West meets east: Chinese and US doctors addressing the medical ecology and disease management from both countries’ perspectives
Author: Wang, Wei
China’s expenditure on health care has increased dramatically over the last 20 years, and three broad trends are seen in the associated health outcomes. Firstly, limited improvements have been achieved to aggregate high-level health outcomes, e.g. infant mortality. Secondly, development of large and widening health inequalities associated with disparate wealth between provinces and a rural-urban divide. Finally, the burden of disease is shifting from predominantly communicable diseases to chronic diseases.
In the US, leading primary care doctors have been invited to meet with the President’s health care reform team and put forward suggestions to revitalise primary care in the US. Key issues for reform are changes to the amount and nature of primary care payment systems, investment in primary care infrastructure and organisation, and strategies to attract more local medical students into family practice as a career.
There are many reasons for the limited gains from investment in health care in both countries, for example: increased out-of-pocket expenditure, including a high proportion of catastrophic expenditure; a geographical imbalance in health care spending, focusing on secondary and tertiary hospital care and greater expenditure on urban centres compared with rural centres; and the commercialization of health care without adequate attention to cost control, which has led to escalation of prices and decreased efficiency.