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Medicine in China

In China, the practice of medicine is a mixture of government, charitable, and private institutions, while many people rely on traditional medicine. Until reforms in the late twentieth and early twenty-first century, physicians were quasi-government employees and with little freedom in the choice of the hospital to work with. In addition, decades of planned economic policy discouraged physicians from opening their own clinics, and the practice of medicine was generally under the control of local units, such as factories, government, offices, or communes. The reforms created a largely private practice, and physicians now are encouraged to open private clinics and for-profit hospitals.

Chinese Medical Association

The Chinese Medical Association is the largest and oldest non-governmental medical organization in China. It was established by a group of medical professionals in 1915 with an aim to uniting medical professionals, upholding medical ethics and advocating social integrity. It currently counts over 430,000 members and 82 specialty societies. It publishes over 70 medical journals WA (including the Chinese Medical Journal), as well as a medical bulletin and a medical education magazine. The CMA plays a leading and active role in the nation's medical education, training and professional exchanges.

Chinese Academy of Medical Sciences

From 1957, Peking Union Medical College is merged into the Chinese Academy of Medical Sciences as one single institution directly under the Ministry of Health, now the National Health Commission.

Physicians

Physician compensation

At government controlled hospitals, physicians are salaried employees. Salaries are based on working experience and professional level. Some hospitals also pay a bonus to physicians according to the hospital's operating performances and the physician's contributions. Physicians' salaries vary greatly. For those working at busy and well-known hospitals, their base salaries can be a few times as much as those of physicians working at low-ranking hospitals. Chinese hospitals are classified as three general levels, with level 3 at the top and level 1 at the bottom. Each level has sub-levels of A, B and C. Some elite hospitals are even rated 3A+.

For many physicians, in particular those at big hospitals, specialty hospitals or hospitals with large reputations, physician incomes can be larger than regular hospitals. Physicians, and in particular, surgeons, can augment their hospital salaries by operating surgeries at hospitals other than the one in which they are employed. Many physicians also receive commissions from prescribing prescription drugs and get "red envelopes" from patients (patients give money or gifts to their wanted physicians for getting treatment) or from sales representatives of drug companies. However, a new regulation issued by the Health Ministry removes physicians from the practice of medicine if they are found to have taken "red envelopes" from patients, and a hotline has been set up to monitor physicians.

Social status

In China, physicians are well respected, but as a group they are not at the top of the social structure of the country because their incomes fall in the middle class.

According to a Ph.D. candidate at a U.S. Public Health School, who was a physician at a well-known 3A hospital in Beijing, like other junior physicians, she seldom received “red envelopes” from patients, and only senior physicians or physicians with fame would have such opportunities.[citation needed] The student said those senior physicians had become members of the high-income class. Like the student, many physicians, went abroad to study because they were not satisfied with their status.

According to a 2002 statistics from Beijing Physicians Association, between 2000 and 2001, in Beijing about 2300 physicians resigned, and most of them went to work as sales representatives of drug companies. Some still practice medicine but work with privately owned hospitals rather than public hospitals.

Competitive pressure for hospitals

Influenced by a centrally-planned economy, many hospitals were managed as government agencies rather than medical service organizations. Hospitals did not have competition pressures. The management team usually did not recognize the importance of developing and retaining high skilled physicians. Administrative personnel were more powerful than physicians at a hospital.

However, with the reform of the medical sector, Chinese hospitals are facing increasing competition from privately owned and foreign-investment-backed hospitals. Physicians are expected to enjoy higher legal income and better social status.

Physician training

The Chinese medical education system follows the British system, but it compressed from six years to five years to shorten the educational cycle. To become a medical doctor, a person needs to study for 5 years at a medical school.[1][2] For foreign or international students, the person needs to study for 6 years at the medical school, namely because the Chinese version is accelerated.[citation needed] Also, international students have to prepare for and take the Hanyu Shuiping Kaoshi for admission, and during med school, the Medical Chinese Exam. After graduation, the newly minted physician needs to complete 2–3 years of residency training, including training for subspecialty.[3]

Upon graduation, the graduate must work as a resident physician for few years to be eligible to take a National Medical Licensing Examination (NMLE) for physician certification. This examination is conducted by the National Medical Examination Center (NMEC). Without approval of registration by the Ministry of Health one can not practice medicine in China as a physician or assistant physician.[4]

American type of residency training has not been implemented nationwide in Chinese hospitals though almost all hospitals require their physicians to be trained as resident for few years before promotion to attending. American type of residency program was launched in some University affiliated hospitals. These students will complete their MD study and have to pass the national certification test during the residency.

