صفحه 1:
4
87
‘aw
صفحه 2:
The Health Care System
and
ic Hea
صفحه 3:
I will discuss...
° China’s Health Care System
° Public Health in China
صفحه 4:
China and its Health Care System
° Basic Statistics/Economic
status
° System overview
° Who pay for health services?
° Government’s health policies
صفحه 5:
China:Basic Statistics
° Area: . 9.6 million km?
¢ Total population: 1.27 billion (2000)
* Population in rural areas: 63.8 []
٠١ Administrative Region: 31 provinces
GDP: 8,940.4 billion RMB
٠ Number of health agencies: 330 thousand
٠ Number of health workers: 5.568 million
۰ Number of school of public health: 36
ina statistical year book,2001
صفحه 6:
96 لا ل انها ما ٩ ٩ مه ۷ ٩
Hot available (1)
Source : China statistical year book,2000
صفحه 7:
CT ne one ee kee
toed
0ك
Ce er eaten katie coro
eee oe
روصا نط0 , (صسيام) dee
00 eee ead
صفحه 8:
Health Network of Three Tiered in
5 County Epidemic County Maternity and
County Hospital |prevention Station) Child Health Hospita
Agencies: 1657 Agencies: 1387
Workers:87468 Workers:49313
ownship hospital(Clini¢)
Agencies: 47928
Workers:1163700
‘ownship hospitals
Agencies:693518
Workers:1282310
صفحه 9:
China Health Information System
[Ministry of Health, P.R.Chin
1 اس
e of Medical 1
China CDC Information Cts تک Center of
1 1
Othe:
Facil 2
Disea:
Healt 1 “| Research Institution:
e f Medical Science
iniv.directh M alth 8
sion ical Colleges 2
Provincial Dept of [=
caer 4
Health Units Local Health Dept _}
صفحه 10:
Who pay for health
_____ services ? ____
* 1949-1977 free health services for
the entire urban population,
government pay system
* 1978-1996 government & hospital
paid health services
* 1996-now government, collective
& individual paid health services
صفحه 11:
The
range
of
increas
e (%)
12.4
33.8
17.4
14.8
8.6
The Medical Expenditure Per Capital
Outpatient (Unit: RMB)
Contain
The cost of
Treatment and
examination
proporti | Absolut | proporti
on e on
number
67.9 2:1 3
64.2 9.1 |22.8
61.4 9.7 7
59.5 |14.4 |18.2
19.6
The cost of drug
Absolut
e
number
74
25.6
37.8
47.4
Average medical
expenditure to
per person-time
10.9
39.9
61.6
79.0
1990
1995
1997
1999
صفحه 12:
Change Trend of the Medical Expenditure Per Capital
Outpatient and Inpatient (Unit: RMB)
Expenditure of
Patient
In- Patient
Cost of
Drug
260.6
1278.8
1363.6
1421.9
22.0
6.6
Treatment
expenditur
e
473.0
2596.8
2891.1
3083.7
23.7
11.3
Treatment of Person-
Time
Out-Patient
acai Cost of Drug
10.9 7.4
68.8 42.7
79.0 47.4
85.8 50.3
25.9 24.5
1990
1998
1999
2000
Rate of
increase (%)
Average rate
90-98
1999
صفحه 13:
uv
Expen
Expenditure
هاهم هو ۳6
صفحه 14:
The proportion of the total
health expenditure in
Gi Government |
Society
OjIndividual
(%) dq
0} abeyuarsed ays
0
1990 1991 1992 1993 4 ۱ 1
صفحه 15:
Maldistribution of Health
1991 1997
Distribution of Distribution of
Resource% Resource%
“AY AY
موحت المح و ER 11772
صفحه 16:
Total Health Expenditure As Percentage of GDP
1995 1996 1997 1998 1999 2000
صفحه 17:
The Percentage of Total Expenditure to GDP
a
5
3
&
8
60 65 70 75 80 82 83 85 86 87 89 90 91 93 95 97 98
w
صفحه 18:
ymparison the proportion of health expenditure to GD
in Five Countries in 1995
|1995 ظ
USA English Spain Japan China
صفحه 19:
Health Policy in
China(1950s)
* Meet health needs of the
workers, peasants and soldiers
* Put the prevention first
* Combine the Western and
Chinese Traditional Medicine
* Link the health care work with
the mass movement
صفحه 20:
Health Policy in
¢ Put the prevention first
* Rely on the advanced scientific
progress
* Mobilize the whole society to
participate in
* Equal emphasis on the Western
and Chinese Traditional Medicine
* Serve for people’s health
صفحه 21:
11601111 ۲ 0110۲۷ 0
China(2000s)
— ile 1996 Health: Meoting of —
China’s Central Gov.
