Medical Reform

• Drug prices continue to dominate headlines with news that basic drug prices may be further reduced by 30 to 40%. Separately, fewer imported drugs are expected on the essential drug lists some community health organizations use.
• The NDRC is to investigate reports of price increases by some companies whose pharmaceuticals qualified for the drug reimbursement listing. Separately, the MOH announced plans to conduct an evaluation of the progress of medical reform that will involve international organizations such as the WHO.
• The Gaozhou hospital reform model drew national attention for its ability to improve health services at a reduced cost through market-based solutions. On the other hand, Shenmu’s hospital reform model, which offers universal coverage through government financing, also showed promise for creating win-win outcomes for patients, hospitals, and government alike. Of note is that the Shenmu model includes private hospitals for providing public-financed care. Additional information on the Shenmu experience can be found here.
• News reports link Johnson & Johnson Medical to the latest scandal at the SFDA, which saw the removal of a high-ranking official over suspected bribery charges. The company has since issued a public statement noting that it has not received any official notice relating to the case and reiterating the company’s stance to abide by Chinese laws and regulations.
• Several incidents of patients stabbing doctors prompt a commentator to urge the government to address the issue of doctor-patient relations in the medical reform.

Business Initiative

• GE Healthcare To Launch Ecosystem In Greater China (Link to full English text)
• Eli Lilly Sets Plans for Emerging Markets (Link to full English text)
• AstraZeneca answers the great call of China (Link to full English text)
• IBM, Chinese hospital start med project (Link to full English text)
• Eli Lilly and Company not to acquire swine vaccine business in China from Pfizer (Link to full English text)
• Abbott targets better nutrition with new R&D facility in Singapore (Link to full English text)

Health & Awareness

• China announces plans to expand and build hospitals dedicated to the treatment of mental illness. The government also announced that medical records have been established for 900,000 patients suffering from critical mental illnesses.
• China eyes milk test after melamine deaths scandal (Link to full English text)
• For China’s Growing Middle Class, Expanding Waistlines Pose Problem (Link to full English text)
• Medical Tourism: A vacation from the reality of high-cost healthcare (Link to full English text)

Public Health

• China, U.S. to enhance collaboration in public health (Link to full English text)
• H1N1 Flu Acts Much Like Its Seasonal Cousin (Link to full English text)

Additional News from the Greater China and Other Markets:

Hong Kong

• Health facts to chew over as scheme starts – A new nutritional labeling scheme took effect from 1 July, 2010 which applicable to 4,000 types of prepackaged food in Hong Kong. (Link to full English text)
• New name takes the ‘crazy’ out of epilepsy – The Chinese name for epilepsy has officially changed to avoid connotations of madness and to prevent discrimination by those who confuse it with mental illness. (Link to full English text)
• Sixth school shut by foot and mouth – A few schools were closed to stop the spreading of foot and mouth disease. The usual peak season in Hong Kong for HFMD and EV71 infection is from May to July. EV71 infection can have severe complications. (Link to full English text)

Taiwan

• Taipei health department collects 1.5 tons of discarded medicines. (Link to full English text)
• DOH sets limit for medical fees. (Link to full English text)
• Healthcare system lets many down – a commentary on the current healthcare system in Taiwan (Link to full English text)
• First fatal case of Japanese encephalitis in 2010 confirmed; Taiwan CDC urges public to protect themselves from mosquito bites and make sure children receive appropriate vaccination. (Link to full English text)

Singapore

• Singapore General Hospital gains elite status. (Link to full English text)
• Researchers in Singapore make breakthrough in treatment of septic shock. (Link to full English text)
• Govt says no to posting of docs’ fee guides. (Link to full English text)

Korea

• Samsung ventures into medical device market. (Link to full English text)
• Weight-loss drugs raise health threat in Asia. (Link to full English text)
• Jeju to become international business hub – it is in the perfect location to become premium tourism, medical and educational hub in Northeast Asia. (Link to full English text)

Medical Reform

According to Securities Daily, the NDRC may be considering to reduce basic drug prices by 30 to 40%:

• A number of pharmaceutical enterprises and associations have received a notice to submit commentaries review on a proposed measure for drug price administration.
• An insider revealed that this round of price reduction may be as high as 30 to 40%. The official announcement is expected this month.
• This will mark the 26^th round of price reduction in China.