There are general hospitals and specialty hospitals. A medical graduate rotates through several departments and then assigned to a specialty department according to his or her strengths and the hospital's needs. Specialty physician usually are attendings who specialized in certain specialty during the training process in a specialty hospital or in a subspecialty at a general hospital. Some medical experts have called for a standardized training and testing system for specialty physicians in accordance to American system. The classification of specialties at a Chinese hospital is similar to that at a U.S. hospital.

Prescription drugs

According to BCG's prediction in 2002, China's prescription drug market is expected to reach $24 billion and become the fifth largest market following Japan. AstraZeneca now ranks as the No. 1 foreign brand in terms of prescription sales in the Chinese market.

Physicians control the distribution of prescription drugs. Some hospitals and clinics stipulate patients must buy prescription drugs from the hospitals or directly from the physicians who make the prescriptions. Such a restriction aims to prevent the loss of sales on prescription drugs to retailers, but retailing drug stores are unhappy with such a restriction, and some of them have tried all means to lure away prescription drugs buyer from hospitals. For instance, they offer to pay drug buyers half a dollar for each prescription the buyers brought to the drug stores. Normally a prescription is effective on the day it is issued, but it can be effective within three days of prescription under certain conditions.

Hospitals

Physicians used to be hired as full-time employees at a government controlled hospital. But with the reforming of the medical service sector, both physicians and hospitals have more freedom in choosing each other.

Young physicians usually have an employment contract with the hospital they work with, and a person can quit at will. The hospital can also lay off the individual if it is not satisfied with the employees performance or morality.

It is not uncommon for physicians to quit and take a different job. The top three reasons that lead many physicians in Beijing to quit include: doctors are not well paid; hospitals are poorly managed; and there are not enough personal development opportunities.[citation needed]

Management

For a government-controlled hospital, the hospital is still operated and managed by a management team under the leadership of the president of the hospital, who is usually nominated and appointed by the healthcare department of a province, a city or a county. But for a private hospital or a publicly traded hospital, the ownership is the same as that of a private company or a public company.

There are two types of hospitals in China – for-profit and non-profit. Profit-oriented hospitals may distribute their profit. Non-profit hospitals are government-owned, and will turn earnings into additional infrastructure or hand them back to the respective government authorities. Non-profit hospitals also enjoy preferential tax treatment and several government subsidies. They also get low-cost financing from the government for their capital investment.

Number

By the end of 2002, China has 306,000 healthcare and medical organizations, 63,858 of which are hospitals and clinics, 219,907 of which are nursing homes and 22,270 fall into other categories. Among them, only 1% are for profit, although all non-profit hospitals and clinics also rely on profits of selling drugs and treatments. Drug sales from hospitals account for 85% of total drug sales, with the remaining 15% going to drug stores.

Stripping out the government's subsidies, all government-subsidized hospitals would have been in the red.[citation needed] This poor operating performance can be partially due to that non-profit hospitals have little incentive to control costs, given the government's subsidies.[citation needed]

Private hospitals

In 2000, a reform started to occur in the Chinese hospital system. Government owned hospitals are being restructured, some of them being sold to individual investors, and more and more private hospitals are founded.

In 2004, Beijing Aikang Medical Investment Company bought a state-run-enterprise owned AAA hospital (the highest standard), and the acquisition was the first of this kind in China. The investment company plans to buy 10 hospitals in the next three to five years. In Fuzhou, the capital city of Fujian province, four government-owned hospitals have been sold to private investors.

Nursing and support staff

Nurses are normally well trained before being eligible for working with a hospital, but support workers are a problem. Some hospitals hire skill-less "underground" labors and after giving them some simple training use them as hospital support workers. These workers, mostly originating from rural areas, are poorly paid by those hospitals.

To secure the quality of hospital services, Beijing recently has passed a regulation on training and hiring qualified hospital support workers. In Tianjin, China's third largest city, about 1,000 unemployed people have been trained by local authority and passed hospital support work test. These people returned to work as certified support staff of a number of big hospitals.

Education

One needs to study at a nursing school for around three years before being eligible to work as a nurse. Most nursing schools enroll middle school graduates (Grade 9) and senior high school graduates (Grade 12), and they run four-year and three-year programs respectively.

