Apr 08

China’s Bold Visions for Universal Healthcare

Written by Allen on Wednesday, April 8th, 2009 at 1:47 am
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The Chinese government announced a couple of days ago guidelines for an ambitious reform of the healthcare system (see also wsj report and danwei report).  The government announced,

By 2020, the world’s most populous country will have a basic health-care system that can provide “safe, effective, convenient and affordable” health services to urban and rural residents….

The government initiated a series of market-based reforms for the healthcare system starting 1997. But the reforms were considered to be a failure by 2005.  The same report explained,

After the founding of the People’s Republic of China in 1949, governments covered more than 90 percent of medical expenses for urban residents, while rural people enjoyed simple but essentially free health care.

But when China began its economic reforms in the early 1980s, the system was dismantled as the country attempted to switch to a market-oriented health care system.

Soaring fees plunged many into poverty and made medical services less affordable to ordinary citizens.

Statistics from the Ministry of Health show that the personal spending on medical services has doubled from 21.2 percent in 1980to 45.2 percent in 2007, while the government funding dropped to 20.3 percent from 36.2 percent in 1980.

The most recent set of proposals was delayed and revised many times since the government unveiled preliminary version for public scrutiny in October last year. The blueprint highlights the establishment of a basic universal health-care system to cover all Chinese citizens.

Under the plan, public health programs, such as those relating to prevention and control, health education, maternal and infant care, mental health and first aid services, will be expanded.

Public, non-profit hospitals will continue to be dominant providers of medical services, although development of “grass-root level” hospitals and clinics, which have traditionally been ill-equipped and understaffed will also be emphasized.  A system with a more balanced mixture of public and grass-root hospitals and clinics is expected to deliver more comprehensive and affordable services.

Diverse medical insurance systems tailored for different sectors of the population, such as urban employees, urban residents who do not work, the  self-employed, and rural residents will be provided. Price of essential medical supplies and medicine will be regulated.

The proportion of population covered by basic medical insurance is expected to surpass 90 percent by 2011.

Other highlights of the plan include:

– The government to enhance the management and supervision of the operation of medical institutions, the planning of health service development, and the basic medical insurance system.

– Public hospitals to receive more government funding and be allowed to charge higher fees for treatment. But they will be eventually banned from making profits through subscribing expensive medicines and treatment, which is a common practice at present.

– Central and local governments to increase investment in the public health sector, grassroots-level clinics, subsidies for public hospitals, and basic medical insurance systems.

– Governments to increasingly regulate the pricing systems of medical services and medicines, with particular control on the price of basic services at non-profit hospitals and essential medicines those hospitals use.

– Supervision of medical institutions, health insurance providers, and pharmaceutical companies and retailers to be strengthened. Governments will also tighten monitoring of drinking water and food safety, and safety in workplace.

Dr. Sarah Barber, a World Health Organization official, said that the aim to improve equitable access to essential health care for all in China is “laudable.” However, she warned, the success of the reforms will depend on how effectively this plan is implemented across China.

According to another government article, it appears particular efforts will be focused on four prongs of reforms, including:

  • Creation of universal coverage and promoting of preventive care;
  • Improved supervision of hospitals and other medical facilities to reduce corruption in China’s medical system;
  • Expansion of primary care to the most remote areas of China; and
  • Improved training and updating medical facilities throughout China.

Given that the healthcare reforms of 1997 were largely unsuccessful, does anyone here have any insight on whether these set of reforms will be more successful?

Given that the government has said the draft proposal is open to public debate until Novemeber, what reactions do people have to this set of proposals?

P.S. For a general background on healthcare reform in China, see this helpful backgrounder from xinhua.

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62 Responses to “China’s Bold Visions for Universal Healthcare”

  1. colin Says:

    Given all of China’s problems, I’ll believe it when I see it.

    That being said, I wouldn’t be surprised if they did pull it off. China is undergoing a technological, knowledge and productivity revolution now.It’s difficult to grasp how much more it will be able to do and accomplish if the nation focuses on an issue and is supported by the said gains in productivity and processes.

  2. Raj Says:

    If it wants to do this, it has to put more money in – a LOT more money. What has been announced so far is peanuts. Even the UK, with just 61 million people, spends about £100 billion of State money. That doesn’t even include private money. China spends something like £30 billion for a population more than 21 times larger.

    Even taking into account lower wages, it’s clear China’s budget is inadequate. The Chinese government is going to have to make those tough decisions and raise more income – i.e. higher taxation/cutting back on other spending like defence – if it wants to make a difference. Otherwise it’s just rhetoric.

  3. Wukailong Says:

    I don’t expect China to pull a fully functional universal healthcare system out of the hat in a few years’ time, but this looks like the right direction, and I’m happy the idea of this change has come about in such a (relatively) short time. What I do wonder about is the idea that the bulk of the system is still state-owned hospitals. This is what many European countries have been doing up to now, and it’ll probably work fine for one or two decades, but ultimately I think the best model is one with public insurance and private hospitals (like France).

    Still, this is a great idea, and I’m optimistic about it.

  4. Mark Anthony Jones Says:

    This is great news, and I have just updated my website essay on China’s improving human rights situation by adding to it news of this development. The aim to introduce universal health care by 2020 is ambitious for a lower-middle income country like China, but one that must be applauded. Such a development also provides an additional challenge to Minxin Pei’s 2006 thesis, that China is somehow ‘trapped in transition’. Clearly Pei is wrong, for the overwhelming weight of empirical evidence shows continual incremental improvements in the areas of human rights – both macro and micro.

