Global Health Blogs with Professor Swahn

Student Reflections on Topics Covered in our Class

Global Health Blogs with Professor Swahn

Looking at healthcare in China as compared to US.

February 18, 2021 · No Comments · Health Care Systems, Uncategorized

China has risen to global stardom in the last few decades. Its economy is increasing in capacity and is estimated to surpass the US and be the world’s largest economy in the next couple of years. They have successfully lifted a considerable percentage of the population out of poverty through economic reforms starting in 1978.  With China as a new world player, it begs the question, “ how is the healthcare system is evolving?’”. With all the success, there are still some issues. It does not come as a surprise to learn China and the United States have differences in health systems funding and organization, resulting in health disparities. There are also similarities and differences regarding health insuring offerings. Both countries have benefits and downfalls. 

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There is a robust primary care system in China where community centers address most health issues regarding prevention measures and acute care. It is possible to see specialists, but the government advocates for patients to use primarily primary care services. However, there is a low doctor-to-patient ratio in the country, and therefore, the government offers large subsidies for tuition for medical school to entice students. The lack of doctors creates health disparities between rural and urban areas. Urbanites enjoy the benefits of access to high-quality health care and have licensed general practitioners. Larger cities often house secondary and tertiary hospitals as well. It is a different story for the 48.2% of the Chinese population living rurally. To reduce health disparities between urban and rural communities, educational institutions will lower entrance requirements for those who will work in rural communities, resulting in practitioners who are not licensed and often require assistance from medical professionals in larger organizations.  


PCP ShortageThe US health care system is less centralized and has slightly different problems. First, there is a shortage of primary care doctors and a cultural preference for specialists. This shortage has happened because of a few reasons. Salaries for primary care doctors are significantly lower than that of specialists. Does this make the primary care position desirable when the average medical student graduates with $200,000 in debt? Not really. The lack of access to primary care physicians often pushes the uninsured and marginalized populations to emergency rooms and urgent care, where treatment can be expensive. Second, there is a business element to healthcare with a symbiotic relationship between physicians, pharmaceutical companies, health insurance companies, and medical device manufacturers. The more services provided, the more money to be made. The fee-for-service model in US healthcare makes it desirable for specialists to prescribe unnecessary procedures to earn extra income.  All of these reasons are why the US is number one in the world for healthcare spending without positive health outcomes. 


In the past few decades, China has pushed to close the gap in health disparities between rural and urban  Through successful policy implementation; China is on a nearly universal healthcare system where they offer its population essential health services without financial hardship. They have two different types of public insurance depending on the citizen’s employment and location; again, most disparities are between urban, rural, and migrant populations. The most common form of insurance is the Urban Employee Basic Medical Insurance, which is mandatory for employed urban dwellers. Employee and employer payroll taxes finance the program, and it requires very little federal funding. Urban-Rural Resident Basic Medical Insurance fills in some gaps and is offered to all others, including the self-employed, children, students, the elderly, etc. The Urban-Rural Resident Basic Medical Insurance plan is optional and financed by annual premiums. The government provides subsidies in parts of the country with less prosperous economies; in healthy regional economies, the insurance subsidies are locally funded. The benefit of universal health care is that it offers marginalized communities access to vital preventative care. With the fast economic growth, there are still gaps in the regulation for quality control. That is where private health insurance comes in.  The wealthier population is more likely to afford this insurance and allows access to better healthcare. Needless to say, the Chinese insurance system is making improvements but still has some issues to address. 

The US does not have universal health coverage. It is a piecemeal system. According to the Common Wealth Fund, employer-sponsored health insurance covers around 55% of residents. Federally-funded Medicare, Medicaid, and Children’s Health Insurance Program, which depends on citizen health status, income, and age, covers 37% of the population. The programs cover essential hospital services.  In 2010 the Obama Administration passed the Affordable Care Act, which expanded government involvement in the health insurance system. This law had four main points. First, all citizens can stay on their parents’ private health insurance until the age of 26. Second, it expanded Medicaid eligibility. Third, there was a mandate for most citizens to be enrolled in health insurance or face a penalty (removed now). Fourth, the government required states to open virtual insurance marketplaces, where lower and middle-income citizens can choose plans with optional federal subsidies.  The health insurance offerings are moving in the direction of universal healthcare. The incoming Biden administration has made promises to address significant health insurance issues to improve healthcare access and quality. 

In conclusion, all countries have problems to address within their health systems. Even though China is a fastly growing economy, it still struggles with healthcare organizations and support. While offering almost universal healthcare, there is room for growth to support the quality of care. The US has structural issues with its healthcare system. It is more of a business and a significant driver of the economy. While the broad offering of health insurance is an improvement, it still can be expensive for the marginalized population. Are the governing bodies in these countries up to the challenges? Only time will tell.


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