctors know their business perfectly, the cost of treatment in Chinese clinics and medical centers is 40% or even 50% less than in Europe or America.
The amount that will be needed to pay for the services, the patient will know immediately after the examination. The very same consultation with a specialist will cost 20-75 US dollars. In this case, the cost of the chamber can reach up to $ 200 per day.
Nevertheless, Chinese medical centers that combine ancient traditions with modern scientific achievements in their work are becoming more and more in demand, and the popularity of Chinese medicine among patients is growing due to the relatively low cost of services and the high level of service and treatment.
How was I treated in China? Chinese Medicine: Video