After the formation of the People's Republic of China, significant improvements occurred in the medical care of the population, as well as in their living conditions. In terms of the main comprehensive indicator of population health - life expectancy - over this time, China has left the category of poor countries and risen to the level of the bottom group of middle-income countries.

These indicators also correspond to the provision of the population with the assistance of qualified medical personnel, although access to such assistance varies greatly by place of residence.
However, medical statistics indicate that the main positive changes in the health of the population were achieved in the pre-reform period of the existence of the PRC. Thus, a sharp reduction in child mortality occurred 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 rate of government 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 expenses in GDP. The share of the state in healthcare expenditures in China was only 38.8% in 2005, while in the world as a whole it reaches 56%. Only 1% of the state budget goes to healthcare in China, while in total, in low-income countries around the world, 4.6% of public funds are spent on these purposes. Since the beginning of reforms in 1978, the share of the state and employers in the structure of total health care expenditures has steadily declined, and the share individuals- 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 healthcare costs were borne by the citizens themselves.
The average per capita cost of treatment for citizens is growing much faster than their income. From 1998 to 2006, the average annual per capita expenditure on ambu-

laboratory treatment increased by 13%, and hospital treatment by 11%2. According to sociological surveys, the population in China places high prices on medical services in first place among all social problems3. Expenditures on these services account for an average of 11.8% of the family budget, second only to expenses on food and education. In 2003, a peasant's net annual income averaged 2,622 yuan, and the average cost of his hospital stay reached 2,236 yuan. Therefore, for most peasants, hospital treatment is unaffordable.
Behind last years the number of hospitals and health centers, as well as the number of qualified medical personnel, began to decline, although the number of hospital beds increased. The number of certified medical personnel per 10 thousand people during 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 is especially noticeable medical workers affects not in cities, where it is actually not observed, but in county centers. It is at the county level that the shortage of technical personnel is acute. It is also not very clear where the additional beds are located: in extensions to the main hospital buildings or through densification. The question of the quality of services in this situation, with a reduction in medical staff, already seems unnecessary.