A bachelor's degree in nursing has been available since late 1980s and early 1990s in China. Many medical schools including the School of Medicine of Beijing University offer five-year programs in nursing.

Locations

Most hospitals are located at downtown areas due to people's reliance on public transportation in China. More than 80% of Chinese medical resources are concentrated in urban areas, and the rest in rural areas.

Recognition of Chinese Medical Universities

Many of the medical universities in China are recognized by following medical bodies around the world:

  • MCI (Medical Council of India)
  • WHO (World Health Organization)
  • MOE (Ministry of Education, China)[5]
  • PMDC (Pakistan Medical and Dental Council)[6]

Payers

Payment for healthcare

The government, employers, and individuals pay for healthcare. In December 1998, a national medical insurance scheme was launched by the State Council. By end of 2002, most of the county or above level cities had joined the scheme and covered a population of about 100 million. Social Insurance Fund Administration Centre, a department of the Ministry of Labor and Social Security, oversees this insurance system. Currently, this system only focuses on employees of enterprises at or above township level. Those in remote or less developed areas cannot enjoy the benefits of this scheme, which is considered a shortcoming of the social medical insurance scheme.

The National Basic Medical Insurance Scheme ensures basic medical access by the public under the social security system. Individuals pay an annual insurance premium for their basic medical treatment entitlements. This scheme has replaced the previous government-funded labor insurance medical system.

Foreign-invested enterprises are required to provide health insurance benefits, but are not required to participate in the basic plan. For example, for employees of foreign enterprises in Beijing hired through Foreign Enterprises Service Corp. (FESCO), foreign enterprises pay FESCO, and FESCO then buys insurance policies for these employees. The government also allows commercial health insurers to operate in China.

In 2004, 119.41 million people had basic medical insurance. Revenues of basic medical insurance funds reached $91 billion, and payments were $74 billion.

Structure and implementation

Drug price regulation

The qualified drug catalogue under the basic medical scheme, which aims to control expenses on drugs, specifies drugs that are covered by the scheme and eligible for reimbursement. As the government-driven drug price regulation mechanism and the centralized tendering drug procurement program are only applicable to the drugs covered by the scheme, the scheme undoubtedly plays a crucial role in the development of the drug industry.

The basic insurance plan does not reimburse expenses for drugs not on the basic medical insurance drug list, the State Scheme Drug List for Basic Medical Insurance, which is based on clinical need, safety and efficacy, reasonable pricing, ease of use, and the desire to maintain a balance between Western and TCM products.

The basic medical insurance and at-work injury insurance of 2004 cover 832 traditional Chinese medicines, up from 415 of 2000; the number of chemical medicines covered by the insurance systems increase from 725 to 1031 from year 2000 to 2004, some of which are patent-protected drugs of Western companies.

Sino-Generali Life Insurance, a joint venture between China and Italy companies, offers a commercial medical insurance that reimburses 80% of prescription drugs, with an annual maximum reimbursement of $1000 per policy.

Changes

Before the reform of healthcare system, roughly 140 million workers and 60 million family members were covered under the State-owned enterprise (SOE) and collective insurance. This system has reimbursed 100 percent of employees' medical costs, and 50 percent of family members' costs. The system has been funded, in name at least, by the enterprises.

Hoping to reduce enterprise subsidies of all types, the State Council launched pilot reforms in 1994 of the two health insurance systems under its control. Begun in two midsize cities, Jiujiang, Jiangxi Province, and Zhenjiang, Jiangsu Province, and expanded to over 60 cities in 1997, this experiment has become national policy, applicable to domestic and foreign-invested firms. The two State health insurance systems would later be consolidated to be the Basic Medical Insurance System.

Only about 120 million to 180 million workers have some form of healthcare coverage that will pay for Western pharmaceuticals, according to industry analysts. Farmers, who make up the vast majority of Chinese, have no real coverage at all.

Government

The Chinese government used to cover up to 100% of medical fees for employees working with government agencies, state-owned enterprises, or educational organizations, but peasants didn't enjoy the policy.

Starting from 2001, a new medical coverage plan took effect, marking the government's withdrawal from shouldering whole medical insurance burden. Under the policy, urban residents must join a government managed basic insurance coverage plan for urban residents and pay a certain amount of monthly fees based on their income levels, and up to 70% of their medical expenses can be reimbursed. So far around 100 million urban residents are covered by the plan.

