Health care ailments easy to diagnose, tough to cure
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E-mail Shanghai Daily, July 16, 2013
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[By Zhou Tao/Shanghai Daily] |
Wharton health care management professor Lawton R. Burns recently returned from Beijing, where he and Gordon G. Liu, professor of economics at Peking University's Guanghua School of Management, co-taught a four-day course on China's health care system.
The course, attended by 20 Wharton students and 20 Peking University students, looked at such topics as quality and availability of care, the disparity between rural and urban health care, corruption in the delivery system, medical training and the needs of a growing elderly population.
Underlying some of China's most basic health care challenges is the "wide but shallow distribution of health insurance," says Burns.
Recent reforms have extended health care to 95 percent of the population - most of whom have never had insurance before - a development that has somehow caused strains on the delivery system.
Now that consumers have access, "everyone wants to go to the major academic health centers, which means there are enormous lines starting early in the morning to get in and see a specialist," says Burns, who toured several health care facilities during his teaching week. Not everyone gets through the line, however, and people who do get in don't always get the results they want.
"People expect good care now, and when they don't receive it, they sometimes blame the doctors," notes Burns, adding that there have been cases of medical personnel physically attacked by dissatisfied patients.
For the Chinese government, the issue is cost: How do you fund health care for a new group of insured people, in both rural and urban areas, who had until recently been lacking coverage for even the most basic health care needs?
"There is always a trade-off between increasing access to health care, and funding that access. It has to do with the 'Iron Triangle'," says Burns, referring to a phrase that describes the three main cornerstones of health care: access, cost and quality.
The difficulty comes when regulators try to improve all three, or even two, at once. "If you increase access, you increase cost. So how do you balance the two," especially when the expectations of newly insured consumers are rising so quickly?
More money, more prestige
The problem of access to quality care is especially acute in rural areas of China.
"Physicians find big disparities in terms of income, status and access to technology in the countryside versus the city," says Burns, noting that doctors naturally tend to gravitate to the research opportunities, higher salaries and clearer career paths offered by big urban medical facilities. "Why would a doctor move from a Class 3 urban hospital to the lower pay of a Class 1 or 2 hospital in a rural area? Doctors lose prestige and money by going outside the cities."
Indeed, with so much investment and technology targeted to urban medical centers - which then attract the best doctors and the highest-paying patients - meaningful redistribution of physicians is difficult to bring about.
Burns does suggest one option: Provide incentives to medical students through a national rural health service program that encourages them to practice in rural areas for the first two or three years after graduation.
The program could target new doctors who come from the countryside and might be more inclined to return there to work.
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