China vs. US Health System

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China Healthcare System vs United States

A health care system refers to the comprehensive organization, structures and strategies through which Medicare and health care is availed by the government to its citizens. A health care system is a product of countries politics. It is a nations system of governance that will dictate upon the most convenient model of health care to adopt. There is no universally acceptable method, and in adopting each; a government has to take into account a variety of factors, which would range from available finances vis-a-vis the total population.

A comparison of two models of health care or two countries approach to the provision of health services has to encompass the core issues of financing and health care management. Health sector is the most vital industry in a country and how effectively or ineffectively it is handled goes forth to reveal the social, political and economic policies of a country towards its citizens. A biggest investment of a government has to be in its people and what better way to do it than to invest in the health sector.

The purpose of this paper is to focus at the comparison of the United States health care system with that of China. It will focus at financing and management of both systems, how they compare and contrast as well as the merits and demerits of each. Despite the fact that United States spends the most in health care in proportion to its gross domestic product, it is among the nations in the developed world that lack a comprehensive health care. Provision of health care in the United States remains the reserve of some several entities that are recognized and mandated by the law to carry out such services.

Around 16% of the GDP in the United States is usually channeled towards health care and according to budgetary estimates; this figure will have increased tremendously in ten years to come (Calman N, p92). A comparison of the united states health care and that of china world be compounded by the fact that China is huge, disjointed and very populous, it has a diversity that can only be compared to Europe’s. A simple analysis of its system reveals huge disparities with that of the United States. Dissimilarities that exist can be attributed to the dominant economic and political paradigm in both countries.

While China has been leaning towards communism the United States is highly capitalistic and the structures of its system have to be understood from this angle. The system is undergoing intense restructuring to see it cater for the rural for or at least emulate a successful characterized by that of Canada. The health care system in the United States is decentralized. This means that various institutions are mandated with the responsibility of providing health care to the public there is the health insurance.

This simply is a system where individuals contribute a certain amount of cash to an insurance firm that has been established for non-profit management of these funds. Close to 85% of all Americans at the moment are subscribed to such an insurance scheme. Health care insurance in the United States may either be private or managed. Private health insurance is where an individual or employers make contributions to the health insurance institutions Chernew M, Cutler DM, Keenan PS, p22).

Unlike the decentralization in the United States, China health care is centralized and the ministry of public health is the one fully charged with the responsibility of health care delivery. The whole network and policy of the health industry is a responsibility of the government. In the U. S, the system is two tiers that both the government and the private sector contribute towards health care. In the recent past, the China health insurance unlike in the United States, has been overtime limited to the government employers who reside in the urban centers only.

Those that live in the rural areas had not been covered by this insurance and neither those outside the state urban employment bracket. Although the situation in the rural areas is fast changing, in the rural areas people have to rely on the communal health care programs, however recent trends indicate a sharp decline in their subscription and the government in turn is introducing a scheme for rural dwellers (Mundinger MO et al, p241). Predominantly the Chinese system is characterized by provision of health services at various levels.

From the top most level, national, through to the provincial and at the bottom, local level. A look at this system from the early 1980s reveals that these services were provided in a three-tier method. The first tier was appropriately localized in the rural areas in what has come to be referred to as the barefoot doctors. This simply refers to the villagers who acquired some basic health provision skills and were allowed to practice in the villages. The next tier comprises of the semi urban health centers majorly specializing in the provision of out patient services.

At the highest level and final tier there were registered and strenuously trained doctors with degrees and they were located in the country hospitals. The situation at the moment has changed dramatically but the China’s health system still exhibits some remnant characteristics of these tier systems. These changes started to be seen in the post Mao era (Banister, Judith, p982). Both the United States and China’s health systems are characterized by one factor. They both have left a large number of people uninsured. The United States has a public oriented and a private driven health care provision vehicle.

Although the China’s system can be to a greater extent be refereed to as universal coverage, they both, together with that of the United States leave a portion of the population uninsured. In the United States, approximately 16% of the American citizens are uncovered. This has been the course of criticism for this system (Falen T, p13). These countries both exhibit a high level of government involvement in the health service delivery. The Chinese government through the ministry of public health makes immense contributions towards health delivery.

The Chinese governments expenditure is at around 6%, which is a gross comparison to that of the United States, however the government plays a key role. The United States federal governments involvement is through Medicaid, Medicare and the children’s insurance program, SCHIP, a scheme introduced in 1997 in the bid to capture those not captured by the Medicaid but still not well up enough for private schemes. The Chinese system is not elaborately divided as that of the United States. The Medicare for example was established in 1965 under the Lyndon B. Johnson regime and was meant to cater for the aged, those specifically above the age of 65.

