Where is the Healthcare System Leading us? A Reflection of Healthcare in the U.S. and China
Carol Xie
Healthcare is a question that concerns every person on the planet; as life expectancy increases and medical care advances, we have higher expectations for the quality and availability of our healthcare. However, global healthcare resources are scarce, and it is difficult to grant affordability, quality, and availability to everyone. It is noteworthy to analyze the healthcare systems in different nations and understand the historical backgrounds that lead healthcare systems to their current state, both successes and failures. In this article, I will compare the healthcare structure and regulations of the United States of America and China, and evaluate the future of healthcare in these two countries.
The insurance-based healthcare system was not introduced until the end of the 19th Century, when Germany launched the first national health insurance in 1883. Since the 1930s, insurance companies prevailed in the United States to cover healthcare expenses for the general public, especially through employee-benefit plans. Since then, the financial structure of American healthcare has been based on employee or private insurance that reimburses people finding care in the privatized healthcare market. Such a system bridges the capitalist healthcare-provider market and the care-seeking public, but it produces increased inefficiency as private medical corporations negotiate with the insurance company.
In contrast, the People’s Republic of China started with a completely socialized healthcare system as everyone was employed by the state and enjoyed health benefits. Nowadays, the government still oversees its citizens’ healthcare, but privatization of medical services is more prevalent since the economic reform of 1978. Still, 95% of the population is covered by state-controlled insurance, which is funded through a portion of personal monthly income and employer contribution in a ratio of 1:2. However, while China’s state-run insurance system covers a much larger population, the patient responsibility is an average of 30% (compared to 10-20% rate in the U.S.). The Chinese healthcare system uses the Hukou system ( where one can only receive coverage in the city where they are registered as residents) which creates a problem of unequal coverage between poorer rural versus coastal areas (which have the best healthcare resources in China). In America, the same problem of geographic inequality of healthcare is also relevant, but it is easier for Americans to access nearby medical services (provided that they can afford transportation).
Aside from the apparent structural differences, the healthcare systems in United States and China also have a cultural difference -- liability regulations and legal support. Healthcare regulations for American medical facilities and practitioners use hundreds and hundreds of pages to define details from the medical consent of minors to the conditions that justify medical malpractice. With clear medical regulations and legal details for medical professionals and patients, patients can easily find support and sue the facilities if they sense improper practice. But, these overly-detailed regulations also increase the cost of healthcare, as doctors have to purchase malpractice insurances and more procedures need to be accounted for to ensure all rules are followed. The accessibility of care can also decrease as more paperwork is needed before an urgent case can be seen, and minors must have parents to accompany them and multiple consents to visit or even contact the doctors. The liability rules for the medical facilities also limit minors’ accessibility to specialist clinics, and it is generally slow for medical facilities to ensure all liabilities are considered.
On the other hand, Chinese society functions mainly with social sanction instead of legal rules, and the healthcare regulations are less defined. For example, minors rarely run into the problem of finding medical service alone and the wait-time for paperwork is minimal. The doctors are employed as a part of the hospital, and hence the liability and malpractice cases rarely apply to individual doctors. The state-defined laws give the state-controlled hospital more legal freedom so as to maximize efficiency with the limited medical resources. However, because of the lack of legal support in China, malpractice and harm inflicted by medical professionals on patients or their families is quite common in hospitals. Patients feel lack of power in malpractice cases, and find no legal recourse to resolve their pain.
As we can see, both healthcare systems offer different insights into the efficiency, affordability and accessibility of healthcare, and neither of them are near optimal. In the United States, each state is refining healthcare regulations to ensure accessibility and accountability of medical professionals, and the potential future is an optimized compromise of the three main goals. At the same time, the fast-evolving society in China is proposing a bolder possible future for healthcare. As medical resources are more scarce compared to the growing population, China is facing an urgent problem of aging as well as insufficient healthcare for all of its economic classes. Several technology and innovation teams are actively pursuing options like using artificial intelligence to train digital doctors to diagnose common ailments such like a flu or thyroid disorder, and the public is also passionate in trying to find more efficient ways to improve China’s healthcare system. If new innovations prove efficient, the government or private healthcare companies might adopt a new structure that will totally change the future of healthcare. Either a more comprehensive healthcare plan, or a revolutionary healthcare structure -- either way, we are up to see the change in the healthcare landscape in the near future as we take an international perspective.
References:
https://www.nber.org/reporter/winter00/kessler.html
http://petris.org/wp-content/uploads/2018/03/CA-Consolidation-Full-Report_03.26.18.pdf
https://www.chcf.org/press-release/chcf-releases-analysis-of-health-insurance-premium-regulation/