Social inequality in access to health services has increased. According to a study conducted by the Chinese Academy of Social Sciences, 80% of government spending on medicine goes to serving a social group consisting of 8.5 million government officials and party functionaries. 2 million government and party officials of various ranks take long-term sick leave. Of these, 400 thousand people spend long time in special hospitals for treatment and recreation, the costs of which amount to 50 billion yuan per year4.
For the urban population in China there is a system health insurance. However, students, people without permanent employment, the unemployed, and rural residents coming to work in the city are excluded from this system. Until recently, compulsory health insurance did not apply to employees of non-state enterprises. New law on labor contracts obliges entrepreneurs to provide their employees with health insurance. But many of them shirk this responsibility by hiring mainly migrants and not concluding an employment contract with them. According to the Report on Key Findings of the 3rd Public Health Services Survey, in 2003, 44.8% of urban residents and 79% of rural residents had no health insurance. The proportion of people without health insurance is especially high among low-income people. At the same time, she was constantly growing. In 1993, approximately 50% of the urban poor lacked health insurance; in 1998, 72%; in 2003, 76%.
In recent years, work has been carried out in the village to create a medical care system 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 that require hospital treatment. The peasant pays an annual contribution of 10 yuan to the rural cooperative insurance fund, and the central and local authorities pay another 20 yuan per person. It is planned to expand the coverage of rural areas by this system from year to year and to complete its expansion throughout the entire country mainly by 2010.5 So far, 80% of government allocations for health care are directed to the city and only 20% to the countryside. On a per capita basis, these allocations are 4 times greater in the city than in the countryside (38.3 yuan versus 9.9 yuan). Complete or partial loss of ability to work due to 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 thousand yuan (about $1,000), which is more than three times the net average annual income of a peasant.
In China, there is a heated debate about the causes of the unsatisfactory state of healthcare and the most optimal ways to overcome it. Liberal “market people” are opposed here not so much to ideological “anti-market people”, but to those who, sharing in principle the orientation of the economy towards market relations, are not ready to leave the most sensitive areas for the people entirely to the market and place a significant share of responsibility for them on the state .
Liberals blame everything on the old planned economic system and its remnants. The planned system, from their point of view, is responsible for the fact that the service sector in the countryside, like the agricultural sector in general, has been sacrificed for decades to the development of heavy industry. Accordingly, the main problem with healthcare is that it is not sufficiently included in market relations. Formally, everything seems to be going well. The market allocates resources. Any capital is allowed into the field of medical services. The creation of new structures and the direction of services are determined mainly by market demand. But in fact, over more than two decades of reforms, conditions for the creation of non-state hospitals have not emerged. Prices for medical services and drugs are still controlled by the state. They are installed not by hospitals, but by relevant government departments. Hospitals, on the other hand, can only operate within a certain price range.
As of 2003, 96% of hospital beds, equipment and medical personnel are concentrated in public medical institutions. Relying on long-term government support, a few hospitals have concentrated the best resources and achieved a monopoly position with which non-governmental medical institutions cannot compete. This situation is considered abnormal. It is argued that in a market economy it is impossible to preserve the reserves of non-market relations, that healthcare has no choice but to undergo market reform. The weight of this position is reinforced by the fact that it is backed by the interests of national and foreign capital, which is ready to invest billions of dollars and yuan in Chinese medicine, considering it as a potentially extremely profitable area for investing capital.
Opponents of marketers, on the contrary, see the main troubles of healthcare in the loss of social significance by state medical institutions and in their excessive pursuit of material gain. It is noted that in state non-profit medical institutions wage and employee bonuses, as well as the operating expenses of institutions, are mainly financed by their own commercial activities, while the share of government funding does not exceed 6%. This is where doctors strive to prescribe a lot of expensive medications to patients and prescribe expensive examinations and procedures. The state controls prices on approximately 20% of those trading on pharmaceutical market drugs and has repeatedly reduced prices in recent years. However, market-regulated drug prices are rising, sometimes manifold. In the vast majority of medical institutions, markups on the price of dispensed drugs reach 30-40%, far exceeding state established standard is 15%. According to the World Bank, in 2003, drug spending in China accounted for 52% of all health care spending, while in most countries it does not exceed 15-40%. At the same time, from 12 to 37% of prescriptions are not necessary. According to a survey of one hospital conducted in 2000, 80.2% of patients were prescribed antibiotics, including
58% - two or more drugs. The fee for a single course of treatment in a hospital sometimes exceeds the average annual salary. From 1990 to 2004, expenses for ambulatory treatment in general hospitals increased by 12 times, for treatment in a hospital - by 10 times. According to statistical yearbooks on health care in China, during this period, the average annual earnings of doctors increased in central hospitals by 11.6 times, in provincial hospitals by 8.2 times, in district hospitals by 6.8 times, and in county hospitals by 5.5 times.
In the spring of 2005, Deputy Minister of Health Ma Xiaohua spoke about the need to defend 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 two decades of health care reform, which placed the main emphasis on the introduction of market relations. There was a widespread campaign in the press for the state to take the main role in solving health problems. A 2005 joint 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 an insufficient role of the state.
The country's leadership once again found itself faced with a dilemma: in what direction to continue the healthcare reform - whether towards further denationalization, the sale of medical institutions, or, on the contrary, back towards the previous state medicine. Or try to somehow combine these principles. Essentially, such debates have not stopped throughout the entire period of reforms, but today the hour has come when it is necessary to make a fundamental choice. A serious epidemic has given particular urgency to this problem. atypical pneumonia in 2003, when all the shortcomings of Chinese healthcare were exposed.
One of the leading theorists and designers of Chinese economic reforms, deputy head of the Center for Development Research 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 out the objective financial and material difficulties faced by the reforms. Thus, in the USA in 2004, $1.8 trillion was spent on healthcare needs. In China in the same year, the entire GDP amounted to $1.6 trillion. At the same time, the population of the USA is slightly more than 200 million people, and the PRC - from above
1.3 billion. If you calculate the costs of treatment and medicine 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 the entire expenditure portion of all budgets of central and local governments at all levels would be spent on this.
Such arguments, however, do not convince everyone. Opponents point out that over the last century, more than 160 countries around the world have sooner or later created various systems social security and health insurance. Moreover, 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 they all managed, using the limited financial resources of their time, to provide decent treatment to their citizens. Why is China unable to do this?
In determining the future path of health care reform, Beijing is closely looking 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 Reform, which visited these countries, found a lot of useful information there, especially in the relations 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 extension of market relations and privatization to healthcare 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 abandoned the privatization of the social insurance fund. The main element of the reform in Poland and Hungary was the creation of independent national 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 the 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 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 increasing role of the state, primarily the central budget, in financing health care and medicine, while simultaneously using various forms of cooperation with private capital. This helps reduce 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 created a coordination group for health care reform, which included representatives of one and a half dozen ministries and state committees. At the end of 2006, most departments approved the project presented by the Ministry of Health, which provided for the provision of practically free medical services in municipal hospitals to almost all city residents. Total government spending under this option was estimated at 269 billion yuan.
At the beginning of 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 McKenzie 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 announced its point of view on health care reform. It boiled down to the fact that medical services should be paid, thereby aligning 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 were focused primarily on the leading role of the state, less - on the market.
In July 2007, the State Council of the People's Republic of China published a document entitled "Guiding Considerations on the Deployment of Experimental Basic Health Insurance Sites for the Urban Population," which called for increasing the number of experimental cities 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 mainly on subsidies to the population covered by the insurance system, rather than on increasing investment in public health. medical institutions. Thus, a course towards the development of the medical services market was proclaimed.
Hu Jintao's report to the 17th CPC National Congress in the fall of 2007 placed more emphasis on the government's responsibility for health care reforms. They spoke about the need to strengthen the generally beneficial nature of healthcare and increase the investment activity of the state. At the meetings held after the congress, it was decided on the basis of existing independent development prepare a new consolidated draft of health care reform “with Chinese characteristics” and present 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 cities and villages.
The controversy between supporters of a predominantly market-oriented and predominantly statist-oriented reform in China has not ceased. The latter advocated establishing low costs for hospital services and reducing to a minimum differences in prices for 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. It was proposed that hospitals be allowed to continue charging for treatment, but 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 path to further increasing corruption.
Against this background, the Health Development Program for the 11th Five-Year Plan (2006-2010) was adopted in 2007. The document noted certain achievements of the previous five-year period (2001-2005). The average life expectancy has increased to 72 years (by 0.6 years compared to 2000). Mortality among newborns, infant mortality and mortality of children under 5 years of age have decreased. Work has intensified on AIDS prevention, identification and treatment of patients with tuberculosis and a number of other serious diseases. The water supply and sewerage networks in the village have expanded significantly. Investments in healthcare have increased. The systems of cooperative medicine in the countryside and the provision of health services at the community level in the cities have been strengthened.
At the same time, the presence of serious unresolved problems was noted. AIDS begins to spread from risk groups to the general population. The number of tuberculosis patients has 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. 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. Danger is growing occupational diseases. The level of protection of motherhood and infancy is low, especially among migrants, and the differences between cities and villages are significant. Village residents suffer more from AIDS, tuberculosis, hepatitis, schistosomiasis and local diseases. Only 18.5% of the staff of volost and village health centers have higher education.

