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[edit]
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.
Physicians[edit]
Physician 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 performance 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 into 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 conducting surgeries at hospitals other than the ones 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 physicians for receiving treatment) or from sales representatives of drug companies. New regulations issued by the Health Ministry, however, remove 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. 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.
Payers[edit]
Payment 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.
Medical education[edit]
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.
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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.[6]