Hangzhou Daily reported that expensive imported pharmaceuticals to significantly decrease in community health organizations. According to the report:

• A number of community healthcare organizations in the test pilot districts are leading the effort to implement the National Essential Drug System.
• Expensive imported medicines will see a significant reduction. Replacing them will be cheap domestically produced medications. Most importantly, 457 types of basic drugs will be sold to patients at cost. The number of medications available (900) will be reduced by half.
• The antibiotics category saw the most significant reduction in the national and provincial drug lists. In the past, 72 types of antibiotics were available in community health facilities; now only 13 are available.
• A formulary administrator commented that the measure will help reduce antibiotic abuse, in particular, patients’ over-reliance on branded antibiotics.

A news program on the Voice of China reported that the NDRC is to investigate reports of price increase of reimbursement listed drugs:

• in 2009, the National Drug Reimburesement List saw an increase of 260 types of medications, of which 30 of them raised their prices immediately prior to listing.
• The National Development and Reform Commission (NDRC) has urgently responded that this type of conduct will be thoroughly investigated.

Minister of Health Chen Zhu disclosed that China is drafting a proposal to evaluate the progress of the medical reform:

• The evaluation method will perform a scientific analysis of the medical reform work and draw up a summary of what was learned from the experience to guide future improvements.
• China plans to invite the World Health Organization and others to participate in the evaluation work.

According to Guangzhou Daily, the “Gaozhou Model” is receiving widespread national attention:

• Within two months, 52 delegates from 12 provinces have visited Gaozhou Hospital to learn from its hospital reform experience.
• After their visits, the delegates praised the Gaozhou model as being able to “provide high-quality medical technology at a low price point. The hospital has successfully provided a triple-win solution to patients, government, and hospitals through market competition that also realizes the public welfare missions of public hospitals.”
• Gaozhou Hospital is a provincial-level hospital that offers up to 2,360 hospital beds and 63 specialty departments. In 2009, it achieved a hospitalization rate of 60,600 persons. Patients come from over 23 provinces in China, as well as from the U.S. and Indonesia.
• According to a review report by the Guangzhou Health Office, “The quality of medical service has not declined due to this high level of patient volume. In 2009 alone, the hospital performed 1,801 cardiovascular procedures with a success rate of 98.9%. This has allowed the hospital to enjoy a high provincial and national rank for 12 consecutive years.”
• Gaozhou Hospital also offers other medical specialties that are usually available only in provincial Level III hospitals. The hospital has succeeded in providing these highly difficult procedures often at half the cost of provincial-level hospitals. Such a feat has been achieved through stringent control of medical costs and a market-based strategy of “low cost and high volume.”
• A counselor of the State Council concluded after visiting the hospital that “the experience of Gaozhou People’s Hospital has clarified many misconceptions in public hospital reforms. It has offered an effective pathway for the public to access care at a low cost.”

Separately, the Oriental Outlook reported on the Shenmu experience:

