The state of healthcare in China is in many ways better than it was in the era of the barefoot doctors, with average life expectancy in the country now trailing the United States by only three years and morbidity rates far lower too. But while even the most cutting-edge medical services are available in first-tier cities for a price, China's transition to a market economy has left many in the lurch, with out-of-pocket healthcare costs soaring even as the government rolls out more comprehensive health insurance support. How have the new healthcare system reforms inaugurated in 2009 worked out so far?

If you're curious what's happening in the Chinese healthcare industry, don't miss this show. Joining Kaiser Kuo and Jeremy Goldkorn from Danwei (a Financial Times company) are three guests with deep expertise on the healthcare industry in China: Dai Lian, a former reporter for Caixin and now executive editor at CN-Healthcare; Benjamin Shobert, founder and managing director of Rubicon Strategy Group who writes on the Chinese healthcare market for CNBC and Forbes; and Dr. David Rutstein, Vice-President for Medical Affairs at United Family Healthcare and former acting deputy surgeon general of the United States.

Note, our thanks to Damjan Denoble who writes for the Asia Healthcare Blog and was instrumental in setting up our guests for this week's discussion. So thanks Damjan! And please also note that we invite everyone to download and share this week's show as a standalone mp3 file, or keep yourself updated on the release of new shows with our Sinica RSS feed. And we hope you like the show!
 said on
April 27, 2013
great podcast and just before my politics and policy exam! :)
 said on
April 28, 2013
I listened to it while going to sleep and never thought healthcare could be such an interesting topic. Great talk and great talkers!
 said on
April 28, 2013
In the introduction, Kaiser said that the state of health care in the PRC is "a fair sight better than it was, or different anyway, than it was in the age of the storied barefoot doctors. While in many ways things have improved (life expectancy has risen very very fast in the years since reform and opening began),..."

But it can't have risen as fast as it did in the Mao era, if you accept the following statement:

"[T]he fact remains that, despite all the horrors of the Great Leap Forward, Mao's time in power saw life expectancy within China jump from roughly thirty-five to seventy" [p.61, "China in the 21st Century: what everyone needs to know" by Jeffrey N. Wasserstrom]

And according to the CIA World Factbook (2011 estimates), quoted in Wikipedia, the present life expectancy has advanced only a little beyond 70 – they say it's 73.47 years.

---- http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy

I'm no expert, but I would like to be able to reconcile these seemingly contradictory statements.
 said on
May 1, 2013
Fascinating and informative. The glee for private business opportunities/potential not so much.
 said on
May 4, 2013
I enjoyed this on the whole, but having Rutstein & Shobert on was a bit like getting a couple of poachers in to talk about the future of gamekeeping - it was tiring hearing constantly about the future of the private sector when its involvement so far has been basically parasitical, and while I appreciate you all use United Family Hospital you should respect that 99% of Chinese have no access to these services and that your discussion should generally concern them.
 said on
May 21, 2013
I have some disagreement with different parts of the discussion per my own experience in Shunde Cty, Foshan City of Guangdong Province: 广东省,佛山市,顺德区。I was living in Shunde and working in Sales for a company that made fairly high-tech packaging and weighing machinery and before coming to China, had a very thorough medical check, above and beyond the requirement for a work visa. My doctor said that I was on the verge of being hypothyroid and should get checked every few months while in China. I went to a hospital every 4 months to get checked.

Shunde is supposed to be well-off compared to many areas in China, and it is, they have their own "White House" for a government building. That did not extend to the hospitals which did not supply toilet paper or soap or towels, which is common in China, but at a hospital?! I shouldn't have been shocked, but...especially since these were post-sars days. Then my check-ups were quick and decisively unhelpful and my blood was "unusual" but I didn't need to go on medication. Needless to say, when I came back to the US, my endocrinologist had me go on thyroid medication immediately.

I should have paid at my own expense to go to Hong Kong for a check-up, no matter the cost.
 said on
June 21, 2013
Great podcast. I appreciated Jeremy's persistence, but his question about the U.S. vs. China largely went unanswered. It's complicated and the two really can't be compared effectively, but here's a few observations.

1) U.S. federal law (EMTALA) requires emergency physicians to see, treat, and stabilize any patient, regardless of insurance status or ability to pay. Only after these things are done can they be sent away. Safety net hospitals do not kick out the indigent, but private hospitals might. There is no such law in China (or most other countries) and stories of Chinese peasants bleeding to death in an ED waiting room as the staff ignores them are numerous and almost certainly do not scratch the surface of actual cases. Any poor, uninsured illegal immigrant in Boston who gets hit by a bus will receive the world's most advanced medical care at Mass General and pay absolutely nothing for it.

2) As the good doctor pointed out, the ~98% insurance coverage rate frequently reported by the media is largely a smoke screen. It's a huge achievement that should be recognized, but non-treatment or under-treatment and bankruptcy due to medical costs remain very real problems for a large portion of China's population.

3) As Jeremy knows firsthand, media coverage between the two countries is night and day. Medical malpractice in the U.S. is often turned into sensational front page news. In most circumstances, similar cases in China are either not reported or buried in local Chinese language newspapers, far away from Western eyes. Occasionally they make it into international press, but the relative absence of reporting on bad medical outcomes due to poorly equipped or poorly trained clinicians should not be interpreted as an absolute absence.
 said on
June 21, 2013
@semeyers

Glad you brought that up since I was thinking the same thing. It is definitely true that emergency rooms in the US can't refuse care and don't check for insurance until after initial treatment if there is a serious enough injury. My father used to work in ER in Southern California and said a significant number of patients did not have insurance and many never ended up being required to pay anything. According to the government, 1/5th of ER visits are from the uninsured.

http://www.hhs.gov/news/press/2009pres/07/20090715b.html

I doubt there are many patients who don't pay anything in China and still receive care. However, it is a major problem that the ER in the US ends up being a replacement for a primary care physician for those who can't afford one. Paying for an "ounce of prevention" might save the money required for "a pound of cure". I wonder if a greater focus on subsidizing prevention might be appropriate for China as well.

 said on
June 22, 2013
I fell ill in Beijing last year and ended up in one of United's hospitals. Felt like I never left Sweden, except that they did make me wait for almost an hour until my insurance company could give them the green light. Not saying that to point out UFH -- I'm sure any other Beijing hospital would've done the same. I can only imagine what it would've been like if I weren't a privileged westerner with a nice health insurance.
 said on
June 23, 2013
@Sinica -- Any chance you could post links or citations for the readings mentioned at the beginning of the podcast? I'd love to read some more background info about this topic. Thanks!
Mark Lesson Studied