    Raj might possibly be correct when he says that more money will inevitably be needed, although the costs of delivering health services in China is far lower than it is in the UK. Also, it is important to keep in mind the fact that the government plans to spend US$124 billion on their health reforms by the end of next year, which, according to their calculations (which I believe the central government formulated in collaboration with the World Health Organisation) should provide at least some form of basic cover to around 90 percent of the nation’s population. Currently only around 30 percent of the population is covered. Much more additional money will be allocated over the coming years with the aim of achieving a more comprehensive universal health care system by 2020. The type of service the government hopes to achieve with the already allocated US$124 billion by the end of next year is far more modest than the level of care UK citizens currently enjoy. That is a more long term goal, set for 2020.

    As I mentioned in my essay on human rights, China already spends a higher percentage of its total Gross Domestic Product on health care than most of its fellow lower-middle income neighbours: 4.7 percent compared to Sri Lanka’s 4.1 percent, Thailand’s 3.5 percent and Indonesia’s 2.1 percent. The Philippines spends 3.2 percent of Gross Domestic Product on health, and Malaysia and Singapore, which are both in higher income classes than China, spend only 4.2 and 3.5 percent respectively.

    Recent World Health Organisation reports together with the World Bank’s World Development Indicators for 2008, show too that China’s health outcomes compare favourably to most of its neighbours, outperforming most other countries in its lower-middle income class, as well as some wealthier middle income countries, on many of the key health indicators.

    As Minxin Pei points out though, on a per capita basis, China’s rural residents currently ‘receive only a third of the healthcare enjoyed by their urban counterparts.’ In 2001, only 15 percent of the government’s health budget was allocated to rural areas, even though rural residents accounted for roughly 70 percent of the population. ‘Consequently,’ notes Pei, ‘both access to and quality of healthcare in rural China have declined dramatically. Whereas 85 percent of the rural residents had health insurance in 1970, less than 20 percent of them were insured in 2003.’

    Per capita health outcomes will no doubt continue to improve now that the government has announced its determination to address these inequalities, with its ambitious plan ‘to build 2,000 county hospitals and 5,000 township clinics in rural areas in the next three years, extending medical services and making them more affordable,’ as Wang Qian reported in yesterday’s China Daily.

  5. Mark Anthony Jones Says:

    Just to add to what I said in my comment above, according to the World Development Indicators for 2008 report, the UK, in 2005, spent 8.2 percent of GDP on healthcare, and of this, the government contributed 16.2 percent of the expenditure. In Australia, similarly, 8.5 percent of GDP was spent on healthcare, with government expenditure amounting to 17 percent. In the US, 15.9 percent of GDP was spent on healthcare, though government expenditure amounted to only 0.7 percent. In lower-middle income China, 4.2 percent of GDP was spent on healthcare, with government expenditure amounting to only 1 percent (still slightly higher than in the US).

    What about per capita spending? The figures, in part at least, reflect the costs of healthcare in each country, and in high income countries the costs are far higher. In the US (where both the costs of health care delivery and private health insurance are very high, even in comparison to most other higher income countries), per capita spending on health in 2005 amounted to US$6,657. That’s a lot of money, and keep in mind that private individuals fork out most of this.

    In the UK, per capita spending on healthcare amounted to US$3,064, and similarly in Australia, to US$3,181.

    In China, where the costs of healthcare delivery are far lower, per capita spending on healthcare amounted to only US$81 – though the quality and scope of that healthcare was also no doubt more modest than it was in higher income countries like the US, Australia, the UK, etc.

    The Chinese central government’s new universal healthcare plan will no doubt help to keep costs low, since the prices of medicines and services will be regulated to keep them widely affordable, yet the percentage of GDP spent on healthcare will nevertheless rise significantly because of the planned increases in government expenditure.

    Provided the new healthcare plans are well implemented, future indicators should show real and significant improvements in China’s overall health outcomes – which as I said above, already compare favourably to many of its lower-middle income neighbours.

  6. Raj Says:

    China’s improving human rights situation

    Did you update your blog with the news of the scholar who was beaten up by Chinese government thugs because he visited Zhao Ziyang’s grave?

    Raj might possibly be correct when he says that more money will inevitably be needed

    Are you saying that you think, on the balance of probabilities, $30 billion a year for 1.3 billion people IS enough?

    China already spends a higher percentage of its total Gross Domestic Product on health care than most of its fellow lower-middle income neighbours

    Is it appropriate to compare China with Sri Lanka? It’s a far poorer nation with a significantly smaller GDP per head. Out of all the developing nations China was best placed to increase spending on healthcare yet dragged its heels. I don’t understand why it is only now bringing forward an “investment plan”.

    For a point of reference, India was spending as much as 5.1% of GDP on health care a few years ago. I don’t know whether that has dropped or not.

    The type of service the government hopes to achieve with the already allocated US$124 billion by the end of next year

    It’s supposed to be an investment strung out over 3 years. That’s only $40 billion a year, plus as far as I can see does not address long-term funding.

    Per capita health outcomes will no doubt continue to improve

    Is that civil servant-speak for “technically people will have more money spent on them but there’s no guarantee they will have significantly better access to medical services”?

    It’s like the phrase “basic healthcare provision”. It’s not defined anywhere. Until the government sets out what services they will provide (A&E, free prescriptions, cancer treatment, organ transplants, etc), who will be able to access them (e.g. anyone in any province, people have to visit the districts they’re registered in, etc) and other real factors I’m not going to jump for joy. I’ve just been disappointed too many times to assume it will be a success.

    By the way, would it be possible for you to not post with lots of references to “X says”, “Y says”? I have no idea who they are, and they aren’t raised in the blog entry. If you want to discuss them on your blog, please do but otherwise I find it makes it harder to read your comments. I’d like to know what you think and what your analysis is.