The program provided guidelines for the development of all healthcare subsystems and determined specific targets for 2010 for further increasing life expectancy and reducing mortality in different age groups.
In the spring of 2008, Premier of the State Council of the People's Republic of China Wen Jiabao, in a report on the government's work at the NPC session, emphasized the need to carry out health care reform in order to ensure everyone has access to basic medical services. The central government announced the allocation of 82.5 billion yuan (about
11.7 billion dollars), which was 16.7 billion yuan more than the amount allocated for these purposes in 2007, with the bulk of the funds
was intended to strengthen the lower levels of the health care system in cities and villages.
A number of deputies who spoke at the sessions of the NPC and the CPPCC, while welcoming the government’s intentions, objected at the same time to the state monopolization of the public health system, in particular in such areas components, such as women's and children's health, prevention, control of infectious diseases, environmental sanitation, health promotion, ambulance. The state was not recommended to invest large funds in capital construction and large equipment. In the interest of creating inexpensive and effective system public health, the government was offered, using market competition methods, to buy the services of medical institutions. Instead of directly investing funds in the medical service system, he was charged with investing them in health insurance authorities, buying 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 pledged to promote the development corporate governance, stimulate the attraction of both state and non-state capital in the development of domestic healthcare.
In April 2009, two documents were officially published aimed at accelerating the development of healthcare in the coming years: “Considerations of the CPC Central Committee and the State Council of the People's Republic of China on deepening the reform of the healthcare system” and “Project for the implementation in the near future (2009-2011) of key programs in areas of pharmaceuticals and healthcare." The first document was presented for open public discussion 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 - basic health insurance, the rural population - rural cooperative medicine. By 2010, the standard amount of subsidies for these two systems is increased to 120 yuan per person per year, and individual contributions will accordingly increase slightly. It is planned to begin creating a state system of basic provision of medicines. In 2009, the creation of the All-China Public Health Data Archive began. It is planned to launch a reform of state medical institutions aimed at improving the management and control of their activities and increasing 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 eased.
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 basic medical services by all layers and groups of society, regardless of the thickness of individual wallets. At the same time, the health care system remains mixed, which implies an influx of capital of various types of property into this system.

No matter how great the achievements of traditional Chinese medicine are, for centuries they were available only to the elite, and ordinary Chinese did not have access to medical care. By the beginning of the formation of the People's Republic of China (1949), the average life expectancy was about 35 years, and out of five babies born, one died... The situation changed with the beginning of the reign of Mao Zedong. And over the past 60 years, Chinese healthcare has experienced rapid, complex and at the same time extremely interesting developments to study.