Private payers and insurance companies

According to a news report, 44.8% of urban residents and 79.1% of rural residents have no medical insurance.[citation needed]} Many of people are private payers. They either cannot afford to buy medical insurance, or do not understand the value of medical insurance.

In contrast to rural residents, urban residents have much better situation. Many employers have bought for their employees group or supplementary medical insurance, and employers deduct from employees' payrolls a small percentage of their monthly incomes.

Medical education

By 1901, China was the most popular destination for medical missionaries. The 150 foreign physicians operated 128 hospitals and 245 dispensaries, treating 1.7 million patients. In 1894, male medical missionaries comprised 14 percent of all missionaries; women doctors were four percent. Modern medical education in China started in the early 20th century at hospitals run by international missionaries. [7]

Today Universities, colleges and institutes, which make up China's higher educational system, offer four- or five-year undergraduate programs as well as special two- or three-year programs. To control the medical education standard the Chinese ministry of education set up a quality control regulation on medical education, this regulation specially for English medium undergraduate medical education.[8]

See also

References

Citations
  1. ^ Lijuan, W. (2014). "Development of a medical academic degree system in China". Medical Education Online. 93 (1): 114–120. doi:10.3402/meo.v19.23141. PMC 3895259. PMID 24434025.
  2. ^ "Undergraduate Medical Education". Shanghai Medical College Fudan University.
  3. ^ Lijuan, W. (2014). "Development of a medical academic degree system in China". Medical Education Online. 93 (1): 114–120. doi:10.3402/meo.v19.23141. PMC 3895259. PMID 24434025.
  4. ^ National Medical Examination Center, China 2016-06-30 at the Wayback Machine
  5. ^ "MBBS in China Guideline 2021". china medical universities:www.sicas.cn. Retrieved 2021-02-01.
  6. ^ "MBBS in China, PMDC info 2022". china medical universities:mbbsinchina.urdusky.com. 29 April 2013. Retrieved 2022-09-02.
  7. ^ Henry Otis Dwight et al. eds., The Encyclopedia of Missions (2nd ed. 1904) p 446 Online
  8. ^ Circular of the Ministry of Education On Interim Provisions for Quality Control Standards on Undergraduate Medical Education in English for International Students in China[permanent dead link]

Further reading

  • Baum, Emily (2020). "Medicine and Public Health in Twentieth‐Century China: Histories of Modernization and Change". History Compass. 18 (7). doi:10.1111/hic3.12616. S2CID 225622823.
  • Croizier, Ralph C. Traditional Medicine in Modern China: Science, Nationalism, and the Tensions of Cultural Change;; (No. Ser-34. Harvard Univ East Asian Research Center, 1968). 340pp
  • Harmsworth, K., and G. T. Lewith. "Attitudes to traditional Chinese medicine amongst Western trained doctors in the People’s Republic of China." Social Science & Medicine 52.1 (2001): 149-153.
  • Hillier, Sheila M., and Tony Jewell. Health care and traditional medicine in China 1800-1982 (Routledge, 2013).
  • Lampton, David M. The politics of medicine in China: the policy process 1949-1977 (Routledge, 2019).
  • Scheid, Volker. Chinese medicine in contemporary China: plurality and synthesis (Duke UP, 2002).
  • Unschuld, Paul U. Medicine in China: A history of ideas (Univ of California Press, 2010).

Nursing

  • Chan, Sally, and Frances Wong. "Development of basic nursing education in China and Hong Kong." Journal of advanced nursing 29.6 (1999): 1300-1307.
  • Chen, Kaiyi. "Missionaries and the early development of nursing in China." Nursing History Review 4 (1996): 129-149.
  • Davis, Anne J., et al. "The young pioneers: first baccalaureate nursing students in the People's Republic of China." Journal of advanced nursing 17.10 (1992): 1166-1170. online[dead link]
  • Grypma, Sonya. "Withdrawal from Weihui: China missions and the silencing of missionary nursing, 1888–1947." Nursing inquiry 14.4 (2007): 306-319.
  • Xu, Yu, Z. Xu, and Jainhui Zhang. "The nursing education system in the People's Republic of China: evolution, structure and reform." International Nursing Review 47.4 (2000): 207–217.