  7. Mark Anthony Jones Says:

    Raj – Chinese government thugs may very well have attacked somebody simply because they visited Zhao Ziyang’s grave, but this doesn’t mean that incremental improvements aren’t taking place in the area of human rights. At no time have I ever argued or even suggested that human rights problems don’t exist in China, or anywhere else for that matter. I examine the big picture in my essay, as you will appreciate if you read it.

    The US$124 billion is strung out over three years, to be spent, as I said, by the end of next year. Is US$30 billion over three years enough to provide a basic level of health cover for 90 percent of China’s 1.3 billion people? I don’t know. In 2005, per capita spending on healthcare in China was only US$81. If costs can remain low, then possibly it will be sufficient. The World Health Organisation, which was involved with the formulation of the plan, has endorsed it as a positive step forward. As far as I know they haven’t called into question to size of the financial allocation. You may be right though, as I have already acknowledged (in my initial comment) – larger sums of money may have to be allocated further down the track, especially if the central government wants to achieve, as it says it does, a more comprehensive level of universal healthcare by 2020.

    Is it appropriate to compare China with Sri Lanka? you ask. In my opinion yes, it is, since both countries are classifed by the World Bank as lower-middle income countries – they’re both in the same income class. At any rate, I compared China to all of its lower-middle income neighbours, as well as to some of its middle income neighbours. China performs favourably on most key health indicators according to the World Bank Development Indicators for 2008 report. It wasn’t as if I was comparing China to Sri Lanka only!

    Raj – you respond to my assumption that “per capita health outcomes will no doubt continue to improve” as a consequence of the healthcare reforms, by asking: “Is that civil servant-speak for ‘technically people will have more money spent on them but there’s no guarantee they will have significantly better access to medical services’?”

    No. I simply meant what I said. I expect per capita healthcare outcomes to continue to improve on all the key indicators, and I qualified this in my above comment by adding that this should be the case “provided the new healthcare plans are well implemented.”

    Are there any guarantees that these reforms will be uniformly well implemented? Of course not. I expect the process on the ground to occur unevenly, since social, economic and political conditions vary so greatly throughout both rural and urban China. I think it likely though, that incremental improvements will take place nevertheless.

    Raj – methinks you are a little too cynical at times. If you don’t want to “jump for joy”, then don’t. I’m generally quite optimistic though, as I expect there will be overall improvements in both the quality and accessibility of healthcare throughout China, with urban-rural disparities significantly reduced. Your cynical attitude is defeatist. It’s not a question of whether or not the glass is half empty or half full. It’s a question of whether or not the glass is in the process of being filled or tipped down the gurgler. When I look at the empirically-verifiable evidence, quantitative especially, I see incremental improvements over time in the area of human rights – both macro and micro. The details I provide in the essay on my blog, if you’re interested. You may choose to ignore such quantitative evidence, preferring instead to focus on qualitative evidence – on the horrors of individual cases, and in absolute numbers there are indeed plenty of horror cases out there. But by not quantifying such cases, you may end up with a rather distorted view – one that is scewed and inaccurate.

    Finally, you request that I refrain from quoting from the works of others when crafting my comments. Nobody apart from you, FOARP and Richard has so far complained here about my style. Most people here seem to appreciate my citing of sources, as well as my quoting from sources. I really don’t see what the problem is to be frank. The assessments I express here in my comments are MINE – they are a product of MY research, MY comprehension and MY synthesis. Because I integrate quotations from some of the sources I cite as a way of supporting MY arguments (which like everyone else’s arguments, are a product of synthesis), doesn’t equate to me hot having views of my own, which is what you seem to imply when you chip me for integrating quotations, adding that you’d, “like to know what [I] think and what [my] analysis is.”

    Anyway, in my last comment above I quoted nobody – though I did cite the source of the statistics I provided as having come from the World Development Indicators for 2008 report. In the comment before that, I quoted from only two sources: Minxin Pei and the China Daily: two brief quotes from Pei, and one from the China Daily, all in the space of six paragraphs. Surely that’s not over-doing it, is it? I suspect that the reason why you are being unnecessarily picky is because you don’t like me personally and because you disapprove of my way of reading China.

    That said, I do appreciate you engaging with me on this site. You may even grow to like me over time. You know, I’m not the “evil” cyber-equivalent of an “axe murder” that some people have made me out to be.

    In other words Raj, there’s no need to adopt such an aggressive tone when addressing comments to me. Let’s tolerate one another’s differing viewpoints with good humour and a friendly smile. That way we’ll BOTH enjoy our exchanges! 🙂

  8. Wahaha Says:


    While you ask others not ‘X says’ or ‘ Y says’, can you tell us where you heard the scholar got beat simply cuz visiting Zhao’s grave ? It got be ‘ X says ‘ or ‘ Y says. ” I personally believe it is someone who purposely picked the day to visit the grave when Chinese government forbid people to visit.

    You sound like one of those activitist thugs, in China or US or SouthEast Asia. When something is improved from F to C, you ask why having not reach B yet; when something is improved from C to B, then you ask why having not reach A yet. All you do is searching something that you can use to sell your agenda…

    People like you are the reasons why democracy doesnt deliver, but under democracy, there is nothing government can do on these thugs, as a result, government cant function properly, cuz POLITICS IS ABOVE ECONOMY, thanks to people like you. Like in New York, human right ? nah, it is all about ‘ giving me the F#$@ing money ‘ or ‘ vote me, I will get more money for you ! ‘

    BTW, in New York, subway fee will be increased hugely, AGAIN, almost all New Yorker complain about this hike. Why have there been no politicians and activitists talking about cut on MTA workers’ money ? Oh, yeah, they need MTA’s support for election, so they cant afford to offend MTA.