Phenomenal stability of the Semashko system

Already in the early 1950s, China began to build an extensive system of public medical care, modeled on the Soviet one and with enormous help from the USSR, at an incredible pace. Semashko’s healthcare model was then the only the right way healthcare arrangements in a country with a huge population and territory.

Hospitals began to appear in cities different levels, the first medical institutes and schools for training nurses and paramedics. In rural areas, a three-stage network began to be introduced at the county, volost and village levels. Central district hospitals were organized in the districts, volost outpatient clinics were organized in the volosts, and in the villages, as well as in industrial enterprises, - first aid stations.

But if the treatment of workers, office workers and military personnel was carried out at the expense of the state, then the leadership of the PRC was forced to leave medical care in rural areas paid for. But what does paid mean? The paramedic in such health posts was usually from the same village, selected by the authorities for his literacy and completed short-term training courses. It was possible to pay him not only with small coins, but also with a chicken carcass, or... nothing at all, when the poorest fellow villagers came. And if the health center was located in the so-called administrative villages, the sanitary and epidemiological station and the “mother and child health care center” were located in the same building.

At first glance, what fruits could this healthcare system, created in just 10 years, bring, where there was one specialist for thousands of village paramedics and midwives? The fruits, however, were unprecedented in the history of global health, and which in 2010 remain inaccessible not only to the poorest countries in Africa, but even to India, which is as rapidly developing as China.

By the mid-1960s, 80% of China's rural and more than 90% of its urban population had access to a network of medical facilities. Life expectancy has exceeded 50 years, infant mortality has dropped from 200 out of 1000 live births to 30. China became one of the first countries in the world to eradicate a number of infectious diseases, in particular smallpox.

In addition to health protection, this system provided economic development and social stability and turned out to be so strong that it withstood two severe blows, which fell mainly on the level of qualified medical care. In the spring of 1960, the “great friendship” of the USSR and China ended, thousands of Soviet doctors and medical university teachers left the country. And six years later the tragic decade began." cultural revolution" Thousands of intellectuals, including those in white coats, went to communes for re-education.

Give me capitalist medicine!

In the thirty years that passed from the beginning of Deng Xiaoping's reforms in 1976 to the Fifth Plenum of the CPC Central Committee, which divided the Chinese "perestroika" into two periods, the development of the country's healthcare took place in a complex and highly contradictory manner. The new leaders overestimated the role of market relations in the development of healthcare, and it has largely degraded compared to the Mao era. However, other things have gone forward.

In 2005, the country's health insurance system covered less than 50% of the urban and only 10% of the rural population. Medical expenses fell from 2.5-3% of the budget in different years Mao's rule to 1.7% (with three quarters of it spent in cities, where about 30-40% of the population lived). And citizens paid more and more medical services out of their own pockets. The average cost of treatment for Chinese people increased incomparably faster than their income, and during the period from 1990 to 2004 increased more than 10 times!

By the way, today high price treatment and medicine ranks first among all social problems in China. Medical expenses eat up about 12% of the family budget, second only to food expenses. The average cost of treatment for a serious illness is now about $1,000, while the average monthly income of a worker is $250, and that of a peasant is three times less.

So, the reformers hoped in vain that the state would be able to ensure the development of healthcare by lowering taxes everywhere, but at the same time reducing its expenses in this industry, while simultaneously opening the doors to medicine to entrepreneurs. Business rushed into the industry of medicines and medical products, and in real healthcare it “rested” on the effective demand of the population for medical services. In 2006 private sector occupied less than 5% of the market for all medical services, and even today this figure has grown by only a few percent, with the lion's share of commercial healthcare being made up of institutions and private practitioners of traditional Chinese medicine.

In 2005, sociologist Yang Tuan, a member of the Chinese Academy of Social Sciences, wrote: “After the distribution of land among peasant families their incomes increased, but the lack of a social safety net and government funding for public welfare meant that peasants returned to an isolated lifestyle. Many government institutions, such as rural schools, medical posts, and nursing homes, are in ruins. China has not invested in the health sector for two decades, relying on people to pay for themselves. Today, WHO ranks China fourth-lowest out of 190 countries for equal access to health care. Only Brazil, Burma and Sierra Leone are behind us, a result the government rightly regarded as 'embarrassing' in one of its official studies."

