In any case, the real point of the article is to set up China as a counterpoint (or a straw man, if we want to be cynical about it) to the United States, which he calls out in the final paragraph (if you can call them that, as I was counting I was struck by how short journalism paragraphs are):

There is, after all, another large country with unimpressive recent gains in life expectancy, even smaller than China’s. That’s right: the United States. Since 1990, we have been passed by Chile, Denmark, Slovenia and South Korea, among others. China is still five years behind us, but it’s gaining.

I was curious to see what the comments on this article thought, and I did a little survey:

There were only 20 comments on the article after two or three hours, and I divided them up into categories. The hash marks count comments and the numbers in parentheses count the total number of “Likes” attached to the comments in each category.

There were a couple off point comments which either reiterated some point in the article or brought up some totally irrelevant fact.

There were relatively few China Bashers, and their comments were mainly a grab bag of “communism blows,” “serves the baby poisoners right,” and then criticism of the one-child policy.

The China apologists were split between people who missed the point of the article slightly, or perfectly rational people explaining China’s mitigating circumstances. The former group seized on the article’s following “omission”:

The article began by saying that the rates of all these other countries (minus the U.S., which I just put there for reference) had increased their life expectancy at a faster rate than China, but the apologists faulted the author for not pointing out that China has nearly a decade on the other third world countries. Of course, those apologists consequently ignore the fact that the author also notes that some countries which started with higher life expectancies than China also improved at faster rates, see below. The latter group of apologists simply brought up points about population size and the like. Nothing earth-shattering.

(Isn’t google cool? That’s the World Bank data visualized.)

Finally, the self-deprecators, in the great majority, certainly got the point that was being made. It’s too bad it had to be made at China’s expense, but they do focus on criticizing domestic policy at least. But that’s not what China Bio Law is about so I don’t feel any obligation to go into it.

One thing I did particularly like about the article was the author’s little historical aside into the “Mortality Revolution,” which basically discussed how economic growth following the Industrial Revolution did not bring immediate health benefits along with it. I’ve put the book on this on my reading list.

Oh, and I suppose here’s the section that was most relevant to this blog; there’s nothing new and there’s already plenty of material out there on this stuff:

Finally, there is the medical system itself. The dismantling of state-run industrial companies over the last two decades has ended the cradle-to-grave benefits system known as the iron rice bowl. In its place was a market-based medical system many Chinese could not afford. Even in emergencies, people sometimes had to bring cash to the hospital to get treatment.

Early last year, the Chinese government began expanding health insurance coverage, with the goal of making it universal by 2020. The initial signs look pretty good. The World Bank does not have data past 2008, but numbers published by the C.I.A. suggest that life expectancy has risen in the last two years. In my travels, I visited a simple, clean clinic in rural northern China that seemed to be providing the kind of basic care that could make a huge difference.

The upcoming reforms will focus on five areas:

• The public health system;
• The medical care delivery system;
• The health security system;
• The pharmaceutical system; and
• Pilot hospital reform.

Financing and budget allocation is going to be a huge issue, because the central government cannot simply cut check and get the money to the right place.  Public resource allocation is highly decentralized, and governments below the central level actually administer 90% of all government healthcare spending.  Local health departments and other health care providers are also expected to generate their own funding, which seriously distorts the provision of health care because those providers then focus on more profitable curative care and medicines and start increasing fees for public health goods.  In 2007 health expenditures totaled 4.5% of China’s GDP (estimate of total GDP in 2007 was $7.332 trillion USD, meaning ~$330 billion USD would have been spent on healthcare; compare that with the U.S.’s $2.2 trillion spent on healthcare, 16.2% of our GDP) , and 45% of those expenditures were paid for out of pocket by private citizens (compared to the U.S.’s 12%!), a percentage that has been growing relative to the government’s own portion.

China’s health care problems broadly separate out into two often-related areas: cost and quality of care.

Cost is in fact the main barrier to health care in China.  Fees and required expenditures are increasing faster than the average income, and health insurance coverage is spotty at best.  The problem is greatly exacerbated in rural and poor areas, making the issue of even greater concern as great portions of the Chinese population are either rural or poor citizens, and usually both.  Rural governments are often unable to implement the government’s medical financial assistance schemes because of cost, and specialized care is difficult to come by in more remote areas.  Payment schemes tend to disadvantage poor and rural citizens, and their health insurance will frequently be limited to catastrophic illness and reimburse patients for only a third of a treatment’s cost at most.  Many rural enterprises operate without sufficient safety regulation, and generate most of China’s occupational diseases, disabilities, and deaths.

As for quality of care, most problems arise out of a lack of comprehensive regulation and thorough implementation.  Hospital accreditation isn’t linked to comprehensive safety records, doctors and health institutions are unrestricted in their pursuit of commercial incentive programs, and there is a severe deficit of clinical treatment guidelines.  The government wants to better define its role in the health sector by creating consistent health and safety regulation across the country and streamlining the administrative end of things.  The government also wants to improve the quality of care by altering the current composition and distribution of human resources.  Currently, only 14% of the nation’s health professionals have bachelor’s degrees or higher, and poorer regions are often unable to attract and retain qualified medical staff.  There are also imbalances within the health care profession; for instance, with a ratio of 1.3 to 1, China is one of the few countries where doctors outnumber nurses.

So China certainly has a long road ahead of them, and their first step comes in the form of a $124 billion USD commitment to the first three-year implementation program.  Along the way they will have to deal not only with problems endemic to the rational structuring of any nation’s health care system, but uniquely Chinese ones as well.  Traditional Chinese Medicine (TCM) is one of these indigenous issues; the majority of the Chinese population seeks out TCM and the government actively promotes it and integrates it into the national health care system.  So a portion of the government’s reform efforts will center around acknowledged issues in the TCM industry, such as the absence of standardized regulations for assessing TCM treatments and medicines, a lack of standards for applying TCM in clinical trials, and a great amount of evidence-based testing and research yet to be done.  There are also issues with the overall quality of TCM professionals and institutions.

And while the WHO report I have been analyzing did not mention the role of emerging technologies, such as stem cell treatments, in China’s healthcare system, I will be very interested in finding a source on that or doing some original research on it.