• The party secretary of Shenmu district’s commission, Guo Baocheng, commented that from an economic perspective, Shenmu’s “universal healthcare coverage” allowed the government to make a profit. Shenmu is in the Shaanxi province. His comment ignited avid discussions among scholars and consultants of seven international think tanks who were attending a meeting.
• According to Guo, although Shenmu was among the regions most impacted by the financial crisis, the district registered a consumption growth of 22%, the government’s net fiscal revenue grew by 2.1 billion yuan. The net income of rural (farm) residents grew by 1,000 yuan, while urban residents’ average disposable income increased by 3,000 yuan.
• Guo believes that these numbers have a direct or indirect relationship to the universal healthcare coverage. According to Guo, “Based on my personal perspective, from an economic perspective, investments in social welfare are a high return investment.”
• While some experts endorse the analysis, some remain cautious, as the Shenmu model has only been implemented for a year. A separate study by a professor at Peking University on the urban basic healthcare insurance in Beijing concluded that the measure contributed to a 5% increase in consumption.
• During the interview, Guo offered that the Shenmu model has succeeded by avoiding the debate between adjusting the demand or supply side of healthcare to solve the problems. Instead, the model directly addresses the needs of the people. From his perspective, healthcare and pharmaceutical reforms are very problematic territories, so Shenmu has avoided these areas entirely in its reform.
• Of the seven hospitals designated for providing universal healthcare coverage on one is a public hospital. This reform experience has invited the comment of an official at the Ministry of Health that “the plan can help the control cost. Some issues are resolved through market practices. This needs to be further observed.”
• Wang Zhenyao，a director of the social welfare and charity promotion office of the Civil Affairs Ministry, estimates that China only needs to spend 430 billion yuan to implement universal healthcare coverage nationwide.
• Other experts have advocated for the mainland to consider the Hong Kong model of providing universal healthcare coverage. Government officials and scholars, however, have questioned the financial sustainability of the Hong Kong model during previous public addresses.

A deputy chief of the State Food and Drug Administration (SFDA), Zhang Jingli, has been removed from post and faces official investigation:

• Insiders reported that Zhang is implicated in a corruption investigation involving Johnson & Johnson Medical and other medical device companies.
• Industry insiders further speculate that corruption charges most likely involved the registration permit for a medical device in China. The application process for the permit usually takes between one to two years for the collection of supplementary clinical data. The permit also requires re-application every four years. Insiders speculate that the product involved may be Lifescan.
• Johnson & Johnson Medical (the maker of Lifescan) and Roche dominate 60 to 70% of the blood sugar meter market in China.

Johnson & Johnson Medical issued a statement relating the case:

• The statement announced that the company has yet to receive a notice from the government regarding an investigation of the company in relation to Zhang Jingli’s case.
• The statement further reiterated the company’s commitment to abide by all SFDA laws and regulations and other related Chinese laws.

A commentary reported that the deteriorating work environment for doctors is a hidden threat in the success of medical reform:

• Several cases of violence against medical professionals have been reported in the media. One case involved a deputy director in a Hubei hospital who was stabbed in the chest. The director survived the attack. Another case involved two incidents of the stabbing of medical personnel in Shandong, which resulted in one death and one critical injury. The perpetrators in these cases were all patient family members.
• A February 2002 survey conducted by the China Physician Association showed that 60% of doctors indicated dissatisfaction with their work environment.
• The commentary further cited a similar survey in 2009 that still showed that over 60% of physicians are dissatisfied with their working conditions. The report concluded that doctors in general fear for their physical safety and do not feel an assurance of personal dignity while at work. Medical disputes were cited as the key factor negatively impacting their working environment.
• The commentary urged government authorities to give more attention to the issue of physician-patient relations to address this hidden threat to the success of medical reform.

Health & Awareness

China to Improve Treatment Rate for Critically Ill Mental Patients:

• The deputy minister of health Yin Li disclosed during a recent meeting that China plans to improve the rate of treatment for critically ill mental patients in order to reduce threats to society.
• The government also plans to expand and build 550 psychological hospitals to strengthen the work of mental illness prevention, treatment, and convalescence.
• He further indicated that medical records for 900,000 critically ill mental patients have been established.

• Premier Wen Jiabao faults the system for problems between doctors and patients (Wen Jiabao: The System is the Fundamental Reason for Doctor-Patient Problems) and advocates Confucius’ values to address issues concerning healthcare and food safety (Chinese Premier Emphasizes the “Power of Morality” to Combat Crises in Modern Society).

• Separately, a survey of health workers in Guangzhou found the group to suffer from a higher than average level of stress (Psychological Problems Afflict Many Medical Workers in Guangzhou).

• A lack of trust in the quality of community hospitals is cited as the primary issue deterring residents in Shenyang from seeking care at these facilities, even though policies are enacted to lower service and medicine costs (No Crowds Observed in Community Hospitals Following the Launch of “Zero Price Difference” Policy; Close to Half of Survey Respondents Indicate Willingness to Visit Community Hospitals Following the Unveiling of the “Zero Price Difference” Policy; Shenyang Government to Buy Public Health Services).