Address neoliberal biases

And yet, the average life expectancy of the Chinese had increased to 70 years by 2005, not only due to the fact that, thanks to the takeoff of the economy, poverty and malnutrition for the vast majority of the population were replaced by poverty, and for some, modest prosperity. The quality of medical services has increased, including in rural areas. Since 2003, a new mechanism for cooperative medical care has been launched for peasants. And the system of medical care for city residents working at state-owned enterprises has advanced compared to the Mao era. And although some businessmen shied away from the obligation to provide their employees with health insurance, a significant portion of those employed in the commercial sector also received it. The formation of national medical science began. The country was already fully self-sufficient in healthcare personnel. A small stratum of the wealthiest citizens received access to high-tech medical care in Chinese clinics.
The Fifth Plenum of the CPC Central Committee, which determined the main guidelines for the Eleventh Five-Year Plan (2006-2010) in terms of economic and social development, was truly a turning point in the implementation of Chinese transformations. The transition from the concept of enrichment put forward by Deng Xiaoping to the slogan of universal prosperity began, that is, the idea of ​​​​greater social equality began to be realized. The obsession with economic growth rates has given way to the doctrine of sustainable development for the sake of improving the quality of life. The goal was to strengthen social security in order to prevent distortions in economic and social development.

Launched in 2005, after the Fifth Plenum of the CPC Central Committee, health care reform was designed to preserve all the best that had been achieved, and at the same time eliminate “neoliberal distortions.” And in the 5 years since that plenum, China has begun to improve its healthcare just as decisively as in the early 1950s. Budget expenditures on it doubled, exceeding 3% of GDP. The number of newly opened village hospitals and medical posts is measured in the thousands, and the number of county hospitals in the hundreds. Every year, more than 100,000 rural paramedics and nurses take medical qualification courses.

There are other, no less impressive figures, but let’s clarify the main ones. Average duration life last year was 72.3 years. Of the 1.3 billion population of China in 2009, 63% of city residents and 85% of peasants were provided with health insurance. And in the second decade of the 21st century, China has plans to create a health insurance system of unprecedented proportions.

Both in breadth and in depth

In October 2008, the Chinese government submitted for public discussion a draft of a new stage of medical reforms, which was approved by the State Council early last year. Let us clarify the key goals of the project: to provide medical insurance to 90% of the population by 2011; create a powerful pharmaceutical industry, not only of generics, but also of innovative drugs; improve the infrastructure of primary basic health care. They decided to allocate $125 billion to implement these plans, and so far investments are going exactly on schedule.

But by 2020, China plans not only to provide 100% of the population with basic medical care, mainly on the basis of budget funding, but also to introduce multi-level system health insurance. That is, it is expected that a significant part of the Chinese people (planned figures are not specified) by the beginning of the 2030s. will also be provided with insurance covering qualified treatment of most diseases, in a word, the same as is common in developed countries.

Let us remind you that there are currently 3 main health insurance programs in China. Two of them, namely the rural cooperative insurance scheme (RCMIS - rural cooperative medical insurance scheme), as well as the basic medical insurance scheme for workers in cities (BMI - basic medical insurance scheme) guarantee only basic outpatient and hospital treatment. But since 2007, the urban resident medical insurance scheme (URMIS) has also been operational, already close to medical “European standards” and providing treatment for most diseases not covered by the BMI policy. In 2007, 41 million people had such policies, and by the beginning of 2010, there were already more than 300 million. If we add to this the wealthy Chinese who do not have insurance, but pay for quality treatment from time to time, then we can cautiously assume that access , albeit not to high-tech, but to high-quality specialized medical care today a third of the country’s population already has.

So, in 10 years will China be able to catch up with developed countries in terms of the state of its healthcare and the level of health of its citizens? The medical sector of China, like the entire Celestial Empire, still remains a land of contrasts, where well-equipped clinics coexist with the house of a village “fershal” from the stories of A.P. Chekhov. But along with the poverty that is becoming a thing of the past, China's healthcare also has the brilliance of an offensive impulse, the accuracy in perceiving the best Western achievements and the ability to weave them with the experience of traditional traditional medicine. In short, I want to believe that the Chinese people will be able to carry out their plans. What about ours?

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The antenatal clinic of the “third” clinical maternity hospital in Vladivostok was one of the first in the city to switch to the “Lean Clinic” format, providing expectant mothers with the most comfortable conditions of stay, observation and treatment and surrounding them with professional care using the most modern technologies.

China is famous for its indigenous traditional medicine, which is based on an ancient system of diagnosis and treatment. The quality characteristic of Chinese medicine is that it ranks medical science many countries have an important place, its methods, including massage, acupuncture, herbal medicine and breathing exercises, are used in a significant number of well-known clinics around the world. Modern China occupies a leading position in the world in such areas of healthcare as the treatment of fractures, burns, replantation of limbs, diseases abdominal cavity and stem cell treatment. Serious successes have been achieved in the fight against such types of diseases as oncological, immune, cerebrovascular, and cardiovascular.

