Correspondence

The Evolving Chinese Health Care System

N Engl J Med 2006; 354:876February 23, 2006

Article

To the Editor:

The otherwise excellent article by Blumenthal and Hsiao (Sept. 15 issue)1 overlooks three critical points regarding Western medicine in China. First, institutions such as ours serve as points of introduction for concepts such as infection control, pain management, peer review, palliative care, evidence-based medicine, quality control, and even primary care — this last being arguably the most cost-effective way of dealing with emerging diseases of industrialization and urbanization, as documented in the same issue of the Journal.2 I can personally vouch for ample experiences of this phenomenon during the severe acute respiratory syndrome epidemic, and it is also evident in the ongoing regular visits of groups of hospital, medical, and nursing directors.

Second, that a small but growing minority of Chinese patients has access to compassionate and patient-centered care, adequate pain relief, and treatment with clean instruments should not be a point of indignation. The goal is to find a way to deliver the same standard of care to every patient. Finally, to dismiss Chinese physicians' access to advances in technology denies the scientific contribution of this highly skilled and talented group to the global understanding and progress of health and illness.3

Artin Mahmoudi, M.D.
United Family Hospitals and Clinics, Beijing 100016, China

3 References

1. 1

   Blumenthal D, Hsiao W. Privatization and its discontents -- the evolving Chinese health care system. N Engl J Med 2005;353:1165-1170
   Full Text | Web of Science | Medline

2. 2

   He J, Gu D, Wu X, et al. Major causes of death among men and women in China. N Engl J Med 2005;353:1124-1134
   Full Text | Web of Science | Medline

3. 3

   Hou FF, Zhang X, Zhang GH, et al. Efficacy and safety of benazepril for advanced chronic renal insufficiency. N Engl J Med 2006;354:131-140
   Full Text | Web of Science | Medline

Author/Editor Response

Dr. Mahmoudi suggests that private, investor-owned hospitals in China play an important part by introducing new forms of technology and approaches to service and by meeting the demands of a “growing minority” of affluent Chinese. However, the growth of a for-profit sector serving a society's elite leads inevitably to inequalities in service. The single greatest problem facing the Chinese health care system is how to reduce inequities by providing all citizens with basic protection against the cost of services and by making services of adequate quality available throughout the country's vast expanse. Furthermore, Dr. Mahmoudi assumes that an investor-owned sector that provides services modeled on the care provided in Western countries will necessarily be more efficient than that provided in the mainstream Chinese sector. That assumption remains to be tested. Certainly, experience with high-technology medicine in the United States suggests that it is plagued with inefficiencies related to the overuse of services. The struggling Chinese health care system can ill afford to replicate the inefficiencies found in much more affluent Western health sectors.

David Blumenthal, M.D., M.P.P.
Massachusetts General Hospital, Boston, MA 02114

William Hsiao, Ph.D.
Harvard School of Public Health, Boston, MA 02115

Citing Articles (2)

Citing Articles

1. 1

   Chi Pang Wen, Ting Yuan David Cheng, Shan Pou Tsai, Hui Ting Chan, Hui Ling Hsu, Chih Cheng Hsu, Michael P Eriksen. (2009) Are Asians at greater mortality risks for being overweight than Caucasians? Redefining obesity for Asians. Public Health Nutrition 12:04, 497
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2. 2

   Liangzhi Yu, Jianye Xu. (2006) The Political Economy of Public Library Development in post-1978 People's Republic of China. Libri 56:2, 117-132
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