Healthcare in China
Health insurance, hospitals and doctors
Cultural and language barriers can make it difficult to communicate health problems and receive the appropriate level of care in any foreign country. China is no exception.
Doctors in China's public hospitals rarely speak any English and the admission process can be lengthy and confusing. Expats are usually unfamiliar with the classing system of hospitals in China, making it difficult to determine which service will provide the right level of treatment. Locating a doctor in China can be difficult and information is usually found through word of mouth. Yet given the right advice, the process can be made easier.
Firslty, China has adopted a classing system that grades their hospitals on a scale to indicate the standard of a healthcare facility. The are three levels (3,2,1) and three sub-level scales (A,B,C). The highest standard is ranked 3A, although some hospitals are graded at 3A+. There are over 800 medical facilities across China that have been issued a 3A ranking, endorsed by the Chinese Ministry of Health. Hospitals that are ranked 3A have a specific high medical standard and are on par with western-standard health care institutions. Hospitals ranked at level 1 are generally town hospitals located outside of China's busy cities.
There has been an increasing demand in recent years on the need for private international healthcare services to accommodate the need of the growing expat population in China. A study of expats living in Beijing showed that among 6,400 registered medical organiations in the city, less than 20 were able to serve expat foreigners. Further to this, only 20 of Beijing's hospitals accepted payment through medical insurance policies.
Private medical institutions currently account for around 35% of total medical institutions in China, while the bed numbers at private medical institutions is only 5% of the total beds in the healthcare system. China’s central government recently declared new policies to encourage private investment to meet the country’s increasingly diversified demands on health care.
China has become an increasingly popular destination for expats to live. Since the 1980s, China changed its economic policies which in turn encouraged a steady growth of international companies and foreign workers into the country. The city of Shanghai has the most highly concentrated expat culture, with around 300,000 foreigners living in the city. Other cities that are popular among the expats include Beijing and Guangzhou.
International Hospitals in China for Expats
Expats in China usually opt for private healthcare services due to the western standard of health care and access to a wide variety of English speaking doctors.
These Western-standard healthcare facilities are very expensive due to the high cost of employing international expat medical professionals. As such, expats are strongly encouraged to obtain some form of China medical insurance to ensure ease of access to healthcare and medical services.
In China there are a selection of internationally funded hospitals and clinics that offer western-standard health care services, with internationally trained and English speaking doctors. Private organizations operate in China, managing groups of hospitals and clinics including Parkway Health, Global HealthCare, and International SOS.
Parkway Health, a large healthcare provider, manages a group of hospitals and medical clinics throughout China including eight locations within Shanghai. There are a wide range of international doctors and specialists providing services in pregnancy and gynecological care, sports medicine, ophthalmology, pediatrics as well as other specialty departments.
Global HealthCare are a smaller organization that have two hospitals in Shanghai that offer a range of medical care and dental services. They also provide a large range of specialty services, including an international heart centre designed for expats with heart problems.
In Beijing, international hospitals and clinics include the United Family Healthcare Hospital, the China-Japan Friendship Hospital, the Peking Union Medical College Hospital, and the Global Doctor Clinic Beijing.
International SOS are a large global company that provide emergency ambulance support and healthcare services. They have four medical clinics located in Beijing, Nanjing, Tianjin and Shekou. Japanese speaking doctors are also located in the Beijing and Tianjin clinics. International SOS clinics are well equipped to provide a range of primary care services and are also able to stabilise critically ill patients. However, they do not have a large bed capacity for inpatient services or the equipment to perform complex procedures.
If required, International SOS can organise repatriation services or emergency air evacuation to a hospital within China, or overseas to Hong Kong or Singapore.
Public hospitals and traditional Chinese medicine
Public hospitals and clinics in China are also an option for expats living in the country. Healthcare costs are significantly cheaper in comparison to international, western standard clinics. However, there are not many English speaking Doctors and healthcare staff within China's public hospitals, therefore an interpreter is highly recommended. Modern medical equipment and complex procedures may not be available in some public hospitals, however primary healthcare standards are generally adequate.
Traditional Chinese medicine (TCM) is another option to expats seeking healthcare in China. TCM bases its practice on Chinese herbal medicine, acupuncture, dietary therapy, and traditional massage. Due to lack of funding, there is little scientific research on TCM. Most studies have focused on acupuncture which have shown to provide some benefit, especially in treating nausea, however remains controversial in the scientific community. TCM should be used with caution in the event of a serious illness or medical condition.