External links

  • Chinese Medical Association
  • List of medical schools in China 2009-08-11 at the Wayback Machine
  • New England Journal of Medicine

medicine, china, this, article, multiple, issues, please, help, improve, discuss, these, issues, talk, page, learn, when, remove, these, template, messages, this, article, needs, additional, citations, verification, please, help, improve, this, article, adding. This article has multiple issues Please help improve it or discuss these issues on the talk page Learn how and when to remove these template messages This article needs additional citations for verification Please help improve this article by adding citations to reliable sources Unsourced material may be challenged and removed Find sources Medicine in China news newspapers books scholar JSTOR February 2010 Learn how and when to remove this template message This article needs attention from an expert in China The specific problem is sources coverage update WikiProject China may be able to help recruit an expert June 2021 Learn how and when to remove this template message In China the practice of medicine is a mixture of government charitable and private institutions while many people rely on traditional medicine Until reforms in the late twentieth and early twenty first century physicians were quasi government employees and with little freedom in the choice of the hospital to work with In addition decades of planned economic policy discouraged physicians from opening their own clinics and the practice of medicine was generally under the control of local units such as factories government offices or communes The reforms created a largely private practice and physicians now are encouraged to open private clinics and for profit hospitals Contents 1 Chinese Medical Association 2 Chinese Academy of Medical Sciences 3 Physicians 3 1 Physician compensation 3 2 Social status 3 3 Competitive pressure for hospitals 3 4 Physician training 3 5 Prescription drugs 4 Hospitals 4 1 Management 4 2 Number 4 3 Private hospitals 4 4 Nursing and support staff 4 4 1 Education 4 5 Locations 5 Recognition of Chinese Medical Universities 6 Payers 6 1 Payment for healthcare 6 2 Structure and implementation 6 2 1 Drug price regulation 6 3 Changes 6 4 Government 6 5 Private payers and insurance companies 7 Medical education 8 See also 9 References 10 Further reading 10 1 Nursing 11 External linksChinese Medical Association EditThe Chinese Medical Association is the largest and oldest non governmental medical organization in China It was established by a group of medical professionals in 1915 with an aim to uniting medical professionals upholding medical ethics and advocating social integrity It currently counts over 430 000 members and 82 specialty societies It publishes over 70 medical journals WA including the Chinese Medical Journal as well as a medical bulletin and a medical education magazine The CMA plays a leading and active role in the nation s medical education training and professional exchanges Chinese Academy of Medical Sciences EditMain article Peking Union Medical College Not to be confused with Chinese Academy of Sciences From 1957 Peking Union Medical College is merged into the Chinese Academy of Medical Sciences as one single institution directly under the Ministry of Health now the National Health Commission Physicians EditPhysician compensation Edit At government controlled hospitals physicians are salaried employees Salaries are based on working experience and professional level Some hospitals also pay a bonus to physicians according to the hospital s operating performances and the physician s contributions Physicians salaries vary greatly For those working at busy and well known hospitals their base salaries can be a few times as much as those of physicians working at low ranking hospitals Chinese hospitals are classified as three general levels with level 3 at the top and level 1 at the bottom Each level has sub levels of A B and C Some elite hospitals are even rated 3A For many physicians in particular those at big hospitals specialty hospitals or hospitals with large reputations physician incomes can be larger than regular hospitals Physicians and in particular surgeons can augment their hospital salaries by operating surgeries at hospitals other than the one in which they are employed Many physicians also receive commissions from prescribing prescription drugs and get red envelopes from patients patients give money or gifts to their wanted physicians for getting treatment or from sales representatives of drug companies However a new regulation issued by the Health Ministry removes physicians from the practice of medicine if they are found to have taken red envelopes from patients and a hotline has been set up to monitor physicians Social status Edit In China physicians are well respected but as a group they are not at the top of the social structure of the country because their incomes fall in the middle class According to a Ph D candidate at a U S Public Health School who was a physician at a well known 3A hospital in Beijing like other junior physicians she seldom received red envelopes from patients and only senior physicians or physicians with fame would have such opportunities citation needed The student said those senior physicians had become members of the high income class Like the student many physicians went abroad to study because they were not satisfied with their status According to a 2002 statistics from Beijing Physicians Association between 2000 and 2001 in Beijing about 2300 physicians resigned and most of them went to work as sales representatives of drug companies Some still practice medicine but work with privately owned hospitals rather than public hospitals Competitive pressure for hospitals Edit Influenced by a