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China's healthcare system under strain

18th September 2012

The Chinese authorities are struggling to mend the country's increasingly unequal healthcare provision, which sparks regular public protests and social unrest from the millions of Chinese for whom adequate medical care is out of reach.


Faced with a sharp rise in the number of violent attacks on hospital doctors and other healthcare workers, the government has prioritised the overhaul of the public healthcare system.

China reported 17,243 cases of beatings, threats, kidnappings, verbal abuse and even killings of healthcare professionals in 2010, a huge rise on previous years, officials figures show.

The violence of some patients who are angry over care they cannot afford and frequent medical errors that create ill-health is unlike to abate, however, critics say.

They say that the government's efforts to cut treatment costs in public hospitals and defuse tensions do not go far enough.

According to a health official in the southern Chinese province of Guangdong, the government is very worried about violence against doctors, and some hospitals now have guards guarding them.

The source, who works in hospital administration, said preventing such attacks was now a top priority.

Measures introduced in July banned a traditional mark-up of 15% on drugs dispensed in government hospitals, a practice which has generated a large proportion of hospital incomes in the face of diminishing subsidies.

The pilot measures will initially be imposed on 300 hospitals at the county level, but many patient advocates and health officials say it will have little effect on the affordability of medicines.

The biggest mark-ups are pocketed by a network of pharmaceutical salesmen, typically reaching levels of 40%, and sometimes, many times the purchase price.

Tens of thousands of pharmaceutical companies and distribution companies exist throughout China, and the tax revenue they generate is relied upon by cash-strapped local governments.

Pharmaceuticals can pass through two or three distribution companies before they ever reach a hospital dispensary, and distributors sometimes have little or no competition, often monopolising supply to a given hospital.

Doctors are also paid, along with advertisers, to promote the drugs on offer from distributors.

According to Guangdong provincial deputy director general for health Liao Xinbo, the issue of price inflation by these middlemen is a far bigger issue that should be tackled.

Liao called on the government to target the drugs vending and distribution system across China.

Meanwhile, hepatitis C patient Xu Shiding said he was struggling to find the money to pay for weekly injections that help treat the viral disease.

Xu has to pay for the injections out of his own pocket, because his state health insurance cover does not cover the treatment.

Hepatitis can lead to liver cancer if untreated, and Xu, whose monthly salary is just 2,300 yuan, can ill afford the treatments that cost him around 1,300 yuan a month.

According to a 2008 study in The Lancet, the cost of a single hospital stay in China is roughly equal to the country's average per capita annual income.


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