A few months after the end of China’s Zero Covid policy, thousands of retirees took to the streets in the city of Wuhan, where the world’s first Covid-19 outbreak emerged, to express their discontent with the Beijing government. decided to cut public health funding. While Chinese officials continue to argue that the economic response, which will vary from province to province, will lead to greater provision of outpatient services, the complaints have not had the desired effect. However, explanations that do not convince the elderly Chinese.
Arrival of special person
Following the unremitting economic growth marked by the reform period between the 70s and 80s of the last century, the Asian giant overhauled its healthcare system. Before the economic plan launched by “Little Helmsman” Deng Xiaoping, China provided medical care for a person’s entire life, with the state paying all expenses. Then came market reforms in the 1980s that gave hospitals more spending autonomy in exchange for less funding from central government. The change allowed public health services to make more room for private sector jobs.
In 2020, the situation got worse. Healthcare costs have become a slippery topic post-Covid. During the years of the strict Zero Covid policy, local governments squandered their resources to fund mass testing and quarantines, fueling public discontent with a system that highlights socioeconomic inequalities in China. When you look at the quality of health services offered in big cities and rural areas and, above all, who has access to these services, differences stand out.
Even Chinese leader Xi Jinping recognizes how socioeconomic inequalities directly impact the health of Chinese citizens. President Xi said, “Efforts should be made to make healthcare workers more active by increasing their salaries and treatment, development areas, environment and social status.” National Health MeetingIt was held in Beijing in 2016.
Many things have changed since that year, thanks to the outbreak of the pandemic, which further exacerbated the deficiencies in the national healthcare system.
95 percent of Chinese have insurance, but there are necessary differences
China is making significant efforts to invest in healthcare infrastructure and bring medical care to as many citizens as possible. So much so that, in order to make the accessibility of services more homogeneous and at the same time to eliminate the phenomenon of corruption among administrators and healthcare professionals, the central government has implemented various reforms that increase the financing of the health insurance system and promote health insurance. use of generic drugs.
Among the recent plansHealthy China 2020Insurance practice introduced in 2009, allowing 95 percent of the population to be covered by basic health insurance: This is an unprecedented success, considering that 45 percent of the urban population and 79 percent of the rural population were not covered by social insurance in 2003. health insurance programs.
But the reform still continues Healthy China 2030, The project, which aims to make the Chinese healthcare system more efficient in the new decade thanks to more scientific research and investment in the technology and artificial intelligence sectors, was launched in 2016.
“These reforms, accelerated during Covid, have led to various advances,” Francesca Spigarelli, professor of Applied Economics at the University of Adventureta and author of the book, explains to Today.it. Globalization of China’s Healthcare Industry. Industrial Policies (with colleagues Marco R. Di Tommaso, Elisa Barbieri and Lauretta Rubini). “Today, the majority of the population has insurance coverage to cover the cost of treatment, there are more healthcare facilities in the area, and there is greater use of technology and artificial intelligence for treatments, even remotely. But – the teacher noted – there are still many gaps and problems with quality of care, poor access to services inequalities, corruption and inefficiencies in the management of health facilities and the insurance reimbursement system”.
The (non)turning point appears to be 2020. Yanzhong Huang, Senior Fellow for Global Health at the US think tank, told Today.it that the pandemic has delayed the implementation and implementation of the current healthcare reform in the country. Council on Foreign Relations, He noted that most of the government funds have been allocated to increase the number of beds in public hospitals for the treatment of patients affected by Covid-19 in major cities of China. However, those who paid the price for this were private healthcare institutions that were unable to hospitalize virus-positive patients and therefore lost income.
With the end of the health emergency in China, the central government adopted various measures to stimulate economic growth. But things don’t go as planned.
The reason lies in the downward revision of the Asian giant’s recovery: The World Bank expects China’s economic output to grow by 4.4 percent in 2024, below the 4.8 percent forecast in April and below the 5 percent growth targets expected by Beijing. is expected to grow. Due to the decrease in money in the state coffers, there is also a decrease in the funds that Beijing directs to various local governments and therefore to the health sector.
