Great piece, Ruby. A valuable info resource. We're up against a declining power that wants to keep China in the 1980s and hammers out its narratives accordingly.
Outstanding report, accurate, precise. I (美国人) and wife (武汉人）experienced life threatening condition on wife's side. 3 months initial treatments, 5 year follow up treatments. All interactions with medical professionals and staff were fair, balanced, and competent. Some things, like MRI analysis, were a little disconcerting such as the MRI equipment was in a former (beat up) bus station, but the actual care and technical expertise was excellent.
We did have connections, relationships provided access probably not available to others, so unequal access is real. But, in the 5 years of follow up, access is noticeably more fair.
Like everything else here, improvements are being undertaken with apparent skill and competence.
On the other side of the ocean, in America, something as simple as a hangnail might result in a 4 month wait to get a referral to a podiatrist. If you're on Medicare, access to the best and brightest is instant because the hospitals know the game and pile on every conceivable extra expense procedure because they know they can...which, if looked at unemotionally, is simple fraud.
So, excellent report in every regard. Thanks much.
On Myth 5, another reason for using digital alternatives for healthcare services in rural areas is the lack of doctors, especially expert 专家 doctors. These experts tend to be in Tier 1 cities, which is why there is (often) overcrowding at the big famous hospitals. Rural people will come to, for example, Beijing to 挂号 and see an expert doctor.
I lived in Beijing for years and years, and I made use of local public hospitals on several occasions. It certainly wasn't bad in terms of speed and efficiency, but I found the quality of the healthcare to be variable and unreliable. On one occasion in 2016 I went to the large Zhongguancun Hospital because I had had a persistent cough for weeks. I was immediately given a blood test and quickly shown the results, but the doctor who visited me didn't even listen to my chest.
A week or so later, after my cough still didn't go away, I went to Oasis, a private international hospital. The British doctor who visited me was rather amazed that they hadn't thought of listening to my chest. She seemed much more professional and attentive, and I immediately felt more trust that they were taking the problem seriously and weren't missing anything.
Great article. On myth 3 - VBP only applies to generic medicines, a market dominated by local manufacturers. The good news is that it has freed up funding to reimburse more innovative medicines, however I do worry from a public health stand point about a 'race to the bottom' on medicine production costs, which could exacerbate health inequalities.
For innovative pharma looking to the future the more impactful policy is reimbursement via the NRDL, and the global-lowest pricing demands for access to the huge volume of the China market (provincial reimbursement drug lists have been eliminated, centralising decision making and importance of the NRDL). This is compounded by your comments in myth 2 - even in an innovative class multi-nationals may be beaten to the market by a local biotech, further impacting both the pricing and volume opportunity.
One area in particular I wish was better undestood is how far ahead China is in adoption of digital technology which you illustrate very well through your personal example at the beginning. Often when thinking about challenges faced by patients in EU or US, I'm left thinking this would be much easier if patients were as comfortable digitally interacting with the healthcare system and managing their health as patients are in China.
Thanks for your thoughts James, the considerable private sector/OOP side of drugs is important and overlooked (myth 1!) - china’s Vbp model does not hold the same powers it did at its start. Beyond drugs alone, reimbursable holistic service pathways are a significant priority now. Regardless, strong domestic bias remains across the board (although there exist various ways for foreign industry to navigate that effectively!) the point about customer/patient acceptance of tech in healthcare is very interesting. I see that China and uk/us/others have differences in preferences - often in stark ways - based on history, cultural context, social norms etc. it’s fascinating to reflect on, but maybe no surprise that health is a perfect medium in which humans and humanity’s tendencies are revealed! I hope to cover all of these in more detail in future posts
Thank you for posting this summary of the most common myths and misconceptions about the Chinese healthcare market. I also appreciate how you apply elements of the "Smart Brevity" approach to writing. I do this, too.
