Week 5 assignment Health Care Policy Analyses

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Quality Improvement Student Project Proposal
: Issues with the Healthcare policies in China
Rosalind Brown
MHA620: Health Policy Analyses
Professor Faisal Aboul-Enein
March 22, 2017
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Setting: Healthcare in china currently has a cash pay system that is not serving its
citizens well. In the past under the leadership of Mao Zedong (1949-1976) if
Chinese citizens became ill they could be seen at one of China’s hospitals for no
fee or a very small fee. When people were not within a reasonable distance from
the hospital they were seen by village doctors that were affectionately called
“barefoot doctors.” Under the command of Mao Zedong coverage was minimal but
available to everyone in China. After Chairman Mao was no longer the leader of
China, Deng Xiaoping took over China and opened the economy, he also pulled
funding for the national healthcare system that was put in place by his predecessor.
This began the demise of China’s health care system. Under the new regime health
care facilities and providers were forced to begin financing their own institutions.
Over the years this has snowballed into a health care system that requires pre-
payment of medical services and leaves most Chinese without any medical
coverage. (CNBC) China’s health care system is one that is in the process of
reformation. Although communist nations historically have free healthcare for all
its citizens, China had a demise of their health care
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system and policies. Currently China’s health care system issues health care based on
tiers, the quality of care that people receive is based upon income or status within the society.
“China is a vast country with uneven economic development. Rural and urban residents are
categorized separately per the household registration system (hukou), and the government
financing systems is different for the two categories of citizens.” (Albertoforchielli.com) This
system allows preferential medical treatment for some of the residents and leaves others without
Reformation of China’s Health Care System is currently underway.
“Leaders have made significant progress in a relatively short period to improve the healthcare
system. After several failed attempts, the PRC State Council in 2008 initiated a formal drafting
process for reform, which included soliciting 10 draft healthcare plans from domestic, foreign,
and multilateral actors. This led to the implementation of China’s ¥850 billion ($124 billion)
healthcare reform plan in April 2009, which aims to provide affordable medical care for the
country’s entire population by 2020 (see China’s Immediate Healthcare Reform Goals). The
reform calls for a complete overhaul of China’s healthcare system, including by establishing or
updating laws related to healthcare investment, pharmaceuticals, and medical devices. In the first
phase of the plan (2009-11), the central government set a ¥139 billion ($20.9 billion) healthcare
budget for 2010, and the PRC Ministry of Finance (MOF) in November 2010 announced it was
allocating an additional ¥12.3 billion ($1.8 billion) for local healthcare reform initiatives.
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The reform plan implemented by the Chinese government is on track to being completed by its
projected completion date. There are five major areas that China are trying to address in the
reform of their health care system. The goals are to address the following:
Broaden basic healthcare coverage
Establish a national essential drug system
Expand infrastructure for grassroots medical networks
Provide equal access to basic public healthcare services
Implement pilot reform of public hospitals.
China is fighting an uphill battle while trying to reform their troubled healthcare system,
however, they are making great progress. China’s health care policies are evolving to include all
its population and striving to eliminate preferential treatment of certain citizens where health
care is concerned. Since China is a communist nation its ideal health care system would be free
for all citizens, however, they have a long road before they are within proximity of a completely
equal and free healthcare system for all its citizens.
The health care system in the United States is one that has been evolving as well. With the
implementation of the Affordable Care Act there were policy changes to the U.S. Healthcare
system. Per WWW.WhiteHouse.Gov
“Far too often before the Affordable Care Act came into effect, health insurance did not
provide peace of mind it provided anxiety, panic, and dread. Up to 129 million Americans
that’s nearly one in two people – could be discriminated against because of a pre-existing
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condition like heart disease, diabetes, or cancer, or for that matter pregnancy or even something
as ridiculous as acne.”
The U.S. health care system prior to March 23, 2010 was discriminatory against American’s with
pre-existing conditions, any condition that plagued someone was not covered by health care
insurance until one year after they were paying insurance premiums. These statistics translate
into almost ½ of all Americans being either underinsured or uninsured prior to the ACA.
Prior to March 2010 the United States had an Employer- Based Health Insurance system
that was created by government control. This limited health care system created a very limited
pool of insurances that an employee could choose from as well as forced them to terminate their
insurance plans upon separation with an employer. However, there was an option to keep
insurance through COBRA but this proved to be too expensive for most Americans and left them
uninsured. These issues put health insurance companies in control of the industry and allowed
them to charge expensive premiums with no reasonably priced alternatives for Americans.