* Emphasize on the health work in
the rural areas
* Put the prevention first
* Equal emphasis on the Western and
Chinese traditional medicine
* Rely on the science and education
* Mobilize the whole society to
participate in
صفحه 22:
Public Health in China
¢ History of Public Health
¢ Public Health Achievements
* Public Health Challenges
صفحه 23:
Brief History of PH in
China”
* Before the Eighteenth Century
* The Eighteenth -Nineteenth Century
* The 20s-30s of the Twentieth Century
¢ The 50s-70s of the Twentieth Century
۰ The 80s-90s of the Twentieth Century
صفحه 24:
Briel History of PH in
China سح
--before of the
eighteenth century
* The Yellow Emperor’ s Canon Medicine - the
earliest and most comprehensive theory of
traditional Chinese medicine The Ancientry
philosophy of PH: The best medical doctor should
know how to deal a disease before it developed
* Disease involves two aspects: pathogen and body
resistance, both should be considered when
dealing with disease prevention.
Holistic health: regular life, a proper diet, an
appropriate exercise, harmony in mental and
emotional activities
صفحه 25:
Brief History of PH in
0019898
-- the 18 - 1
century
* Book on epidemic febrile diseases
¢ Experience of diagnosing and treating
* Western(modern) medicine into China
in 1830s, by Christian missionaries
صفحه 26:
Brief History 01 111 0
China ااا
-- the 20s-30s of
20% contury:
* The western medical hospital in China,
represented by Peking Union Medical
College Hospital
¢ The first Department of Public Health
within PUMC in 1921, by Dr. John B. Grant,
who was the Far-East representative of RF
¢ A model of health-care community in Ding
County, Hebei province, as an educational
field of department of PH in 1928
¢ An early example of primary health care
system was established in Ding county
during 1932-1937 by Prof. Chen Zhi-gian
صفحه 27:
Brief History of PH in
001998
-- 1116 505-705 01
20% century
* Coping the public health system of the
former Soviet Union in 1950s
Setting up an anti-epidemic system in 1950s
Separate public health school from clinical
medicine in 1950s
¢ Forming Patriotic Health Campaign,
established PHC
¢ Barefoot doctor system in rural areas in
1960s
* Red cross clinic system in urban areas in
1960s
صفحه 28:
Brief History 01 111 0
hr China
-- the 50s-70s of
20% century
* The great sanitary awakening
* Preventing acute infectious diseases
* Health education
* Free basic immunization
* Established three-tiered PHC network
٠ A war against ‘four devils’: flies, mice,
mosquitoes and sparrows
* In the 1960s-1970s
controlled many serious epidemics of
communicable diseases, such as cholera, plague
and malaria
صفحه 29:
Brief History of PH in
001998
-- the 805-905 01
20% century
* The rapid development of public
health in China
reform and open policy
development of science and
technology and education
the primary health care in China
international collaboration
* Established and perfected health
three-tiered network
¢ Strengthened maternal and child
heal
* Expanded program immunization
صفحه 30:
805-05
20
century
Western
medicine
505-09
20"
century
20s-30s
7۱
century
Traditiona
1 medicine
of China
18-19%
century
The Development
and improyement
15610
pr
century
Establishme
“nt
صفحه 31:
Birth rate(BR). Infant mortality
rate(IMR).
Crude death rate(CDR). Life
—_—_—expectancy(LE) سس
Year BR(%) IMR(%o) DR(%o) LE(Year)
1950 37.0 195 18.0 40.8
1960 20.9 121 25.4 49.5
1970 33.4 61 7.6 63.2
1980 18.2 47 6.3 67.8
1990 21.1 38 6.7 70.9
1999 15.32 33 6.46 72.0
(1998)
صفحه 32:
Leading Causes of
. جع(
Order Urban Rural
1 Cancer COPD
2 Stroke Cancer
3 Heart Dis. Stroke
4 COPD Heart Dis.
5 Injury Injury
صفحه 33:
Birth Rate Decreased
(900) عنأه8 لتسنظ
5 :
Coo) 1 1 5-5 ee
7
8 8 8 8 58 8 وه
PPPOE EEE LOLS
a year 1
صفحه 34:
The Incident Rate of Communicable Disease in
China(1965~1998)
صفحه 35:
Parasitic Diseases:Under
90's
BO thou,
750 thou.
40's
12 million
Patient ‘s
umber Si million/year
of Malaria
Patient ‘s
number of
Schistose
صفحه 36:
Proportion of different
infectious disease cases 1965-
1995 (%)
Ae | |
۳
SS (|
صفحه 37:
صفحه 38:
Strengthening Health legislatio
- issued 9 laws, 24 rule of laws and more than 400 regulation
Pe be Je ante
8 WA:
صفحه 39:
QDevebpwed oP Epidewic Prevecion شاه
7000 7007 300000
t—Nunber of Heal th Vérkers wa
6000 ۰ 3
——Nunber of Health Agenci es a 5900 250000
5000 7 3
A 7 200000
2
4000 7 .