Previous comment, now just back from 7 months in Wuhan (major urban) and Enshi (rural countryside "small" city of about 300-400,000 with another 300-400,000 in the outer prefecture depending on where the lines are drawn. New issue with wife's knee surgery requiring hospital stays and elderly in-laws with multiple elderly issues with daily and overnight stays.
Experiences that follow the 5 points in the report to the letter. Better than last year, with 2 new hospitals going up next to the one in Wuchang that is old and at the end of its useful life. Care was attentive and competent. Big improvements across the board.
Some of these myths may apply to the healthcare system in Malaysia too. The developing world is fast catching up, if not surpassing healthcare in the West.
An important subject to be talking sense about! As a user and observer of China’s healthcare, I’d say the quality at the routine end is very affordable, fast, and good. Having money skews the system in your favor - but that is the story everywhere at anytime. Feeling like you are really cared for and not a problem to solved and moved on quickly is another thing - service and bedside manner is a different lower standard. Personal experience, it comes up often that China doesn’t have this or that medicine that places like the US already are using, but that’s anecdotal. 🙏
Thanks for sharing your experiences Paul! Very valid points & do give more detail if you’d like on the specific services, anecdotes and so on if you have, I’m always a interested to hear different povs
Just my own observation, and I wouldn't say one approach is better than another, but cultures are different. The willingness to go to hospital for relatively minor issues, and the expectation to leave with medicine is something I notice. I think that increased traffic per population leads to the crowded and brief consultation environment and the impression that health care is under-invested. Its just my guess or impression too, that doctors and nurses are under-paid, and probably incentivized oddly too.
The US might have had some similarities before WW2 without all the fancy technology. Deeply unequal and without access in many situations. It might have been better had the US stuck with it, although I wish we would have nationalized it like Harry Truman wanted.
Great myth busting. I too got educated on a couple of these. It would be great to understand how public and private bodies collaborate in joint ventures, if any, in the digital and analytics space.
Great piece, Ruby. A valuable info resource. We're up against a declining power that wants to keep China in the 1980s and hammers out its narratives accordingly.
Thanks so much Anna!
Outstanding report, accurate, precise. I (美国人) and wife (武汉人）experienced life threatening condition on wife's side. 3 months initial treatments, 5 year follow up treatments. All interactions with medical professionals and staff were fair, balanced, and competent. Some things, like MRI analysis, were a little disconcerting such as the MRI equipment was in a former (beat up) bus station, but the actual care and technical expertise was excellent.
We did have connections, relationships provided access probably not available to others, so unequal access is real. But, in the 5 years of follow up, access is noticeably more fair.
Like everything else here, improvements are being undertaken with apparent skill and competence.
On the other side of the ocean, in America, something as simple as a hangnail might result in a 4 month wait to get a referral to a podiatrist. If you're on Medicare, access to the best and brightest is instant because the hospitals know the game and pile on every conceivable extra expense procedure because they know they can...which, if looked at unemotionally, is simple fraud.
So, excellent report in every regard. Thanks much.
On Myth 5, another reason for using digital alternatives for healthcare services in rural areas is the lack of doctors, especially expert 专家 doctors. These experts tend to be in Tier 1 cities, which is why there is (often) overcrowding at the big famous hospitals. Rural people will come to, for example, Beijing to 挂号 and see an expert doctor.
I lived in Beijing for years and years, and I made use of local public hospitals on several occasions. It certainly wasn't bad in terms of speed and efficiency, but I found the quality of the healthcare to be variable and unreliable. On one occasion in 2016 I went to the large Zhongguancun Hospital because I had had a persistent cough for weeks. I was immediately given a blood test and quickly shown the results, but the doctor who visited me didn't even listen to my chest.
A week or so later, after my cough still didn't go away, I went to Oasis, a private international hospital. The British doctor who visited me was rather amazed that they hadn't thought of listening to my chest. She seemed much more professional and attentive, and I immediately felt more trust that they were taking the problem seriously and weren't missing anything.