centrally planned economy many hospitals were managed as government agencies rather than medical service organizations Hospitals did not have competition pressures The management team usually did not recognize the importance of developing and retaining high skilled physicians Administrative personnel were more powerful than physicians at a hospital However with the reform of the medical sector Chinese hospitals are facing increasing competition from privately owned and foreign investment backed hospitals Physicians are expected to enjoy higher legal income and better social status Physician training Edit See also List of medical schools China The Chinese medical education system follows the British system but it compressed from six years to five years to shorten the educational cycle To become a medical doctor a person needs to study for 5 years at a medical school 1 2 For foreign or international students the person needs to study for 6 years at the medical school namely because the Chinese version is accelerated citation needed Also international students have to prepare for and take the Hanyu Shuiping Kaoshi for admission and during med school the Medical Chinese Exam After graduation the newly minted physician needs to complete 2 3 years of residency training including training for subspecialty 3 Upon graduation the graduate must work as a resident physician for few years to be eligible to take a National Medical Licensing Examination NMLE for physician certification This examination is conducted by the National Medical Examination Center NMEC Without approval of registration by the Ministry of Health one can not practice medicine in China as a physician or assistant physician 4 American type of residency training has not been implemented nationwide in Chinese hospitals though almost all hospitals require their physicians to be trained as resident for few years before promotion to attending American type of residency program was launched in some University affiliated hospitals These students will complete their MD study and have to pass the national certification test during the residency There are general hospitals and specialty hospitals A medical graduate rotates through several departments and then assigned to a specialty department according to his or her strengths and the hospital s needs Specialty physician usually are attendings who specialized in certain specialty during the training process in a specialty hospital or in a subspecialty at a general hospital Some medical experts have called for a standardized training and testing system for specialty physicians in accordance to American system The classification of specialties at a Chinese hospital is similar to that at a U S hospital Prescription drugs Edit According to BCG s prediction in 2002 China s prescription drug market is expected to reach 24 billion and become the fifth largest market following Japan AstraZeneca now ranks as the No 1 foreign brand in terms of prescription sales in the Chinese market Physicians control the distribution of prescription drugs Some hospitals and clinics stipulate patients must buy prescription drugs from the hospitals or directly from the physicians who make the prescriptions Such a restriction aims to prevent the loss of sales on prescription drugs to retailers but retailing drug stores are unhappy with such a restriction and some of them have tried all means to lure away prescription drugs buyer from hospitals For instance they offer to pay drug buyers half a dollar for each prescription the buyers brought to the drug stores Normally a prescription is effective on the day it is issued but it can be effective within three days of prescription under certain conditions Hospitals EditPhysicians used to be hired as full time employees at a government controlled hospital But with the reforming of the medical service sector both physicians and hospitals have more freedom in choosing each other Young physicians usually have an employment contract with the hospital they work with and a person can quit at will The hospital can also lay off the individual if it is not satisfied with the employees performance or morality It is not uncommon for physicians to quit and take a different job The top three reasons that lead many physicians in Beijing to quit include doctors are not well paid hospitals are poorly managed and there are not enough personal development opportunities citation needed Management Edit For a government controlled hospital the hospital is still operated and managed by a management team under the leadership of the president of the hospital who is usually nominated and appointed by the healthcare department of a province a city or a county But for a private hospital or a publicly traded hospital the ownership is the same as that of a private company or a public company There are two types of hospitals in China for profit and non profit Profit oriented hospitals may distribute their profit Non profit hospitals are government owned and will turn earnings into additional infrastructure or hand them back to the respective government authorities Non profit hospitals also enjoy preferential tax treatment and several government subsidies They also get low cost financing from the government for their capital investment Number Edit By the end of 2002 China has 306 000 healthcare and medical organizations 63 858 of which are hospitals and clinics 219 907 of which are nursing homes and 22 270 fall into other categories Among them only 1 are for profit although all non profit hospitals and clinics also rely on profits of selling drugs and treatments Drug sales from hospitals account for 85 of total drug sales with the remaining 15 going to drug stores Stripping out the government s subsidies all government subsidized hospitals would have been in the