• The issue of trust also underscores the public’s reaction to a new standard introduced by the Ministry of Health (Public Concerned with Possible Abuse with New Standard Allowing Hospitals to Sign Consent Forms on Behalf of Patients).

• A number of public hospital directors are reluctant to participate in the public hospital reform pilots ahead of further clarity on the compensation system (With the Compensation System Remaining Unclear, Public Hospitals Reluctant to Participate in Reform Pilots), while an expert opines that health authorities should not be allowed to play both the regulator and investor of public hospitals (Experts: Health Authorities Should Not be Allowed the Identity of Public Hospital Investor).

• China issues the first national standard prescription drug formulary that is expected to curtail prescription abuse (China Issues Prescription Drug Formulary; Prescription Abuse Expected to be Curtailed).

Feb 2

Doctor-Patient Disputes are More Involved than a Matter of Expression

With the goal of resolving medical disputes, the Ministry of Health plans to initiate a project to promote the use of colloquial language in consent forms for surgical procedures. The reform in the communication model between doctors and patients will be tested in two public hospitals in Beijing for 6 months before a test pilot report is prepared and submitted to the ministry for consideration of a national rollout. From my perspective, the escalation of medical disputes is not just an issue of expression. The issue may be as what the Minister of Health Chen Zhu wrote recently that unreasonable systems have contributed to the dilution of public service mission of hospitals and contributed to the economic adversarial positioning between doctors and patients. The fundamental way to improve doctor-patient relations is by aligning doctors and patients that let the two parties join to become one party with shared interests. (Link to Chinese text)

Feb 5

With the Compensation System Remaining Unclear, Public Hospitals Reluctant to Participate in Reform Pilots

On February 2, the Executive Meeting of the State Council passed in principle a guiding opinion on public hospital reforms. According to the director of the Office of Reform of Nanjing Health Bureau, “Hospital directors do not want their hospitals to be selected for the pilot.” Until further clarifications are made on the issue of the financial compensation scheme, public hospitals are all cautious. This newspaper reporter learned that after the elimination of allowing sales margins on prescription drug sales, differences of opinion exist pertaining to the compensation schemes for hospitals to make up for the shortfall in revenues and the issue of separating hospital [regulatory] management from operations. Taking Nanjing for example, the city’s three-year pilot program requires over 8 billion yuan, but fiscal financing represents less than 10% of hospital revenue. Moreover, reforms of public hospitals’ property rights structure remain absent in this round of medical reform. (Link to full Chinese text)

Feb 8

Public Concerned with Possible Abuse with New Standard Allowing Hospitals to Sign Consent Forms on Behalf of Patients

The “Basic Standard for Medical Record Writing” issued by the Ministry of Health will be implemented starting March 1. The “Standard” specifies that during the course of saving a patient’s life, in the absence of a legal representative or authorized person for signing [the required medical authorization forms], a legal person or authorized person of the medical institution can sign [the required forms]. Some doctors acknowledged that the “Standard” might mean a greater share of responsibility for hospitals. One doctor commented, “The purpose of signing the forms on behalf of a patient is to save lives. However, should the medical procedure fail, the patient’s family members may turn around and pursue a legal judgment against the hospital.” Another doctor commented that given the strained doctor-patient relations today, patients and their families may believe that hospitals use the “Standard” as justification for ordering unnecessary tests and procedures in order to make a profit. Some citizens have expressed concern that individual doctors might abuse the “Standard” and believe that it needs further specification and clarification. (Link to full Chinese text)

Feb 27

(??????)Wen Jiabao: The System is the Fundamental Reason for Doctor-Patient Problems

During an online exchange with netizens, Premier Wen Jiabao commented that the overall situation between doctors and patients is good. He added that there are some problems that are not attributable to issues with doctors or patients and that the fundamental problem is with the system. (Link to full Chinese text)