Like the rural programs introduced recently in China, Medicaid is a scheme introduced in 1965 and expects to provide essential health services to those families with meager earnings. It is managed at the state level. This, in the United States, remains the most elaborate scheme that focuses at the low level income group and whose funding is managed at the state level. While the United States’ woos brought forth by the two tier system are still under an intense debate, especially with the midlevel earners complaining of over taxation, China is undergoing major restructuring as it seeks to rejuvenate and overhaul its health care system.

It has introduced a multi-tiered scheme to address the health situation of those living in the rural areas. A program introduced in 2005 to cater for the disparities in healthy provision. New Rural Cooperative medical care system has kicked off in earnest. Health services in this scheme are still provided in the national, provincial and local level system. The central government, in this scheme, foots a certain percentage of the bill, provincial government the same while the patient foots the remaining amount of the bill.

The structure of this scheme has it that depending on the quality of the health facility, either small or modern, the government will foot a portion of the bill. At the complex medical facilities, patients have to absorb almost all the medical bills. The purpose of this scheme is similar to that of the U. S Medicaid, in that it seeks to help the lower income group access health facilities at a subsidized rate. The major difference is that unlike Medicaid, it does not discriminate according to the income level; it is also hierarchical in that the different cadre of facilities is funded disproportionately (Liu, X. Z. / Wang, J. L p105).

There is almost a close comparison in how the Untied States health care system is financed and that of China. In United States, health care is privately funded apart from the federal established scheme, although the government still contributes much. 27% of the health insurance is publicly funded. However, access to health facilities in the United States, though advanced in technology remains expensive, despite the medical insurance. Taking both public and private funding, into consideration reveals that the United States has the highest per income expenditure in health than China for that matter and the world at large.

Similarly, as China moves away from Chinese ¬communism into capitalism, patients have had to contend with the problems of partly footing their own bills (Feng, Xueshan et al, p1112). There are no private schemes established to cater for those wishing to contribute to private health insurance. One can either be served by the rural insurance scheme or the urban one. This is the biggest difference between the United States and the Chinese and current efforts are being geared towards accomplishing this.

Another difference that exists between China and United States arises from the lack of primary health care in China contrary to the reality in America. Although this trend is gradually changing, there are no private clinics and patients have to be attended in the main hospitals. As a result, this system is usually marked with confusion and disorganization. However like in the United States, there exist specialized hospitals especially in the major urban centers. At the ground, the situation is grim, as the localities in the village have to survive with unfurnished health centers characterized by lack of modern equipments.

In China, if one is not satisfied with the general health care, one has the option of paying at extra fee to seek audience with their moist preferred physicians for personalized services. Such a system is non-existent in the United States where patients have to pay for the services that they receive if their insurance or the government has not footed such expenses. Whereas in the United States, health practitioners undergo strenuous training and certified in the modern training parameters, in China, traditional Chinese medicine and the modern medicine are run parallel wise.

Both are permitted and patients are free to choose which system suits their condition. Also at the local level health centers, strenuous skills are not a precondition for registration, what is required is that one passes a basic test. This is unlike the United States. In comparison, the United States health system exhibits a higher level of organization and comprehensiveness unlike that of China. However it has been widely criticized for it has left out over 16% of the American citizens. It has not been able to cover all of its citizens prompting some of its worst critics to read a racial angle in the discrimination.

Majority of those left out in the program are the minority racial groups among them the blacks and the Hispanics. The government in this program has been accused of not being keen in improving the situation. However, this system has been touted by many for its ability to encompass special cases such as the aged, the extremely poor, war veterans and children. It also enables people to access medial facilities depending on how much they are able to pay. The china’s system has been blamed for overcrowding and for not providing quality health care at the ground level.

Medical practitioners are not also appropriately remunerated, as they have to compete with the traditional practitioners. However, it has to be noted, that it is these said problems that the current reforms in the health sectors seeks to address.

Works cited

  • Calman N. Making health equality a reality: the Bronx takes action. Health Aff (Millwood). 2005 Mar-Apr; 24(2): 91-98.
  • Chernew M, Cutler DM, Keenan PS. Increasing health insurance costs and the decline in insurance coverage. Health Serv Res. 2005 Aug; 40(4): 21-39.
  • Falen T. U. S. Health care policy and the rising uninsured: an alternative solution. J Health Soc Policy. 2004; 19(4): 1-25.
  • Mundinger MO, Thomas E, Smolowitz J, et al. Essential health care: affordable for all? Nurs Econ. 2004 Sep-Oct; 22(5): 239-44
  • Banister, Judith Population, public health and the environment in China. In: China Quarterly, No. 156, 1998; 986-1015
  • Feng, Xueshan / Tang, S. / Bloom, G. / Segall, M. / Gu, Y. Cooperative medical schemes in contemporary rural China. In: Social Science and Medicine, Vol. 41, No. 8, 1995; 1111-1118
  • Liu, X. Z. / Wang, J. L. An introduction to China’s healthcare system. In: Journal for Public Health Policy, Vol. 12, 1991; 104-116

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