red citation needed This poor operating performance can be partially due to that non profit hospitals have little incentive to control costs given the government s subsidies citation needed Private hospitals Edit In 2000 a reform started to occur in the Chinese hospital system Government owned hospitals are being restructured some of them being sold to individual investors and more and more private hospitals are founded In 2004 Beijing Aikang Medical Investment Company bought a state run enterprise owned AAA hospital the highest standard and the acquisition was the first of this kind in China The investment company plans to buy 10 hospitals in the next three to five years In Fuzhou the capital city of Fujian province four government owned hospitals have been sold to private investors Nursing and support staff Edit Nurses are normally well trained before being eligible for working with a hospital but support workers are a problem Some hospitals hire skill less underground labors and after giving them some simple training use them as hospital support workers These workers mostly originating from rural areas are poorly paid by those hospitals To secure the quality of hospital services Beijing recently has passed a regulation on training and hiring qualified hospital support workers In Tianjin China s third largest city about 1 000 unemployed people have been trained by local authority and passed hospital support work test These people returned to work as certified support staff of a number of big hospitals Education Edit One needs to study at a nursing school for around three years before being eligible to work as a nurse Most nursing schools enroll middle school graduates Grade 9 and senior high school graduates Grade 12 and they run four year and three year programs respectively A bachelor s degree in nursing has been available since late 1980s and early 1990s in China Many medical schools including the School of Medicine of Beijing University offer five year programs in nursing Locations Edit Most hospitals are located at downtown areas due to people s reliance on public transportation in China More than 80 of Chinese medical resources are concentrated in urban areas and the rest in rural areas Recognition of Chinese Medical Universities EditMany of the medical universities in China are recognized by following medical bodies around the world MCI Medical Council of India WHO World Health Organization MOE Ministry of Education China 5 PMDC Pakistan Medical and Dental Council 6 Payers EditPayment for healthcare Edit The government employers and individuals pay for healthcare In December 1998 a national medical insurance scheme was launched by the State Council By end of 2002 most of the county or above level cities had joined the scheme and covered a population of about 100 million Social Insurance Fund Administration Centre a department of the Ministry of Labor and Social Security oversees this insurance system Currently this system only focuses on employees of enterprises at or above township level Those in remote or less developed areas cannot enjoy the benefits of this scheme which is considered a shortcoming of the social medical insurance scheme The National Basic Medical Insurance Scheme ensures basic medical access by the public under the social security system Individuals pay an annual insurance premium for their basic medical treatment entitlements This scheme has replaced the previous government funded labor insurance medical system Foreign invested enterprises are required to provide health insurance benefits but are not required to participate in the basic plan For example for employees of foreign enterprises in Beijing hired through Foreign Enterprises Service Corp FESCO foreign enterprises pay FESCO and FESCO then buys insurance policies for these employees The government also allows commercial health insurers to operate in China In 2004 119 41 million people had basic medical insurance Revenues of basic medical insurance funds reached 91 billion and payments were 74 billion Structure and implementation Edit Drug price regulation Edit The qualified drug catalogue under the basic medical scheme which aims to control expenses on drugs specifies drugs that are covered by the scheme and eligible for reimbursement As the government driven drug price regulation mechanism and the centralized tendering drug procurement program are only applicable to the drugs covered by the scheme the scheme undoubtedly plays a crucial role in the development of the drug industry The basic insurance plan does not reimburse expenses for drugs not on the basic medical insurance drug list the State Scheme Drug List for Basic Medical Insurance which is based on clinical need safety and efficacy reasonable pricing ease of use and the desire to maintain a balance between Western and TCM products The basic medical insurance and at work injury insurance of 2004 cover 832 traditional Chinese medicines up from 415 of 2000 the number of chemical medicines covered by the insurance systems increase from 725 to 1031 from year 2000 to 2004 some of which are patent protected drugs of Western companies Sino Generali Life Insurance a joint venture between China and Italy companies offers a commercial medical insurance that reimburses 80 of prescription drugs with an annual maximum reimbursement of 1000 per policy Changes Edit Before the reform of healthcare system roughly 140 million workers and 60 million family members were covered under the State owned enterprise SOE and collective insurance This system has reimbursed 100 percent of employees medical costs and 50 percent of family members costs The system has been funded in name at least by the enterprises Hoping to reduce enterprise subsidies of all types the State Council launched pilot reforms in 1994 of the two health