Rural areas have limited medical care
Rural areas of China have limited access to basic health care resources. Medical care is provided by town hospitals and basic medical clinics. Private medical facilities are virtually non existent in these rural areas.
Although expat communities are usually confined to larger populated cities, many expats will spend their leisure time taking trips to different areas within China. Due to the limited medical services outside of China's larger cities, emergency evacuation may be required to receive the appropriate level of care. As such expats in China are strongly encouraged to obtain some form of China medical insurance, to ensure ease of access to health and medical facilities within China and overseas, including air transportation and repatriation services.
Rural communities in China have been deprived of medical care throughout history. This has lead to major outbreaks of infectious diseases and a generally poor health status among the rural population.
During the 1960s, China recognized its urgent need for doctors, particularly in remote regions where urban Doctors would not settle. The Chinese Government, under Mao Zedong, implemented a health reform which involved training “barefoot doctors” within community hospitals to perform both traditional Chinese medicine and western-medicine practice. Barefoot doctors focused on epidemic disease prevention and family planning as well as correcting water treatment systems to improve hygiene standards.
Two-thirds of rural Doctors today started out as barefoot doctors. After the implementation of economic reforms under Deng Xiao Peng, Government funding of barefoot doctors dropped considerably and the system collapsed. Barefoot doctors were given the opportunity to take an exam to work in community medical clinics or alongside Doctors as community aides.
Health reforms have been put in place to improve access to healthcare in China's rural community. The New Rural Co-operative Medical Care System was introduced by the Chinese Government in 2005, making healthcare more affordable for rural patients. The initiative covers 70 to 80 percent of the patient's hospital bill. The coverage gets lower depending on the location of the medical clinic with 60 percent coverage in outer city regions and 30 percent coverage within city hospitals.
Public health issues in China
China's public health system has received some criticism over the years. The country has the second largest tuberculosis epidemic worldwide and has also experienced major outbreaks including SARS (severe acute respiratory syndrome) and swine flu (H5N1 Avian influenza).
After the SARS epidemic was brought under control, China put into place a series of measures to improve its public health system, including the eradication of tuberculosis. In 1991, China implemented the World Health Orgnisation DOTS (Directly Observed Treatment Shortcourse) program by following specific diagnosis and treatment measures to control TB. The DOTS program has proven effective and is estimated to prevent around 30,000 TB deaths per year in China.
China’s HIV/AIDS prevalence (0.1% among adults) remains relatively low in comparison to other nations, however it is highly concentrated among injecting drugs users, men who have sex with men, former plasma donors and has more recently spread to the general population. The HIV/AIDS epidemic in China was exacerbated in the past due to unsafe blood transfusion practices performed in rural areas. Today, heterosexual transmission is the highest route of infection.
Air pollution and water contamination by industrial waste, as well as overuse of chemicals, continues to threat China's population, killing over 400 000 people every year. Smoking related diseases are also a major health concern in China. However, the Government depends on its tobacco revenue and has therefore not implemented any health promotion strategies to combat the problem.
Health Insurance for expats in China
A China health insurance plan is highly recommended for expats living in China.
Private healthcare services are generally very expensive. Due to this, expats living in China are strongly encouraged to obtain a China international medical insurance policy to ensure ease of access to health and medical facilities within the country.
In the event of a serious health problem, the adequate level of care may not be available in China. Expats in China may therefore require repatriation or emergency evacuation to a hospital located in Hong Kong or Singapore. The costs involved in covering medical expenses can be very expensive. As such, expats in China are strongly encouraged to obtain some form of China medical insurance, that includes air transportation services.
A letter of guarantee from the insurance company is required for direct billing. Expats will be treated immediately in the event of an emergency and will be held liable for medical costs until the letter of guarantee is issued. Otherwise, expat patients may pay by cash or credit card and receive an account to receive reimbursement from their insurer.
Emergency medical services in China
Emergency protocols should be adopted by expats during the event of an accident, serious illness or criminal offense.
In the event of an emergency, expats in China can contact the International SOS emergency alarm centre to speak to an English speaking staff member, 24 hours a day, all days of the year. The emergency evacuation teams are experienced and provide air and land transportation services within any location of China, as well as repatriation services if required.
In the event of a serious accident or health problem, repatriation or emergency air evacuation to Hong Kong or Singapore may be required to receive the appropriate level of care.
Depending on the circumstances, the medical costs involved in covering emergency air evacuation transportation can cost up to US$50,000-$100,000 – (£32,000-£64,000), or even more in serious cases.
As such, expats in China are strongly encouraged to obtain some form of China medical insurance, to ensure ease of access to health and medical facilities, including emergency transportation services.