It should immediately be noted that the healthcare system of the PRC cannot be called particularly developed and progressive; today, many rural areas and their large population are not provided with accessible and high-quality medical services. Since the middle of the last century, a public health care system has been organized in China, but only since 2003 a modern cooperative health care model began to emerge, the basis of treatment of which is based on the principles of insurance medicine. Today's China has begun to form a sufficiently powerful system for training medical personnel, helping to create a significant number of outstanding specialists in Western and Eastern medicine.

Chinese directions of treatment
Treatment in the Republic of China is carried out in three directions: Western, traditional and mixed medicine. Modern medicine is complemented by ancient medicine, which is the specificity and advantage of the Chinese system for providing medical services.

In large cities of China, high-quality treatment is provided in numerous hospitals and clinics of traditional medicine, the largest private and public medical centers of international level, most of which are equipped with modern medical equipment. Several of these hospitals are accredited.

Along with this level of medicine, the impossibility of receiving medical services for the majority of village residents is rampant - they simply cannot afford to pay for a doctor’s services. True, thanks to health care reforms, more and more villagers are beginning to receive preferential health care, thanks to health insurance, which covers almost 90% of the country's population.

Pharmaceutical industry in China

China cooperates with many countries of the world, the number of which is equivalent to a hundred, in the field of medical care, scientific research and training of specialists. Thanks to this extensive cooperation, the World Health Organization has built a number of traditional medicine and pharmacology centers in China. Recently, the development of the pharmaceutical industry is gaining momentum at a rapid pace, and recipes and technologies of traditional medicine are widely used in the drug production process.

About the availability of medical services in China
The most modern type of medical institutions, providing high-class medical services thanks to qualified personnel and equipment, are located in Beijing, Guangzhou and Shanghai, as well as some other large cities. Common hospitals in China are "gaogan bingfang" - they are equipped with modern medical equipment and experienced qualified doctors, most of them provide medical services to foreign citizens, local nurses and doctors speak English, which greatly facilitates the provision of medical care to foreigners.

In most large clinics, doctors have a high level of training thanks to training in ancient and prestigious medical universities countries, and some of them are hereditary healers, which ensures that they find a way to treat the most strange and unexpected diseases, while leaving effective treatment for common diseases inherent in our time.

Additional information for foreigners
All medical services in the Republic of China are paid. Both Chinese citizens and foreigners receive emergency medical care without delay, but with subsequent reimbursement of the full cost of the services provided. A cash deposit is required before elective surgery.

Do not forget that when visiting medical institutions you often have to hire a translator, otherwise the diagnosis, name of the medicine and prescriptions will be impossible to understand. In pharmacies it is not always possible to find the medications that a European or a foreigner is accustomed to, so it makes sense to take the most frequently used ones with you. In Chinese pharmacies you can find bizarre combinations of drugs: from medicinal herbs and traditional Chinese potions to European medicines.

All treatment and medicines for foreign citizens in China are paid, and payment must be provided in cash. Medical insurance services are provided only in certain hospitals, the list of which must be reviewed in advance with the insurance company. In some clinics, medical services are paid in cash on the spot, but upon returning home they are reimbursed by the insurance company according to the invoices provided.

When feeling unwell that occurred while outside large city, all tourists are strongly recommended to call a taxi or use other transport in order to get to the nearest city hospital - rural areas are poorly provided with medical services, most often only basic medical care is available there. Rural medical personnel are for the most part poorly trained, clinics are poorly equipped, and the choice of medications is small - only for immediate life-saving measures.

The ambulance, in terms of arrival time and equipment, also leaves much to be desired.
Free treatment provided to those citizens who come to the country to study or work.

In Chinese hospitals, life is in full swing, because in the struggle for health, the strongest wins. There is no time for sentimentality in the corridors of medical institutions: many procedures are literally put on a conveyor belt, and patients and their relatives are fighting, alternating attacks on doctors with defense at the reception desk. What is the healthcare system like in a country of one and a half billion people?

If it were not for the healthcare system, there would be no talk of any 1.4+ billion population. In 1953, when the first census was conducted in the PRC, 580 million people lived in the country. After 40 years, the population has almost doubled, despite famine and social experimentation, and mainly due to the development of basic medical services.

The healthcare system created after 1949, to a certain extent, followed the example of the USSR. The state was solely responsible for providing virtually free medical care for the most part rural population(80%) through the system of “barefoot” doctors. Despite basic training (3-12 months) and limited supplies (2 syringes and 10 needles), 200,000 rural healers were able to reduce neonatal mortality from 200 to 34 per 1000 over 30 years, as well as increase basic knowledge of the population on the prevention of infectious diseases .