Feb 27

Psychological Problems Afflict Many Medical Workers in Guangzhou

According to a survey conducted by the Guangzhou health authority, slightly over 17% of doctors and nurses in Guangzhou have had thoughts of suicide; close to 90% believe that they have had to deal with difficult patients; over 90% feel that they need to defend themselves against questions or investigations brought on by patients; and close to 50% indicate that given another career opportunity choice, they would not choose their present occupation. The survey was conducted in 2008, targeting 84 hospitals in 12 districts. It interviewed 1,182 medical workers. The survey found that the level of depression among medical workers is higher than in the overall population. Another recent survey found that over the past six months, close to 30% of medical workers have been assaulted verbally by patients, while 0.42% have experienced physical assaults. (Link to full Chinese text)

Feb 28

Chinese Premier Emphasizes the “Power of Morality” to Combat Crises in Modern Society

On the eve of the NPC and CPPCC 2010 session, Premier Wen Jiabao has once again joined netizens online. This is the second time that the premier has conducted an online exchange with citizens. Regarding the issue of problem infant formula, Wen reiterated that business people need to have a sense of morality in their blood. He highlighted that credibility and morality are urgent issues requiring resolution in modern society. He called upon youths and doctors to respond to the call for the “power of morality.” Analysts believe that the reiteration of the “power of morality” shows that, confronted with various crises, the government has given the “power of morality” a high level of consideration in order to rebuild Chinese moral and value systems, in addition to the government’s efforts to improve laws and other systems. Scholars pointed out that China is in the midst of a transition in which the old value system is being dismantled while the nation is still in the process of searching for a new value system. Wen Jia-bao’s promotion of concepts such as “loving others” and “compassion” are the core values of Confucius’ philosophy and should also be the common values of the modern civilized society. (Link to full Chinese test)

Feb 28

China Issues Prescription Drug Formulary; Prescription Abuse Expected to be Curtailed

The Ministry of Health issued the “China National Formulary (Chemical and Biological Products Volume)” on February 7. The volume is China’s first authoritative national standard formulary. The director of the Chinese Hospital Association, Cao Ronggui, remarked, “[The objectives for] the preparation and release of the National Formulary are to regulate medical practices, to improve clinical drug application, and the implementation of clinical path management. The National Formulary is also of significance for promoting better physician-patient communication and establishing a harmonious relationship between doctors and patients.” Some experts also commented that, in addition to providing citizens with a guiding reference on frequently used medicines, the “National Formulary” is also expected to curtail practices of prescription abuse. (Link to full Chinese text)

Feb 28

Experts: Health Authorities Should not be Allowed the Identity of Public Hospital Investor

Following the issuance of the guiding opinion on public hospital reform pilots, voices for promoting and supporting private sector participation in the medical sector have become clearer and louder. Some opine that the business environment for private hospitals will change for the better. Others believe that private hospitals will face further challenges. Yu Hui, an analyst at the Industrial Economics Institute of the Chinese Academy of Social Science, believes that the guiding opinion specifying that “the government is responsible for the basic building of public hospitals and the purchase of large-scale equipment” suggests that the government maintains a role to intervene in the internal management of public hospitals. This suggests that health authorities continue to play the role of an investor in public hospitals. This overlap of interests—health authorities as both the regulators and “bosses” of public hospitals—would be unfair to non-public hospitals. He further pointed out that discrimination remains in the scheme for qualifying hospitals for the [public] medical insurance. (Link to full Chinese text)

Feb 28

Close to Half of Survey Respondents Indicate Willingness to Visit Community Hospitals Following the Unveiling of the “Zero Price Difference” Policy

Following the implementation of the “zero price difference” policy on medicines in Shenyang community hospitals, a survey conducted by the Chinese Business Morning Post shows that close to half of the respondents indicated an interest in visiting community hospitals for care. The survey also showed that because many residents do not trust community hospitals, many would not be able to enjoy the benefits of the policy. A hospital director commented, “Until we address the issue of residents’ distrust of community hospitals, additional government policies will not translate into real benefits for residents.” Another hospital director pointed out that in order to achieve the goal of directing patients to visit community hospitals for common conditions and large hospitals for life-threatening diseases, it is not enough to rely solely on the “zero price difference” policy on drugs. The survey distributed 120 questionnaires of which 103 questionnaires were returned. (Link to full Chinese text)