“The Affordable Care Act’s focus is on providing more Americans with access to
affordable health insurance, improving the quality of health care and health insurance, regulating
the health insurance industry, and reducing health care spending in the US. The law
contains hundreds of different provisions that address different aspects of “the healthcare crisis
in the US. (www.obamacarefacts.com)
Since the ACA was enacted “16.4 million people have gained health care coverage in the United
States, young adults can stay on their parent’s health care insurance until the age of 26 and there
have also been Medicaid Expansions.” (www.HHS.GOV) This alone enables millions of
Americans that were once uninsured to have access to quality health care. The ACA has also
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improved statistics in minority communities as well, per www.hhs.gov, since the enactment it
has decreased the percentage of uninsured African Americans by 9.2% and Latinos by 12.3%
and the uninsured rate of women decreased by 7.7%. These improvements in the rates of
uninsured minorities proves that the ACA is working for all Americans.
The health care systems in China and the U.S. do share some similarities. The
government of both countries have a hand in its healthcare reform as well as its current system.
China has complete control over its system while America has set forth rules for the private
sector as well as set up the marketplace that offers affordable options.
The workforce in China does not directly affect their health care system, because it is a
communist country health care is being established for all citizens. Although it is being reformed
many Chinese citizens are forced to use their wages in a pay for service health care system.
Similarly, in the U.S. before the ACA Americans acquired health care insurance by paying out of
their wages and when they did not have coverage they were required to pay cash out of pocket
for services unless it is an emergency. In the case of an emergency in the U.S. emergency rooms
were required to treat and stabilize a patient that presents to the ER while in China this was not a
In the U.S., there is a wider use of more advanced technologies in health care, the quality
of health care is more advanced than in China. However, China’s health care system will include
medical care for all citizens for little or no charge.
The future of the United States health system seems to be brighter than the past for its
citizens. There is a decrease in the rate of uninsured people of all races which allows greater
access to medical care for Americans. There is also an instance of what is being called “Big
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Learning Curve” “The big learning curve for everyone in the healthcare industry over the next
five to 15 years, says Newbold, is moving from just making the medical model more efficient to
implementing the health model.” (www.hfma.org) The health model encompasses three new
competencies in healthcare. First, providers will benefit by keeping the healthy out of trouble or
maintaining or improving their health through preventative measures. Secondly, providers will
be more involved in helping patients handle their risk factors and chronic illnesses. Tertiary,
there will be better management of the top 5% to 10% of the sickest patients will be managed
more closely to reduce frequent ED visits and hospitalizations due to chronic conditions that can
be managed as out patients. These efforts will decrease the amount of revenue spent on treatment
for preventable illnesses and hospital visits. Cost of healthcare in the United States it should level
out over the following years due to the newly insured no longer being a financial burden on the
insured and lowering overall premiums as well.
Both China and America are on the correct paths for their respective health care systems.
While these two countries differ in their approach for health care reform they are both attempting
to provide healthcare for all its citizens. Hopefully soon, all the citizens of these countries will
enjoy healthcare for everyone.
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C. (2014, August 07). China's Ailing Healthcare System | Inside China | CNBC International.
Retrieved January 10, 2017, from https://www.youtube.com/watch?v=z3qV7-cD3vQ&t=7s
China’s Healthcare Reform: How Far Has It Come? (n.d.). Retrieved January 10, 2017, from
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Secretary, H. O. (2015, June 24). The Affordable Care Act is Working. Retrieved January 10,
2017, from https://www.hhs.gov/healthcare/facts-and-features/fact-sheets/aca-is-
Simas, D. (2014, January 23). Health Coverage Before the ACA, And Why All Americans Are
Better Off Now. Retrieved January 10, 2017, from
The U.S. Health Care System: An International Perspective. (n.d.). Retrieved January 10, 2017,
from http://dpeaflcio.org/programs-publications/issue-fact-sheets/the-u-s-health-care-system-an-
U.S. Health Care from a Global Perspective. (n.d.). Retrieved January 10, 2017, from
What Will Health Care Look Like in 5-15 Years? (n.d.). Retrieved January 10, 2017, from
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