But with the beginning of economic reforms, the state reconsidered its role in the health care system. Since 1984, funding for hospitals and the system as a whole has been sharply reduced. Although the state continued to own medical institutions, it ceased to tightly control their activities, in which they increasingly began to be guided by the principles of commercial enterprise in an unregulated market. By the end of the 90s, health insurance covered 49% of the urban population (mostly those working in budgetary organizations and state-owned enterprises) and only 7% of the 900 million rural population.

Practically the only aspect of healthcare that the state continued to control was pricing. To ensure access to at least basic medical care, it limited pay for the hours of work of doctors and nurses, but at the same time lowered prices for medicine and technical services. Thus, the main source of livelihood for hospitals and doctors became income from prescriptions and procedures, which indirectly contributed to the growth of technical equipment. Even in a provincial hospital there is a much higher chance of finding modern medical equipment than a qualified doctor.

By the early 2000s, tensions reached a breaking point: mistrust of doctors and the system as a whole resulted in public discontent and incidents of physical violence. In 2003, realizing that the problem could no longer be ignored, the government introduced an insurance system to cover basic medical expenses for rural residents. However, it soon demonstrated its ineffectiveness: bills for medical care often drove the patient’s family into poverty.

In 2008, it was realized that not only the insurance system needs reforms, but also healthcare as a whole - it cannot function adequately solely on the basis of market principles. By 2012, the state health insurance system provided 95% of the population with basic services, but the quality of services is much more difficult.

Battlefield

In China, it is rare for a patient to come to the hospital alone: ​​the support of relatives is required even when the patient has no physical limitations. In addition to moral support, chaperones perform two important functions. Firstly, they take care of registration and payment for services. For example, the doctor gave a referral for a blood test, but first you need to pay for it. And while the patient is in line at the laboratory, his wife/sister/brother-in-law pays for the service at the cash desk. Also despite electronic queues, an independent “live” often gathers near the doctor’s office, where the patient’s “punching” abilities increase his chances of getting an appointment before others.

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Secondly, support is necessary to monitor the doctor’s activities. When instead of one sufferer you have several healthy and aggressive people in your office, the doctor’s attentiveness increases significantly. Unsuccessful treatment can also become a reason for violence against the physician. It is not surprising that in China doctors do not want to be left alone with the patient and his relatives and prefer to keep the doors open. After all, a patient upset by the diagnosis or relatives upset by the result of treatment causes injuries to the doctor, even incompatible with life.

Medicine has ceased to be a prestigious specialty in China, and many end up as medical university students if they don’t get enough points to enroll in engineering faculties, some are forced by their parents. According to the All-China Doctors Association, in 2011, only 7% of doctors in China would like their children to continue their professional dynasty.

Also in China, the traditions of a professional medical community that could regulate the standards of behavior of doctors and, if necessary, revoke a license to practice, have not yet developed. Of course, in China there are specialists who value their reputation and are truly professionals, but in general, the existing system does not reward compliance with the “Hippocratic Oath.”

The situation is aggravated by the huge flow of patients, sometimes up to a hundred per day. Having 5-7 minutes at his disposal for one appointment, the doctor does not physically have time to delve into the medical history; he is in a hurry to write out a referral for examination or prescribe treatment.

However, if the doctor’s decisions do not meet the expectations of the patient and his relatives, then this is a reason to doubt his qualifications. For example, Chinese doctors understand that intravenous drips are not the most preferred method of administering medicine, but those suffering from high fever are unlikely to understand them. The same applies to large doses of antibiotics: Chinese patients expect immediate results from modern pharmacology, and doctors try to meet their expectations.

Material incentives

The bulk of hospital revenue comes from tests, other technical procedures and prescribed medications. Thus, both the hospital and each individual doctor have an incentive to prescribe more medications and make referrals for additional tests.

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Foreigners traveling abroad in search of quality and affordable medical treatment are the basis of a new, thriving economy for several developed Asian countries, China among them.

In recent years, China has occupied a prominent place in global medical tourism.

Global medical tourism is valued at $40 billion a year, and China is keen to attract a significant share of tourists to its clinics.

China brings joy to thousands of foreign patients affordable prices for treatment, high-quality training of doctors, modern technologies and multilingual medical staff.

Medical tourists head to China for cancer treatment, cardiac surgery, orthopedics, stem cell therapy and, of course, traditional Chinese medicine (TCM), an alternative system that relies on acupuncture and ancient herbal medicine.