  9. Wahaha Says:

    Oh, there is also something you and all the westerners should know :

    It sounds great that government’s power should be limited, (to some extent, I agree.), it is more important to limit the power and influence of riches, ….. for your own good, unless you are among the top 5% of the society.

    What is really, really, really sad is that government is the only agency that can possibly limit the power of riches. If you, as an ordinary person, dont want to give some power to government, how will government have power over riches ? if a govenment have no power over a person who makes $10,000 a year, do you think the government can limit the power of a person who makes $10,000,000 a year ? So here is another really really really sad fact : the power of government over riches is proportional to the power you give to government, or how much power government have over your life.

  10. pug_ster Says:

    My guess is that China is trying to replicate Hong Kong’s healthcare system, where the government is providing the bulk of the basic care. By the time when the health care system in China is in full swing, there will be long wait times for non-critical procedures, like knee surgery, and such and long wait times to see a doctor if you are sick. However, the private practices are there for the middle and rich Chinese who can afford better quality and short hold times for care and procedures. Like I said, is it just my speculation.

  11. Mark Anthony Jones Says:

    Raj – one more thing that might interest you. I checked the figures for India, which is classified as a low income country – so it sits in a poorer income class than China. According to the World Development Indicators for 2008 report, India in 2005, spent 5 percent of its GDP on healthcare – higher than China’s 4.2 percent. Government expenditure on healthcare was also higher, at 3.5 percent compared to China’s 1 percent. The per capita expenditure on healthcare was lower, at US$36 (compared to US$41 in China).

    India does well in terms of healthcare expenditure given that it’s a low income country, although its actual health outcomes are poorer than China’s on most of the indicators. Although India spends more of its GDP on healthcare than does China, India struggles to effectively deliver quality services, with financial resources often misdirected or poorly spent.

    If you’re interested in knowing how the two compare, you can go to my human rights essay, where I present all of the healthcare statistics for both China and India (footnotes 39-45). Alternatively, you can read through the actual World Development Indicators for 2008 report, available online at:


  12. Mark Anthony Jones Says:

    Raj – sorry, one more small thing. A correction I’m afriad. In my above comment (Comment No.7) the line “Is US$30 billion over three years enough to provide a basic level of health cover for 90 percent of China’s 1.3 billion people?” is meant to read:

    “Is US$124 billion over three years enough to provide a basic level of health cover for 90 percent of China’s 1.3 billion people?”

    Sorry for the careless typing error – I was in a hurry and I’m also a little tired, having had a rather long day.

  13. bianxiangbianqiao Says:


    This is a very timely post. I feel the reform in medical care will be a major transition in China’s development model. But I don’t have the expertise to figure out how.

    Mark Anthony Jones,

    Thanks for the systematic documentation of the facts.

  14. TonyP4 Says:

    The better way is to BAN smoking. It will cut down the health cost by at least 25%, but it would cost more to take care of the elderly who would live longer after the ban. Common sense always works.

    Then ban all the fast food from the west.

    Prevention is the best medicine. Click TonyP4 to check out many helpful hints on health.

  15. TonyP4 Says:

    Learn from Canada on universal health care. I posted the following at FM not too long ago.

    Universal health care is good and bad as most systems are. Usually Canadians adopt what works in US, but not this time. Some die because the system does not allow them certain treatments or they’re in the waiting list too long.

    US has a lot of holes in the current system. When you go to emergency, you’re automatically covered in most states, even you’re illegal aliens. Not so as a regular doctor’s visit for the same health problem. The poor in Mass is pretty much covered except dental for adults.

    My proposal, ideal but not practical or too many politicians/purists twisting my arm… A safety net for basic treatment for all. The better coverage is paid for by individual. My point is to encourage folks to work hard, make more money and pay their own health coverage. Nothing special, noble – just common sense.

  16. miaka9383 Says:

    A better way is to put tax on cigarettes. High tax on cigarettes and use that tax to fund a universal health insurance coverage. I have been thinking a lot the other day and I think, instead of universal health care, we should just enable universal health insurance coverage so everyone is covered.

  17. Mark Anthony Jones Says:

    Raj – sorry again, but I have just noticed yet another small error in my Comment No.7. The line that reads “The US$124 billion is strung out over three years, to be spent, as I said, by the end of next year” should instead read:

    “The US$124 billion is strung out over three years, to be spent, as I said, by the end of 2011.”

    Perhaps the owner of this site might like to make these corrections to Comment No.7 for me, and then delete these last two comments of mine!

  18. Mark Anthony Jones Says:

    bianxiangbianqiao – thanks for your encouraging response.

    TonyP4 and miaka9383 – I agree, preventative measures like making cigarettes less affordable and accessible would make a long-term difference, eventually improving per capita health outcomes whilst simultaneously minimising expenditures.

  19. Shane9219 Says:


    In China, Zhao Ziyang was often compared with Mikhail Gorbachev. These two people were not popular inside their countries.

    Unfortunately, this particular professor brought trouble to himself by announcing his personal vist on his Internet blog. He did not have any similar problem before.

  20. miaka9383 Says:

    So he said something on his blog and so he deserved to get beat?
    Also, I was reading on UDN this particular professor was under police surveillance, so the police didn’t do anything?

  21. Shane9219 Says:

    @miaka9383 #20

    I condemn such beating action myself. Police should investigate this case and hold those people responsible. It showed rule of law still has a long way to go in China.