Great article. On myth 3 - VBP only applies to generic medicines, a market dominated by local manufacturers. The good news is that it has freed up funding to reimburse more innovative medicines, however I do worry from a public health stand point about a 'race to the bottom' on medicine production costs, which could exacerbate health inequalities.
For innovative pharma looking to the future the more impactful policy is reimbursement via the NRDL, and the global-lowest pricing demands for access to the huge volume of the China market (provincial reimbursement drug lists have been eliminated, centralising decision making and importance of the NRDL). This is compounded by your comments in myth 2 - even in an innovative class multi-nationals may be beaten to the market by a local biotech, further impacting both the pricing and volume opportunity.
One area in particular I wish was better undestood is how far ahead China is in adoption of digital technology which you illustrate very well through your personal example at the beginning. Often when thinking about challenges faced by patients in EU or US, I'm left thinking this would be much easier if patients were as comfortable digitally interacting with the healthcare system and managing their health as patients are in China.
Thanks for your thoughts James, the considerable private sector/OOP side of drugs is important and overlooked (myth 1!) - china’s Vbp model does not hold the same powers it did at its start. Beyond drugs alone, reimbursable holistic service pathways are a significant priority now. Regardless, strong domestic bias remains across the board (although there exist various ways for foreign industry to navigate that effectively!) the point about customer/patient acceptance of tech in healthcare is very interesting. I see that China and uk/us/others have differences in preferences - often in stark ways - based on history, cultural context, social norms etc. it’s fascinating to reflect on, but maybe no surprise that health is a perfect medium in which humans and humanity’s tendencies are revealed! I hope to cover all of these in more detail in future posts
Thank you for posting this summary of the most common myths and misconceptions about the Chinese healthcare market. I also appreciate how you apply elements of the "Smart Brevity" approach to writing. I do this, too.
Thanks for your kind words mark!
Previous comment, now just back from 7 months in Wuhan (major urban) and Enshi (rural countryside "small" city of about 300-400,000 with another 300-400,000 in the outer prefecture depending on where the lines are drawn. New issue with wife's knee surgery requiring hospital stays and elderly in-laws with multiple elderly issues with daily and overnight stays.
Experiences that follow the 5 points in the report to the letter. Better than last year, with 2 new hospitals going up next to the one in Wuchang that is old and at the end of its useful life. Care was attentive and competent. Big improvements across the board.
Some of these myths may apply to the healthcare system in Malaysia too. The developing world is fast catching up, if not surpassing healthcare in the West.
An important subject to be talking sense about! As a user and observer of China’s healthcare, I’d say the quality at the routine end is very affordable, fast, and good. Having money skews the system in your favor - but that is the story everywhere at anytime. Feeling like you are really cared for and not a problem to solved and moved on quickly is another thing - service and bedside manner is a different lower standard. Personal experience, it comes up often that China doesn’t have this or that medicine that places like the US already are using, but that’s anecdotal. 🙏
Thanks for sharing your experiences Paul! Very valid points & do give more detail if you’d like on the specific services, anecdotes and so on if you have, I’m always a interested to hear different povs
Just my own observation, and I wouldn't say one approach is better than another, but cultures are different. The willingness to go to hospital for relatively minor issues, and the expectation to leave with medicine is something I notice. I think that increased traffic per population leads to the crowded and brief consultation environment and the impression that health care is under-invested. Its just my guess or impression too, that doctors and nurses are under-paid, and probably incentivized oddly too.
The US might have had some similarities before WW2 without all the fancy technology. Deeply unequal and without access in many situations. It might have been better had the US stuck with it, although I wish we would have nationalized it like Harry Truman wanted.
Great myth busting. I too got educated on a couple of these. It would be great to understand how public and private bodies collaborate in joint ventures, if any, in the digital and analytics space.
Thanks Sukhmeet! Yes the collaboration structures are diverse and interesting - each with pros and cons. Happy to dive into this in a future post
Yes pls do