Feb 28

No Crowds Observed in Community Hospitals Following the Launch of “Zero Price Difference” Policy

Yesterday was the first weekend following Shenyang’s implementation of a “zero price difference” policy for basic medicines in community hospitals. Patient traffic remains quiet at several community health centers and stations visited by a reporter from the China Business Morning Post. Residents’ reactions to the news of the policy were mostly uninspired. One resident commented, “I learned from TV about the ‘zero price difference,’ but I don’t have a favorable impression of public hospitals, so I will not visit there for care.” Another resident reported, “I will only buy medicines when I need them. I will not buy a lot of medicines simply because they are cheaper.” (Link to full Chinese text)

Feb 28

Shenyang Government to Buy Public Health Services

Shenyang issued a guiding opinion on a compensation scheme for community health organizations. According to the guiding opinion, Shenyang’s municipal government will now pay for residents’ healthcare services in community healthcare centers, in effect acting as a purchaser of public health services. The guiding opinion affirms the role of the government as the primary responsible party for basic health investments. Most of the public health services will be provided through government financing. (Link to full Chinese text)

The Ministry of Health announced findings from a national survey on health literacy (Less than 10% of Citizens Have Health Literacy). Separately, a commentary argues for an overhaul of the current thinking on healthcare communication in order to enable health literacy (Health Literacy: Rethinking Patient Communications in China).

Minister of Health Chen wrote an article to highlight the mutual interests shared by doctors and patients. The article proposed improvements in public education as a way to promote a positive atmosphere in public opinions, among other government measures (Minister of Health Chen Zhu: Irrational System Reason for Doctor-Patient Standoff). In response, a blog urges the government to focus on capital investments in the sector as talks of mutual interests between doctors and patients would not yield changes in the short-term (Doctor-Patient as a “Collective Interest Body” is Easier to Understand than Implement). Along a similar theme, a commentary proposes changes to the compensation system for doctors (Let Doctors Live with Dignity).

The Beijing court system estimates that two-thirds of medical disputes in the city may be attributable to doctors and hospitals failing to adequately explain the treatment processes to patients (Two-thirds of Physician-Patient Disputes Due to a Lack of Communication). Such situations may find relief through a clinical path treatment program pilot that the government is launching (Treatment Models Available for 112 Medical Conditions).

The government supports a plan to roll out the hospital volunteer program originally started in Peking University People’s Hospital (China to Implement Hospital Volunteer Program Nationwide). Separately, Shanghai announces plan for standardized training for resident physicians (Shanghai Explores Standardized Trainings for Resident Physicians), while a hospital introduces an assessment system in the emergency room as a majority of patients use the ER for non-critical conditions (Assessment System Introduced for Emergency Room Care).

A researcher at the Chinese Academy of Social Science proposes the introduction of public policies to address issues in housing, education, and healthcare (The Next 10 Years: Public Policies Expected to Remove Obstacles in Housing, Education, and Healthcare). The Ministry of Commerce in the meantime announced plans to further liberalize the medical education and service sectors to promote foreign investments in these areas (Ministry of Commerce: Further Liberalization of Foreign Investment in Medical Education in 2010).

December 2

Two-thirds of Physician-Patient Disputes Due to a Lack of Communication
A number of medical disputes have drawn widespread public attention recently. The number of cases in the judicial system in Beijing is estimated to be more than 1,000. During a recent discussion seminar organized by the Beijing Second Intermediate Court, a judge noted that from his observations, two-thirds of all cases are due to a lack of communication between physicians and patients. He further commented that in many cases, patients sue because they do not understand the process of therapies provided by the hospitals. In the lawsuits, patients often complained of the indifferent attitudes of medical staff, which led the patients to believe that hospitals do not care about patients’ welfare. (Link to full Chinese text)

