Eckehard Scharfschwerdt

“Where are you going?” I asked a nurse in the county hospital where I worked.
“我们要下乡. We will go to the village.”


In 2014 the hospital dispatched its staff to survey the entire county, house by house. The goal was to learn about the community’s financial situation and reasons for poverty. President Xi Jinping had pledged to eliminate poverty by 2020, an initiative later followed by the Healthy China 2030 strategy. The hospital director summarised, “Families became impoverished mostly due to catastrophic healthcare expenditure.”


In 2009, China launched a major health-care reform programme to provide all citizens with equal access to basic health care. Funding for health care has since quadrupled. Following the worldwide economic crisis of 2008, China invested heavily in health care infrastructure. We saw new hospitals mushrooming at all levels from village clinics to city hospitals. In 2013, social health insurance coverage reached over 95%. In Yunnan, the heavily subsidised farmer’s health insurance cooperative had started in 2006 by sending all government employees down to the villages and only allowing them to return after 90% of the farmers had signed up. Within a year, the number of inpatients had tripled. We have seen further progress made towards improved access and financial risk protection, especially for the lower socio-economic quartile.


In spite of these improvements, hardships remain. If you’re on WeChat, you are familiar with desperate crowd funding initiatives of families whose loved one suffers from cancer. Even though the ceiling for reimbursement has increased substantially, major surgeries or chemotherapy quickly deplete all family resources.


Since 2012 the government has focused on transforming resources into effective services, which is much more challenging. Although a zero-mark up policy for drugs was implemented in 2013, incomes of hospital directors and physicians are still tied to hospital profits, which hinders a shift from hospital-based curative care to preventive primary health care. Years of profit-seeking behaviour has eroded medical ethics. While several of my young friends went through GP training, it will take a couple of decades to overcome the lack of quality at lower levels, which keeps pushing ever more demanding patients to overuse costly tertiary hospitals.


Where does MSI fit in? China still welcomes professional expertise from abroad. Helping to raise quality of care and preventive measures at the PHC level will decrease the burden of non-communicable diseases while China’s population keeps aging – even beyond the country’s 70th anniversary.