Since the deep change started in the 80s, the Chines healthcare system is facing different issues nowadays: there is a lack of access to care in remote areas, 3A hospitals are overloaded, China’s population is aging rapidly…
The government and the industry have a keen interest in hi-technology solutions, especially telemedicine.
China’s digital health sector generated 20 billion RMB (€ 13,3 billion) in 2014. A number expected to grow to about 3 billion (€ 2,7 billion) in 2014, according to a study published in September 2015 by the Boston Consulting Group.
An evolving healthcare system
1. Before 1980. Health care was free but the quality of the offer remained quite poor. Patients were referred to a public hospital depending on the severity of their problems.
2. After 1980. The system changed because of various economic reforms launched in 1978, after the death of Mao Zedong (1976), and de-collectivization. “It was a pro -market position, Carine Milcent, research Professor CNRS – PSE and CEFC, said to H&TI. There was both a significant improvement in the health system (better quality of care, equipment and level of doctors) and a sharp increase in inequality.”
Indeed, the transition from a collective production to a private economy had fundamentally changed the market organization:
- Public hospitals were no longer exclusively funded by the State. The Chinese government now funds fewer than 8% of their expenditures.
Consequences: industry professionals began to favor the pursuit of profit at the expense of quality of care; patients had to pay more.
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People living in rural areas did not have to contribute to the community medical system anymore.
Consequences: as they were not satisfied with the quality of care, most of them stop contributing to the system and therefore to be covered. Thus, access to care in remote areas declined.
Current problems arising from this change:
- Queues are getting longer in the waiting room. « As they must pay dearly anyway, creditworthy patients look for the best care practitioners: so, they go to 3A hospitals, even if they are away from their home, causing an overload of patients in these facilities, Carine Milcent said. Therefore, there is more vacant rooms in other hospitals. »
Impact: practitioners are overloaded, patients feel they receive a sloppy consultation.
- The cost of care increases: mainly because of overdiagnosis and oversold drugs (related to the fact that public hospitals must now finance themselves).
Impact: access to quality healthcare is reduced for low-income people.
- Customers patient relationship sours. Compounded by the existence of numerous bribes (hong bao), this situation results from the two aforementioned problems.
Another big challenge: the aging population
There were 222 million people aged 65 or above in China at the end of 2015 (16.1 % of the total population), the Ministry of Civil Affairs said on July 2016. There will be 331 million in 2050 (nearly 40% of the total population), the United Nations said.
Consequently, the number of cancers and chronic diseases is increasing. In 2015, there were 4.3 million new cancer cases and more than 2.8 million cancer deaths in China, according to national authorities.
The government has introduced major reforms since 2009
The Health Care System Reform was launched full scale in 2009. An investment plan of 850 billion Yuan (€ 113 billion) is planed by Chinese government between 2009 and 2011 to set up the reform (280 billion Yuan per year, about € 37 billion).
The main goals of this program:
- 100% of the population insured by 2020. Chinese officials say they have 95% of the population already insured since 2014.
- development of community care;
- improvement of healthcare quality;
- regulation of the access and the security of basic drugs by creating an essential drugs list;
- modernization of public hospitals.
World Bank urges China to deepen healthcare reform
These developments are promoted internationally. In August 2016, World Bank suggest Chinese government to take ten years to fully implement changes. According to the international organization’s report, structural changes to China’s current healthcare system could result in cost savings equivalent to 3 per cent of GDP by 2035.
Main goal: putting patient-centered care at the center of the system. This means a shift from an hospital-centric model to a primary care-centric model, by improving the quality of basic health services and delivers high quality care but also cost-effective health services.
The authors of the study strongly encouraged the use of electronic tools and health data sharing.
« The report’s recommendations (…) will contribute positively to the formation of the 13th Five-Year Plan on health reform (2016-2020). We look forward to carefully studying and applying the report’s findings, so it will help us push ahead on health reform, » Liu Yandong, Vice-Premier of the State Council of China, said in a statement.
How eHealth can help solving China’s Healthcare challenges
To solve the current challenges in healthcare, the government and many key players in the industry look at the eHealth sectors.
- 1. Telemedicine is the sector which is growing most rapidly.
Main objectives:
- improving access to quality care in remote areas.
The Provincial Health and Family Planning Commission (PHFPC) encourages the creation of platforms to simplify the communication between patients and practitioners.
Example: 72 million Chinese users consulted a doctor online in 2014, said Perspectives chinoises magazine (April 2016).
- reducing patient wait times.
Example: All major hospitals under in Beijing will stop issuing registration tickets on site for nonemergency patients by 2017. Patients can make appointments through the Internet or mobile phone.
- 2. The IT sector could also allow hospitals and practitioners to be more effective
Example: 21 Chinese hospitals plan to adopt the IBM’s platform (Watson for Oncology) to help physicians deliver personalized, evidence-based cancer treatment options.
A recent report of International Data Corporation research firm (IDC) shows that China’s healthcare IT solutions market could double by 2020 .
3. « The connected devices market is also growing, Carine Milcent said. These products could help to monitor the elderly people at home, to remind them of their medical appointments or their medications, etc. »
Samsung and Huawei are among the most entrepreneurial companies in this sector.
Example: in May 2016, Huawei has signed a partnership with Visiomed Group, a French society specialized in new generation medical electronics. The first products chosen by the Chinese group for its services are: a telemedicine kit and a medical trolley (both connected).
The underlying issues to the development of eHealth
Several issues related to the development of China’s eHealth market are emerging:
- The predominance of the private sector.
Three major companies dominate the market:
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- 1. Alibaba and its online Future Hospital plan.
- 2. Baidu and its eHealth platform to book appointments online.
- 3. Tencent and WeChat, an application to facilitate communication between practitioners and patients.
This oligarchic market is problematic from an ethical point of view. These private companies could be tempted to value the pursuit of profit at the expense of quality of care. For instance, in 2015, Baidu has been singled out for having put forward advertisements for unlicensed hospitals in its disease-themed forums.
In China, the health data collection is decentralized. Each province has its own system. One of the government’s goals is to create a national electronic health records system but « this will be extremely complex to set up, » Carine Milcent said.
There is also security, privacy, and confidentiality issues related to the sharing of health data, especially if they are partly collected by private companies such as Alibaba.
China must now examine these different themes to continue the important transformation of its health system and, perhaps, to become one of the world leaders in the healthcare market.