insurance systems under its control Begun in two midsize cities Jiujiang Jiangxi Province and Zhenjiang Jiangsu Province and expanded to over 60 cities in 1997 this experiment has become national policy applicable to domestic and foreign invested firms The two State health insurance systems would later be consolidated to be the Basic Medical Insurance System Only about 120 million to 180 million workers have some form of healthcare coverage that will pay for Western pharmaceuticals according to industry analysts Farmers who make up the vast majority of Chinese have no real coverage at all Government Edit The Chinese government used to cover up to 100 of medical fees for employees working with government agencies state owned enterprises or educational organizations but peasants didn t enjoy the policy Starting from 2001 a new medical coverage plan took effect marking the government s withdrawal from shouldering whole medical insurance burden Under the policy urban residents must join a government managed basic insurance coverage plan for urban residents and pay a certain amount of monthly fees based on their income levels and up to 70 of their medical expenses can be reimbursed So far around 100 million urban residents are covered by the plan Private payers and insurance companies Edit According to a news report 44 8 of urban residents and 79 1 of rural residents have no medical insurance citation needed Many of people are private payers They either cannot afford to buy medical insurance or do not understand the value of medical insurance In contrast to rural residents urban residents have much better situation Many employers have bought for their employees group or supplementary medical insurance and employers deduct from employees payrolls a small percentage of their monthly incomes Medical education EditBy 1901 China was the most popular destination for medical missionaries The 150 foreign physicians operated 128 hospitals and 245 dispensaries treating 1 7 million patients In 1894 male medical missionaries comprised 14 percent of all missionaries women doctors were four percent Modern medical education in China started in the early 20th century at hospitals run by international missionaries 7 Today Universities colleges and institutes which make up China s higher educational system offer four or five year undergraduate programs as well as special two or three year programs To control the medical education standard the Chinese ministry of education set up a quality control regulation on medical education this regulation specially for English medium undergraduate medical education 8 See also EditChinese Medical Doctor Association Chinese Medical Journal Christianity in China Classification of Chinese Hospitals Healthcare reform in the People s Republic of China Medical missions in China Pharmaceutical industry in China Smoking in the People s Republic of China National Administration of Traditional Chinese MedicineReferences EditCitations Lijuan W 2014 Development of a medical academic degree system in China Medical Education Online 93 1 114 120 doi 10 3402 meo v19 23141 PMC 3895259 PMID 24434025 Undergraduate Medical Education Shanghai Medical College Fudan University Lijuan W 2014 Development of a medical academic degree system in China Medical Education Online 93 1 114 120 doi 10 3402 meo v19 23141 PMC 3895259 PMID 24434025 National Medical Examination Center China Archived 2016 06 30 at the Wayback Machine MBBS in China Guideline 2021 china medical universities www sicas cn Retrieved 2021 02 01 MBBS in China PMDC info 2022 china medical universities mbbsinchina urdusky com 29 April 2013 Retrieved 2022 09 02 Henry Otis Dwight et al eds The Encyclopedia of Missions 2nd ed 1904 p 446 Online Circular of the Ministry of Education On Interim Provisions for Quality Control Standards on Undergraduate Medical Education in English for International Students in China permanent dead link Further reading EditBaum Emily 2020 Medicine and Public Health in Twentieth Century China Histories of Modernization and Change History Compass 18 7 doi 10 1111 hic3 12616 S2CID 225622823 Croizier Ralph C Traditional Medicine in Modern China Science Nationalism and the Tensions of Cultural Change No Ser 34 Harvard Univ East Asian Research Center 1968 340pp Harmsworth K and G T Lewith Attitudes to traditional Chinese medicine amongst Western trained doctors in the People s Republic of China Social Science amp Medicine 52 1 2001 149 153 Hillier Sheila M and Tony Jewell Health care and traditional medicine in China 1800 1982 Routledge 2013 Lampton David M The politics of medicine in China the policy process 1949 1977 Routledge 2019 Scheid Volker Chinese medicine in contemporary China plurality and synthesis Duke UP 2002 Unschuld Paul U Medicine in China A history of ideas Univ of California Press 2010 Nursing Edit Chan Sally and Frances Wong Development of basic nursing education in China and Hong Kong Journal of advanced nursing 29 6 1999 1300 1307 online Chen Kaiyi Missionaries and the early development of nursing in China Nursing History Review 4 1996 129 149 Davis Anne J et al The young pioneers first baccalaureate nursing students in the People s Republic of China Journal of advanced nursing 17 10 1992 1166 1170 online dead link Grypma Sonya Withdrawal from Weihui China missions and the silencing of missionary nursing 1888 1947 Nursing inquiry 14 4 2007 306 319 Xu Yu Z Xu and Jainhui Zhang The nursing education system in the People s Republic of China evolution structure and reform International Nursing Review 47 4 2000 207 217 onlineExternal links EditChinese Medical Association List of medical schools in China Archived 2009 08 11 at the Wayback Machine New England Journal of Medicine Retrieved from https en 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