  22. miaka9383 Says:

    Lack rule of law is a sad sad thing indeed. I just can’t believe that the police stood by and did nothing, well I can.. but I think if I were them I would’ve stopped it…

  23. scl Says:

    Building health care facilities and expanding medical education are excellent stimulus for the economy. The current economic downturn seems like a godsend for China’s long term prosperity. I hope most health care workers will become civil servants, and most hospitals and nursing homes will become public facilities.

  24. Steve Says:

    After reading Allen’s thorough synopsis and everyone’s comments, I was curious as to how quickly medical care could be ramped up. It seemed to me that increasing the number of qualified professionals, both doctors, nurses and other medical staff, would be critical in implementing the increased care. I was able to find some information at this site, which claims there are 106 doctors per 100,000 people, which comes out to one doctor per every 943 persons. I’m not sure how accurate this number is, but I would think the quality of medical care would be directly related to the workload and accessibility of the nation’s doctors, and the thoroughness of their medical training.

    Here is another chart showing the numbers and ratios of doctors and hospital bed in both urban and rural areas between 1952 and 2002. The numbers have increased significantly for both in urban areas, but for some reason the numbers have flattened or even decreased in rural areas in recent years. It would seem the major focus will be to spend most of the money in the countryside to improve medical facilities and conditions there.

    In my opinion, just spending money isn’t an answer in itself. It takes time to train medical professionals and build proper facilities. It isn’t how much money is spent, but how that money is spent. A hospital without trained doctors and nurses is just an empty shell.

  25. huaren Says:

    @Steve, #24

    “The numbers have increased significantly for both in urban areas, but for some reason the numbers have flattened or even decreased in rural areas in recent years.”

    That’s because hundreds of millions of people are moving into urban areas lately. Also, the remaining 700-800million will continue to migrate to a point where the ratio between urban and rural areas will approach that of the developed countries. This is a massive transformation.

    Doctors and lawyers are 2 of the highest growth professions in China for decades to come.

  26. huaren Says:

    @scl, #23

    Really good point.

  27. huaren Says:


    I agree with other readers here – thx for your compilation of facts – lots of work, no doubt!

  28. miaka9383 Says:

    The thing is… less and less people want to be in the healthcare profession. Being a nurse have great pay, but long hours and you have to be extremely patient to do this job… and getting into med school.. graduating from it… and internship and resident programs are so selective now that not many young people wants to go that route

  29. Steve Says:

    @ huaran #25: You make a really good point about the population shift to urban areas. With the huge influx of people moving to the city, I’d expect there’d be a much greater shortage in urban areas. But I wonder how many existing hospitals are in rural areas, or how many doctors want to practice in rural areas?

    That’s always been a problem in developed countries where doctors can make more money by living in cities with their greater populations. There is also a much better chance that urban patients would have more comprehensive insurance, while farmers in rural areas would have to draw from their savings.

    My point was that no matter how quickly China wants to develop it’s medical capabilities, it takes time to do so. I was addressing Raj’s point that the spending levels weren’t as high as maybe he’d like to see them. I don’t know if spending is really the main obstacle here. I would think developing enough professionals would be the more time consuming task. Basic coverage is the most important aspect since that would hopefully encourage spending among the people, but overall medical care is also important.

    miaka, I’m not sure if the long hours are really a concern in China. The normal working day is 9 to 6 but no one ever leaves at 6. It’s typical to stay until 8 or 9 and many companies work Saturdays. The shifts for nurses might be fewer hours per week than a normal office job. It might come down more to the pay scale. US medical people earn a lot but I know doctors in South America earn considerably less. I’d expect medical personnel in China to earn far less than in the USA, but it might still be a very well paid job over there. Does anyone know what the pay scales are for both doctors and nurses? Does it vary according to location?

    A friend of ours visited one of the hospitals in Pudong and said the doctors were all trained in the States and the medical facilities were excellent. She also said the prices were very inexpensive compared to the States, but it was unusual to find a hospital that nice in China. She and her husband currently live in Shenzhen but preferred that hospital in Shanghai.

  30. Allen Says:

    I have enjoyed reading the many points people are making.

    I wonder if it’s overkill to consider this article from McKinsey on the challenges and rewards of implementing universal healthcare across the world.

    Here are the introductory paragraphs:

    Health care systems around the world struggle to reconcile three competing objectives: equitable access, high quality, and low cost. The trade-offs among these goals are inherently political. Should governments, for example, ration capacity in order to lower costs, even if doing so creates longer waiting times for care? Should they provide coverage to all citizens? Mandate quality standards?

    As political and local as such choices may seem, many of the challenges reformers face are common to almost every health care system: for instance, increased supply creates additional demand for care and often fails to generate commensurately better outcomes, such as longer life expectancy. In many countries, higher spending does not correlate with higher-quality health care as perceived by consumers.

    The universal features of health care systems across the developed world suggest that today’s reformers, who tend to be piecemeal in their interventions, would benefit from a more holistic approach: one that recognizes the strong interdependency of seemingly autonomous actions. Reformers need a comprehensive perspective lest their remedies for one aspect of a health care system generate unintended—and potentially negative and costly—implications for another part.

    As political as designing healthcare systems may be, here is an area where I definitely think China can learn from the experiences of the developed world… 😉

  31. miaka9383 Says:

    Lets hope that China won’t develop a health care system as crappy as the one in U.S

  32. Allen Says:

    My personal thought (for now) about universal healthcare can be boiled down to the following.

    Is universal health more about insurance (distributing risks among individuals), savings (forcing individuals while healthy to save up for a rainy day) or socialism (contribute what you can, take what you need)?