Despite the popularity of ancient techniques, the Chinese healthcare system is one of the most progressive on the planet, and local scientists have made enormous strides in cardiology, neurosurgery, traumatology, oncology, and in the study of stem cells.

China's potential as a medical tourism destination cannot be overstated because, in addition to its advanced medical infrastructure, the country has many unique sites and historical attractions. It is not surprising that Western tourists go to the Celestial Empire for a unique “ medical leave"- to heal, relax, and at the same time enjoy the local beauty.

Why treatment in China?

China is one of the world's economic colossi, in fact the second economy on the planet. It is also a country with a rich history and diverse culture, which has become a favorite holiday destination for foreigners.

It's also fast developing country, with one of its most prosperous areas being healthcare, which, along with open policies, has led to a significant increase in the flow of medical tourists in recent years. Patients from the West, as well as from other Asian countries, flock to China to combine a wonderful holiday with high-quality and inexpensive treatment.

Why should we consider China as a good place for treatment and rest?

This country has six important advantages:

1. Low cost of treatment

Affordability is a key reason why people travel to China for treatment. For residents of Western countries with huge prices for medical services, the experience of treatment in China looks impressive: a high technological level and good service for an amount that is several times less than in America or Britain. Even a flight across the ocean won’t hurt to save on a major procedure.

2. First-class hospitals and clinics

The healthcare system of the People's Republic of China consists of an extensive network of modern hospitals providing high-quality care. The country already has 25 JCI (Joint Commission International) accredited institutions, and many more hospitals are members of the International Society for Quality in Health Care (ISQua) or are approved by the American Medical Association (AMA). , American Medical Association).

3. Doctors and surgeons with American certificates

It should not be overlooked that it is important for sophisticated patients to know that they are dealing with medical professionals trained to the highest standards. There are many American Board Certified doctors in China who are fluent in English. This is partly due to the large number of doctors from the States who remained to live and practice in China.

4. A mixture of Western and Eastern medicine

Medical tourists go to China for cancer treatment, heart surgery, joint replacement, and spinal surgery. Also very popular among both local patients and foreigners are: acupuncture for the treatment of pain, depression and osteoarthritis; herbal medicine and alternative treatments for cancer, diabetes, heart disease. In many Chinese clinics, modern Western methods are combined with traditional Eastern recipes.

5. The vacation possibilities are endless.

China has become an important global tourism destination since the advent of its open policy in the 1970s, and the country has now become the third most visited country in the world. History, culture, amazing cuisine, famous places, bustling cities, shopping and entertainment centers - China has everything that can interest tourists.

6. Strong research centers

This is especially true for stem cell therapy and cancer treatment.

Regarding the first, China has the most liberal rules for embryonic stem cell research. Accordingly, in China it is much easier and faster to conduct such research than in Western countries. As a result, many Western scientists are eager to collaborate with Chinese colleagues, and thereby ensure rapid progress in this area of ​​medicine.

As for oncology, the combination of government support and private biomedical investment has led to the level of cancer research and treatment of cancer patients in the PRC almost equaling the best standards of the West.

Health care system in China

China's healthcare system is improving under the influence of the country's economic growth and competent control by the state, the goal of which is to provide high-quality and affordable medical care for all Chinese citizens.

Recent reforms have been aimed at improving the population's access to health care. The new scheme allows wealthy city residents to have health insurance so they don't have to set aside large sums of money in case of sudden illness. The government, as before, provides a guaranteed minimum of medical services for rural residents at its own expense.

In general, the People's Republic of China managed to provide about 95 percent of its population with affordable medical care by 2009, which is an outstanding indicator in the region.

Hospitals and doctors in China

The huge area of ​​China places certain demands on its medical system, and the country, it must be said, is coping with the problem quite well. In China, per 1000 population there are 3.8 hospital beds in medical institutions of all types - large and small, urban and rural, public, joint and private. The Ministry of Health of the People's Republic of China conventionally divides all medical institutions into 3 levels, where the best specialized hospitals receive highest rating- 3AAA.

Service for foreign patients in Chinese hospitals is excellent. The Chinese government decided to apply the prestigious American standards of the Joint Commission International (JCI) - the “gold standard” of hospital quality and safety recognized by the entire Western world. There are already 25 JCI-accredited institutions operating in China, which can safely offer their services to the most demanding patients from Europe and America.

Doctors in China care about patient comfort and high quality treatment, especially surgical operations. They are known for their excellence in areas such as cardiology, orthopedics, oncology and traditional Chinese medicine. Chinese stem cell therapy experts are considered among the best in the world, and many of them are trained at America's most respected medical schools.

Dmitry Levchenko