December 3
Health Literacy: Rethinking Patient Communications in China

Healthcare companies in China would benefit strategically from improving the health literacy of their patients. The traditional communication approach—promoting disease and therapy awareness — engaged by healthcare companies in China often fails to address a current gap in healthcare communication in China: the lack of an enabling communication system that promotes patient health literacy. An overhaul of the thinking processes guiding current patient communication would offer an opportunity to strongly position these companies as a vital and beneficial force for the next stage of market developments. (Link to full text)

December 4
Assessment System Introduced for Emergency Room Care

The number of patients visiting hospital emergency rooms has steadily increased in the city recently. The limited space and medical resources in these emergency rooms have further aggravated the doctor-patient relationship. The No. 3 Hospital in the city has taken the lead by introducing a grading system for diagnosis and treatment of emergency cases. This would allow hospitals to attend to patients requiring the most urgent services. According to the director of emergency room service at the hospital, the hospital admits about 200 emergency patients per day. However, most of the patients suffer from non-urgent conditions such as colds and stomach flues. Based on the research conducted by this journalist, only about 10% to 20% of emergency patients require emergency care. The high number of emergency room patients, along with a shortage of medical staff and the anxiousness of patients’ families, has contributed to the chaos observed at emergency rooms in hospitals. (Link to full Chinese text)

December 4

Let Doctors Live with Dignity

Within a span of three weeks, three medical dispute cases in three regions in China have drawn widespread public attention. While the nature of each medical dispute case is different, public opinion is surprisingly unanimous: Doctors and hospitals have killed the individuals [involved in the cases] and should assume full responsibility. Based on this reaction, we can conclude that there is a heightened state of public mistrust towards doctors and hospitals, which has given rise to the strained state of relations between doctors and patients. The root cause is distortions in the medical management system that has distorted the compensation system for doctors. This writer believes that compensations for doctors must take into consideration the need to preserve doctors’ professional dignity. If the compensation practice treats hospitals as administrative organizations or corporate businesses, the public will continue to remain suspicious of doctors’ professional integrity. (Link to full Chinese text)

December 5
China to Implement Hospital Volunteer Program Nationwide

The Peking University People’s Hospital effectively improved physician-patient relations through a hospital volunteer program. Officials from the Ministry of Health have explicitly indicated that such a program will be launched nationwide. In addition to having mastered professional social work knowledge, hospital volunteers are skillful in identifying the social, psychological, and physical factors of those they serve. Hospitals also provide training in preventive care, assessment of frequently seen medical conditions, and risk management to volunteers. Certificates are issued to qualifying volunteers. Since the official start of the first group of volunteers in April, in addition to their regular duties of assisting patients, these volunteers have proposed 99 recommendations for improving physician-patient relations. (Link to full Chinese text)

December 10
Minister of Health Chen Zhu: Irrational System Reason for Doctor-Patient Standoff

The Minister of Health Chen Zhu wrote in an essay published in People’s Daily that the true nature of doctor-patient relations is one of “collective interest body.” The root cause impacting doctor-patient relations is the lack of a rational system which has diluted the public interest nature of hospitals and pitted the economic interests of physicians against those of patients. To address the issue, Minister Chen wrote that work in four areas will be needed, including strengthening of government functions in public service and increasing investments in the healthcare sector; improvements in medical professional ethics; improvements in the system for mediating medical disputes; and improvements in public education to promote a positive atmosphere in public opinions. (Link to full Chinese text)

December 12
Doctor-Patient as a “Collective Interest Body” is Easier to Understand than Implement

The Minister of Health Chen Zhu recently claimed that the nature of doctor-patient relations is one of a “collective interest body.” It is true that doctors and patients share the same interest. Ultimately, patients’ level of satisfaction with treatment outcomes impacts doctors’ interests. However, in some areas, doctors are indifferent to patient benefits. Moreover, hospitals and doctors place their own interests ahead of others. Many doctors will not change their minds just because the minister has spoken. Similarly, patients will not change their views of doctors just because of a slew of news reports. In this writer’s view, investments in healthcare hardware facilities remain the prerequisite for improving doctor-patient relations. (Link to full Chinese text)