5 a + 150000
3000 7
1 7 100000
2000 7 A
1000 + 590 7 50000
1
9 {+ 42500, 4 4 1 1 ۱ ۱ ۲ ۳
1952 1957 1965 1975 1980 1985 1990 1995 1999
صفحه 40:
World Health Report 2000 Selected Indicators
Nace Ce ae) relate)
۱ نالا
0 مذ ووومعتوع CTR Cay کی
1۷ ‘ss irra لأكاقوم cy
۱:۱
contribution
سس ديسل ۱۹۹
تن
كك
صفحه 41:
The Experts of the World
Bank Evaluate Primary Health
Care in China:
“Truly, Declare of Alma-
Ata in 1978 about the
realization ‘Health for all by
the year 2000’ by primary
health care was deeply
influenced by Chinese model”
صفحه 42:
Challenges
* Change of Population
* Urbanization and industrialization
٠ Double burdens of diseases
° Behavioral and Environmental
° Unreasonable of allocation
صفحه 43:
Trend of Age Composition
2050 year
یرنه
:53م
World:
صفحه 44:
Trend of Population and Aging
(10.1 Billion)
18
1953 1964 1982 1990 1995 2000 2015 2050
صفحه 45:
The change trends of the structure of
opulation, dependency ratio and
medical vulnerable population in China
from 1980 to 2025
70
=> 60 © Theperventage of popalation
£ 8 apd 65+ years 654] 0 0
9 50 © Thedependemy ratio of the
40 1 you] 00 000
5
~30 3 « Thedependemy ratio of the
§ ره ت92 0 0 0
20 2 ‘The percentage of medical
5 10 = ae wunerdble popilaion(] 0 0
1 : ع
0
1978 1980 19909 2000 2010 2029 0
Year
گ
صفحه 46:
Figure 7-3.
Youth and Elderly Support Ratios in China: 1985 to 2050
(Youth ratio: persons 0 to 19 years per 100 persons 20 to 64 years;
Elderly ratio: persons 65 years and over per 100 persons 20 to 64 years)
Youth
Elderly
100
a8
88888
10
°
1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050
Source: U.S. Bureay of the Census, Center for International Research,
International Data Base on Aging.
صفحه 47:
Urbanization and تا
Industrialization
* Environmental pollution
۰ Life and work stress
* Injury
° Immigrant
صفحه 48:
The Natural Ecological
Environment
=>Wastewater
The comparison of ellutign discharge between
1998 and 1999
450
400
350
300 a Domsic
Thesewage
dischaye aroun Ee was
0
000 ماه و
100
50
1998 1999
صفحه 49:
> Waste
residue
The amount of urban refuse in China
7 8.98%
Beijing 7 15%~20%
In 1996 the amount ۶
refuse cleared
transported
In
2000
صفحه 50:
> Waste
gas
«In 1999, the coal smoke type still the
main type é of air pollution in China
°A few megalopolises were the
complex type of coal smoke
and automobile exhaust
pollution
صفحه 51:
Threats of communicable
disease and parasitic disease
still exists
Chronic and non-
communicable disease
CURR ولك اا
صفحه 52:
صفحه 53:
Changing Trend of Case of Death In urban
1957 Year 1999 Year
Injury
6%
her
3
Infecti on
2%
صفحه 54:
1116 1۵16۷82101060 6110 102011۵111۷ rate of chronic
and non-communicable diseases rises
continuously
(In urban areas, 1954-1998)
۰ ۰
cancer .
۰ 2
1954 1957 1963 1975 1980 1985 1990 1995 8
oo
=~
1 1
Metaboliz
thous: 7 100
85 8 8 2 م 8 ۵ لاه
صفحه 55:
Behavioral Risk Factors
Smoking
Drinking
Dirt
صفحه 56:
Smoking
At present China has turned into the biggest
country of tobacco consumption in the world
Accounting for more than 30% of the total
tobacco consumption in the whole world
Increasing at the speed of 5.3% annually
صفحه 57:
Production and Marketing of tobacco in Chinz
Source:The Report of Tobacco in Chin
صفحه 58:
1952-8:
It is expected Drinkin
that it will The annual
reach 47.2624 growth rate
million tons in was 5.3%
2Bhe statistics of the annual sales volume of
1982~1989: China
_— The annual
|__ growth rate * 4726.24
was 13.3%
و
Le 1 1 ۹ ۱ ۱
5000
4500
4000
1990~1995: 55 960 1970 1988 1999 2000 2010
The annual Year
growth rate
was 13.1%
صفحه 59:
Diet
The comparison of food consumption
by residents between 1991 and 1997 in
the city and country of Chongqing
municipality (kg/year-person)
Cit Count
y ry
1 ۷
117.91 250.37۰
5
صفحه 60:
Overweight: Obesity: BMI
BMI=25kg/m? 230kg/m?
The prevalence of ‘1ne prevalence or
overweight obesity
18.28% 2.48%
In Chinese population
aged 20+
Overweight Obesity
240 million More than 30
million
صفحه 61:
Environments Risk Factors
Social population
environment
Natural ecological
environment
Working environment
Living environment
صفحه 62:
The new concept of environment
nodel of the Human
‘cosystem.
——Hancock and Perkins,