    If it’s about insurance – and we know ndividuals have different state of health and may desire different levels of care – to what extent should universal healthcare be fragmented to allow such variations? What should we do about freeloaders (individuals who refuse to participate in paying premiums but will require medical care later on)? Should government mandate lifestyles (no smoking, daily exercises, etc.) as part of effort to reduce burden on healthcare system?

    As technology advances and provides more and more ways for people to extend their lives – is it morally ethical for an insurance regime to make private medical decisions based on public health criteria? That is, is it morally ethically for example for the government to say approve heart bypass surgery for someone in their 50’s but not someone in their 80’s – as part of a scheme to optimize cost/benefit? This is not just a teaser philosophical question. It goes I think into the essence of what the purpose of a universal healhcare regime is.

    Should government cap medical spending for a society at a fixed % of gdp and then “equitably” distribute that fixed resource within the population – or should this be economically / socially driven?

    In competitive economies, quality and price are set through competition. In an insurance regime (where price is centrally set), what are the incentives for cost reductions (while keeping quality high)? What is to prevent people from perpetrating insurance fraud (e.g. overbilling) – which seems to be a systemic problem not just in China, but also in developed economies like the US (e.g. insurance code manipulation, saying you did X when you only did Y, because X cost twice as much as Y)?

    These are general issues that China will have to deal with if it is serious of setting up a working, comprehensive healthcare regime.

  33. Allen Says:

    Does anyone know what “grass-root level” hospitals mentioned in the announcement cited in the post are?

  34. huaren Says:

    Allen, #30

    “The universal features of health care systems across the developed world suggest that today’s reformers, who tend to be piecemeal in their interventions, would benefit from a more holistic approach: one that recognizes the strong interdependency of seemingly autonomous actions. Reformers need a comprehensive perspective lest their remedies for one aspect of a health care system generate unintended—and potentially negative and costly—implications for another part. ”

    Interesting quote from McKinsey.

    I would think with China’s form of government, its easier to avoid this “piecemeal”-ness.

    If China succeeds with this reform, then this is another great example why government system must fit “time and conditions” of a society – there is no magic pill solution as a lot of boneheads out there religiously pay homage to.

  35. huaren Says:

    @Steve, #29

    Also, don’t forget – I believe the current Chinese citizens tend to take a lot more personal responsibility. In the U.S., there is a very very strong sense of entitlement and feeling that everything is screwed up. Chinese people are also accustomed to less privacy – in many hospitals, you could have 10-20 people in line with a doctor in a room – cookie cutter fashion.

    To me, the key is the average Chinese citizen feeling they have equal access to care as most other Chinese people.

    I completely agree it takes time. If urban care is better than rural care, that accelerates China’s population migration. In aggregate, more labor moves into non-farming activities. I don’t even see this better care between urban vs. rural as that big a deal.

  36. JXie Says:


    The urban/rural stats have a very easy explanation. When a town is reached certain size and level of urbanization, it is converted to a city. There have been quite a lot of conversions overtime. For example, Dongguan officially became a city in 1985, so stats-wise hospitals in Dongguan were considered rural in 1984, but urban in 1985.

  37. Raj Says:


    While you ask others not ‘X says’ or ‘ Y says’, can you tell us where you heard the scholar got beat simply cuz visiting Zhao’s grave ? It got be ‘ X says ‘ or ‘ Y says. ”

    You miss the point, as usual. I wasn’t forbidding people from citing sources, I was asking him for his views.

    I personally believe it is someone who purposely picked the day to visit the grave when Chinese government forbid people to visit.

    Lol, what “special” days have come up recently that would require the Chinese government to forbid anyone to visit his grave? Since when is Tomb Sweeping Day linked to national security or a “provocative” choice? Forbidding people to go to graves at that time of year would be like forbidding cities from having firework celebrations on Chinese New Year!

    You know, sometimes I think you can’t say anything more ridiculous and then you surprise me!


    In China, Zhao Ziyang was often compared with Mikhail Gorbachev. These two people were not popular inside their countries.

    He was compared to Gorbachev for being associated with pushing for reform. But I don’t agree that Zhao is unpopular. He was actually a very popular man when in power and remembered fondly afterwards. Even after his death the censors had to lock down many forums because the online tributes were flooding in and they couldn’t control them. In contrast there were few comments that I’ve heard of saying he was as bad as Gorb – I didn’t read any to be honest.

    Unfortunately, this particular professor brought trouble to himself by announcing his personal vist on his Internet blog. He did not have any similar problem before.

    Shane, last time I looked visiting someone’s grave and saying you’ll do that is legal. People should receive protection from the State, not victimised by it because they’re willing to say what they want to do rather than skulk around and pretend they’re not doing it.

    The Police won’t investigate or if they do it’s highly likely they’ll ignore the people who actually ordered the attack.

  38. JXie Says:

    BTW, some of the “studies” done by the likes of Minxin Pei and Yasheng Huang neglect this conversion factor. For instance, an often quoted “fact” is that the rural income in the 90s and 00s haven’t been growing as fast as the urban income. This _may_ not be the case. The rural towns being converted each year tend to be among the richest rural towns. An example would be let’s say each American gets 5% pay increase each year, but the top 1% will be taken out (to say a happy island somewhere). Likely stats-wise the average income increase will be far less than 5%.

  39. huaren Says:

    @JXie, #36

    Great point. Probably the biggest factor vs. that stat.

  40. Steve Says:

    @ JXie: I agree with Huaren, both of you had great points. I had forgotten that China has been undergoing rapid urbanization so not only are people leaving the country, but towns are becoming cities and this trend is going to continue in the foreseeable future so the statistics will continue to skewer in this fashion. Thanks for bringing this to our attention!