How does healthcare work in China?
First, let’s try to understand how healthcare works in the People’s Republic. The Chinese healthcare model features pyramid management. Beijing’s central government outlines the resources to be allocated to healthcare based on national strategies and reforms after assessing the country’s economic performance. However, individual states are responsible for managing health resources; but these resources must be within the goals set by the Communist Party. Therefore, there is no lack of balance between national and local operations, which varies from province to province.
Spigarelli explains that the Chinese healthcare system is financed by three major macro pillars: the government, which contributes mainly to the management of prevention plans through public expenditure, and the government, which finances health insurance. Then there are social contributions, which cover all types of insurance, and finally direct payments that citizens pay privately. Wanting to break it down in percentage terms, the government provides about 30 percent of the resources allocated to healthcare, the rest is provided by the population: 30 percent comes from direct payments from citizens, the remaining 40 percent comes from social contributions.
But be careful, we are not faced with a “universal” system like ours. As the professor from the University of Adventureta explains, the reforms that have been carried out have certainly guaranteed all citizens greater access to public health insurance, but this often only covers basic medical expenses without guaranteeing those for serious or chronic diseases. There are also taxes and insurance premiums to pay, and the programs are not mandatory for individuals. This means not everyone has access to public healthcare.
In fact, basic health insurance is currently divided into two branches: employee insurance and home insurance. The first of these covers the urban working population, especially urban workers and retirees from public economic enterprises, as well as current employees of some private sector enterprises; The second typology is aimed at the unemployed urban population and rural population. However, health insurance in China is not directly and fully subsidized by companies, but by the local government insurance pool. This is where the first socioeconomic differences in the health sector begin to emerge.
How are things going in Chinese hospitals?
The situation is especially critical in public hospitals in cities; Departments are overcrowded and medical staff are struggling. Unlike managers, doctors and nurses have not benefited from the economic growth of the sector: with a population of 1.4 billion, the People’s Republic has only 2.5 doctors and 3.5 nurses per 1,000 people; in contrast, in Italy there are an average of 4.4 white coats and 1000 people. 6.4 nurses per 1,000 people, according to the latest data from the Organization for Economic Co-operation and Development (OECD).
For this reason, doctors and nurses in the public sector, who complain about very low salaries, job stress and abuse of patients, prefer to work in private hospitals. “There is an increase in the number of medical altercations and violence against white coats in China,” says Spigarelli. This shows society’s lack of trust in the medical profession. Related to this is the problem of corruption,” says the Professor, as well as kickbacks and bribes in exchange for prescribing certain drugs or purchasing medical devices. hongbao (cash gifts in red packets) from patients. However, healthcare workers constitute the bottom rung of the pyramid of corruption. Hospital administrators are, in fact, among the main victims of the anti-corruption campaign launched by Xi Jinping. The crackdown by authorities is part of the 2023-2027 five-year plan recently launched by the Central Anti-Corruption Coordination Group, which aims to fix various sectors, including healthcare.
Professor Huang notes that the anti-corruption campaign, in which more than 160 healthcare executives have been investigated, “is a tool the Chinese government has at its disposal to solve short-term problems and force local government officials to respect Beijing’s directives.” The repressive measure is not sustainable in the long run. The problem underlines the analyst Council on Foreign Relations, the government’s scarce investments in public hospitals, and therefore they are forced to resort to profit-oriented behavior, even if it is illegal. Beijing is trying to divert attention from the government’s real responsibilities with its anti-corruption campaign. Citizens and healthcare professionals pay the costs.
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Source: Today IT
Karen Clayton is a seasoned journalist and author at The Nation Update, with a focus on world news and current events. She has a background in international relations, which gives her a deep understanding of the political, economic and social factors that shape the global landscape. She writes about a wide range of topics, including conflicts, political upheavals, and economic trends, as well as humanitarian crisis and human rights issues.