December 17
Treatment Models Available for 112 Medical Conditions

The Ministry of Health plans to identify 50 hospitals to implement a pilot clinical path management program by the end of the year. Clinical path management method means the use of a standardized treatment protocol for a certain disease. Patients will now be able to refer to the method to understand the flow of treatment process. According to Ma Xu-dong, director of the Medical Administrative Department of the Ministry of Health, under the current system, doctors rely on experience to administer diagnoses and treatments. With the clinical path management program, hospitals across the board can reference standardized protocols for treatment plans. Most ideally, patients now have access to a standardized treatment flowchart so they can anticipate the treatment process and estimate treatment budgets. The new model can be expected to improve physician-patient relations. According to Ma, 80% of all medical disputes reported to the Ministry of Health are due to miscommunication. The clinical path management program provides the transparency required to facilitate improved doctor-patient communications. (Link to full Chinese text)

December 21
Less than 10% of Citizens Have Health Literacy

On December 18, the Ministry of Health reported results from the first national survey on health literacy of Chinese residents. The survey was conducted between June 2008 and August 2008 and covered 31 provinces and regions. Close to 80,000 individuals between age 15 and 65 participated in the survey. The survey found that only 6.48% of those interviewed have basic health literacy. Health literacy refers to an individual’s ability to acquire and comprehend health information and the ability to use the information to care and promote his or her own health. Mao further commented that “in the past, we were used to using quantitative measures to assess our work in health communications, for example, the number of health seminars conducted, the numbers of people attending, the number of posters plastered, the number of pamphlets printed. We are now more focused on assessing the actual results of health education. He concluded by saying, “We should all remember: Every person is the primary responsible party for his or her own health.” (Link to full Chinese text)

December 31

Shanghai Explores Standardized Trainings for Resident Physicians

According to Shanghai municipal public health departments, Shanghai has launched standardized trainings for resident physicians that are in line with the national medical reform plan. Thirty-nine large- to medium-size hospitals have been identified as training hospitals. Standardized training for resident physicians is a widely used practice internationally for training medical clinical talents. The United States, the United Kingdom, Australia, and other developed countries, as well as China’s Hong Kong and Taiwan have established government-led, thoughtful, standardized training systems that effectively guarantee the professional standards and quality of clinical practice. (Link to full Chinese text)

December 31
Ministry of Commerce: Further Liberalization of Foreign Investment in Medical Education in 2010

According to the Minister of Commerce Chen Deming, the government plans to target healthcare, training, and other related services as areas for liberalizing foreign investments. The government plans to proactively and steadily open the markets in services including encouraging foreign investments in healthcare organizations and occupational training institutions. Such a policy perspective follows the framework drawn up in the medical reform plan released in 2008. Since the mid-1990s, foreign investments have been made in the areas of special clinical service and medical equipment. However, since 2005, the implementation pace for foreign investment in the sector became more restrictive. The new medical reform plan in 2008 explicitly proposed to “encourage and guide private sector capital in the development of the medical and healthcare sectors, aggressively promote the development of non-public healthcare institutions, and facilitate the formation of multi-source investments to the sectors.” (Link to full Chinese text)

December 31
The Next 10 Years: Public Policies Expected to Remove Obstacles in Housing, Education, and Healthcare

Housing, education, and healthcare are necessary goods for citizens. In recent years, prices for these goods have escalated at an increasing rate, resulting in a drastic increase in economic burden for people. Since the underlying nature of these products is largely that of a public good, it is difficult to effectively guarantee adequate supply of these goods by relying only on market mechanisms. The problem is the lack of public policies for these sectors. These sectors have only departmental or sector policies. Healthcare in particular is considered by many a “pseudo market.” The lag in fiscal investment has led to hospitals relying on prescription sales to raise funds for operation. Moreover, policies have obstructed the entry of private sector capital into the healthcare sector. To resolve issues in the provision of these goods, public policies must be introduced and established. (Link to full Chinese text)