  41. Mark Anthony Jones Says:

    Raj said: “I wasn’t forbidding people from citing sources, I was asking him for his views.”

    But quite clearly I was expressing my views. As I said earlier in response to your request: “The assessments I express here in my comments are MINE – they are a product of MY research, MY comprehension and MY synthesis. Because I integrate quotations from some of the sources I cite as a way of supporting MY arguments (which like everyone else’s arguments, are a product of synthesis), doesn’t equate to me hot having views of my own.”

    Allen – in comment No.32, you raise a number of interesting questions, providing real food for thought. I guess we’ll all just have to wait and see how these reforms evolve over time.

    huaren – thanks for your encouraging comment (No.27).

  42. imagebilly Says:


    Indians should do better focusing on the development of their own country, whose progress is really a shame to democracy.

    It’s telling that Mr. Singh felt the need to be defensive about India’s “democracy” the other day. Oh yes, democracy really needs to be defended because it failed the Indian people. Poor Singh, he forgets that democracy is a means not an end.

  43. Raj Says:

    Indians should do better focusing on the development of their own country, whose progress is really a shame to democracy.

    This is a blog about China is it not? You’re not suggesting non-Chinese should be forbidden from talking about China, are you?

    But as I’m not Indian, nor is anyone else here as far as I know, your point is nonetheless irrelevant.


    MAJ, I may be somewhat cynical but that’s because the CCP has done little to warrant my good faith. The (relatively recent) economic growth, whilst welcome, can at best only make up for the lost decades of potential development from 1950 onwards and at worst provide token compensation. It can’t make up for the decades of cruelty and current abuse dished out to those who are so “outrageous” as to openly state they are not satisfied with the status quo.

    Things have improved for many Chinese, which is good (though as I said they lost out for many years too). But I cannot celebrate the “middle class deal” between affluent Chinese and the CCP – no political development in exchange for them having a good time – as it leaves poor Chinese at the whim of economic tides and officials. I cannot enjoy wealth if I know if my fellow countrymen and women suffer from poor/no civil rights so that I can enjoy it.

    The news announced is a welcome start, but it can only be a start if Chinese are to have not just a basic but necessary level of health care. I need to see a long-term financial commitment – i.e. a significantly larger public budget – before I will believe a final solution is on the cards. Otherwise I will wait and see.

  44. Mark Anthony Jones Says:

    Raj – I’m going away camping for four days (about to leave home now) but I will respond to your last comment above in detail when I get back.

    Thanks for your patience,

  45. Raj Says:

    You don’t have to respond in detail, you can just respond. Go on, limit yourself to five minutes and see what you come up with.

    I prefer to have conversations with people rather than read mini-essays.

  46. yo Says:

    Nice topic guys. This “Universal health care” isn’t the type we are looking for in the States(ie in respect to the quality), but a good move forward. Judging from my own perspective of providing basic health care, it really doesn’t take much to make a big impact so I’m glad to hear the government is moving in this direction. I’m interested to see how they implement this plan, which i think is the challenge.

  47. Mikhail Says:

    Laudable aims. Let’s hope the plan is implemented. I was recently in a hospital in a poor part of Yunnan. The relatively wealthy and government employees could afford basic treatment. But the poorer rural residents could not afford even basic care. I saw one tragic case of a young women with diabetes, who could not afford the insulin she needed to stay alive.

  48. TonyP4 Says:

    We need to face reality. China is still a poor developing country. 100% sure you cannot implement similar plan as in Canada or any developed country. All the talks are just talks. Even if you can afford to spend $1,000 per person, it is not a big sum in the west’s standard but a lot in China compared to China’s per capita income of about $4,000 (or so depending on which report you use).

    You need a mean and effective way to deal with.

    1. As in my comment #14, prevention is the most mean and effective way for health care. When you ban (or discourage it by raising taxes as Mia suggests), tobacco, fast food…, you could cut down 25% (my rough estimate) of country’s health cost.

    2. Public health education is another one. Like AIDS education (Africa is the worst example), tobacco, fast food, exercise…

    3. Provide clean water and air.

    4. Regulation and enforcement on food products.

    As in message #15, there is nothing wrong to encourage folks to work hard and get a better health care coverage than the basic.

  49. Shane9219 Says:

    Full Text: National Human Rights Action Plan of China (2009-2010)




    I. Guarantee of Economic, Social and Cultural Rights

    (1) Right to work

    (2) Right to basic living conditions

    (3) Right to social security

    (4) Right to health

    (5) Right to education

    (6) Cultural rights

    (7) Environmental rights

    (8) Safeguarding farmers’ rights and interests

    (9) Guarantee of human rights in the reconstruction of areas hit by the devastating earthquake in Wenchuan, Sichuan Province

    II. Guarantee of Civil and Political Rights

    (1) Rights of the person

    (2) Rights of detainees

    (3) The right to a fair trial

    (4) Freedom of religious belief

    (5) The right to be informed

    (6) The right to participate

    (7) The right to be heard

    (8) The right to oversee

    III. Guarantee of the Rights and Interests of Ethnic Minorities, Women, Children, Elderly People and the Disabled

    (1) The rights of ethnic minorities

    (2) Women’s rights

    (3) Children’s rights

    (4) Senior citizens’ rights

    (5) The rights of the disabled

    IV. Education in Human Rights

    V. Performing International Human Rights Duties, and Conducting Exchanges and Cooperation in the Field of International Human Rights

    (1) Fulfillment of international human rights obligations

    (2) Exchanges and cooperation in the field of international human rights

  50. Mark Anthony Jones Says:

    Shane9291 – thanks for providing the above link. As I argued in the essay I wrote on China’s improving human rights for my China Discourse website, the central government in Beijing does take human rights seriously, and the overall human rights situation in China has been steadily improving over the past 25 years. Even the U.S. State Department notes that China’s modernisation has ‘improved dramatically the lives of hundreds of millions of Chinese, increased social mobility, and expanded the scope of personal freedom. This has meant substantially greater freedom of travel, employment opportunity, educational and cultural pursuits, job and housing choices, and access to information.’

  51. Mark Anthony Jones Says:

    Raj – I’m back early from camping (due to wet weather), and I will respond to your last comment tomorrow morning. I’m plan to spend the rest of this dark wet Sydney day in a nice cosy pub.

  52. TonyP4 Says:

    For a poor country like China, prevention gets the best bang for the money. They cannot afford the expensive drugs and treatments from the west. However, prevention and eating healthy beat them by a mile.

    To summarize, no smoking, limited liquor intake, lot of vegetables, less meat/oil/fried food, lot of rice, wheat…Lot of sex too. 🙂

    I came across an article on how to cure diseases even with cancer by eating healthy with 10 grains. It is in Chinese but the above covers the main points.


    Like to share it with FMers and good health to you all.

  53. Mark Anthony Jones Says:

    TonyP4 – I agree with you, focussing on prevention is the best way forward.

  54. Allen Says:

    @TonyP4 #52,

    Yes … prevention is better than treatment most of the time…

    But I have 2 questions:

    1. How do you mandate behavior changes? If people don’t change – do they not get public care? Is it realistic to ask for mass scale change in smoking habits (esp. when tobacco is so profitable?)?

    2. For the more “modern” expensive care – I assume doctors will be allowed to perform them … presumptively for the “rich”? Is it sustainable to have two health care systems – one basic geared for public health – another private geared for the rich? Is that fair? Wouldn’t there be pressure to expand the basic to incorporate more expensive treatments?

  55. Mark Anthony Jones Says:

    Allen asked: “How do you mandate behavior changes?”

    This is a very good question. I actually addressed this in some small detail in a comment I left on another thread here – the one about universal education, which was somehow subverted back onto the topic of healthcare. As I suggested:

    Only if China can maintain relatively low per capita rates of obesity, cancer, etc, (all of which, alarmingly, are on the rise) through its more traditional emphasis on prevention, will it be able to continue to produce impressive per capita health outcomes on its relatively modest budget.

    To do this will require more government regulation – to make fast foods more expensive and so less appealing (perhaps through taxation, and through planning laws that restrict the number of outlets allowed in a given area), along with a sustained and widespread public health education program.

    In other words – some measure of socialist planning, rather than excessive capitalist “freedom”. China, like much of Western Europe and Australia, strives to maintain a mixed economy, and so some kind of balance will always be required.

  56. TonyP4 Says:

    Hi Allen, I think MAJ, MIA and I addressed some of your questions. Let me expand a little.

    #1. Public health. We can incorporate some of what worked in US or any developed country into China’s existing system.

    * Public messages on the harms on smoking, fast food… are required to broadcast on TVs to educate the masses. Ban cigarette ads as in US.

    * Voluntary Enforcements. Span smoking in public places, government buildings…Encourage corporations to do same.

    * Non-voluntary Enforcements. Extra taxes on cigarettes and fast foods. Food product inspection/enforcement. Water and air pollution control…

    #2. See my message #15. It is OK to have one basic system for basic care and you need to pay for more expensive treatments via a paid insurance system. It is nice to cover every one with all help, but be realistic as it would bankrupt China or any developing countries. Your health care expense is a percent of your average income per capita.

    Prevention goes a long way. Check out my blog on the benefit of a 10 grain diet that could prevent (and cure some) almost every disease. Not 100% true but very cost effective.

    Foreign cigarettes and fast food are the flies when Deng opened the window. If they’re not controlled, it will cause a lot of harm. The young think cigarettes could release the high pressure in the competitive world of today’s China. The parents and grand parents spoil their kids by taking them to McDonald’s without realizing the harm.

    If banning cigarettes would help closing 20% of hospitals (fact or myth for you to decide), how much it costs to build 20% of all existing hospitals, training 20% of health folks to run the hospitals… Obesity (due to fast food, lack of exercise…) is a fast rising problem. China’s obesity problem could be same as in US after 50 years.

  57. TonyP4 Says:

    Correction. Use ‘ban’ instead of ‘span’. I need my cup of coffee before I write. Have a good day!

  58. S.K. Cheung Says:

    Canada has 1/40 of China’s population, and though we have universal health care, it is becoming increasingly difficult to sustain, as it eats up a growing proportion of tax dollars. So if China can pull it off, for that many people, it would be a great achievement. As others have said, certainly a laudable goal.

    I agree with Tony and Allen that prevention is great. But as Allen says, how do you mandate behaviour, especially when it comes to consumption of a legal product like cigarettes? Plus, prevention is not sexy, and it takes a long time to bear fruit. In the meantime, you’ll still have guys with grapefruits on the side of their head who need someone to cut it out for them.

  59. TonyP4 Says:

    China encourages its citizens to smoke cigarettes to stimulate its economy.

    This could be the STUPIDEST statement from any government and the BIGGEST joke of the year. Who made that statement should be fired and then retire with a good pension from the cigarette industry.

    Besides the cigarette industry, it would stimulate jobs in hospitals and funeral services. 🙂

  60. Allen Says:

    @TonyP4 – we’ll put a post on that absurd incident soon!

  61. Cedric Timchula Says:

    Hi there, nice page however there is a issue whereby on occassion I get sent back to the root page when I look at other posts within your blog.


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