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Perspectives from CHINA
Can you explain the general structure of the Chinese Healthcare system?
The Chinese government support or run hospitals providing most of the health care services and are currently undertaking progress in health care insurance enterprises including society insurance (often through an individuals work unit) and commercial insurance.
In most cases this will pay a limited amount of the health care cost for city people. However, most people will pay the majority of the healthcare cost on their own, in addition to the healthcare insurances. In the countryside, there is a “rural health insurance system” consisting of some limited national and local support. Patients pay the cost for some kind of diseases.
What is the overall state of Patient Safety currently in China from your patient perspective?
The problem has been increasingly recognized by Chinese government via public media, conferences and meetings. But many other challenges face the government, the related mechanism for patient safety needs to be improved including national policy, healthcare insurance system and the medicine management etc.
How would you describe the Doctor-patient relationship?
Based on the actual situation including culture, education, healthcare system, it is still doctor dominated decision-making although this situation is changing so that patients increasingly have rights to share with doctors. In 2002, ” Regulation on the Protection of Medical Malpractice” was issued by the government for the sake of patients.
To some extent, doctors, are sensitive to taking responsibilities or may be afraid of being involved in patient disputes. Doctors may ask patients to take responsibility by asking them to sign many documents before taking treatment. Patients do not always fully understand the content of these documents.
What current channels can patients follow to get their voices heard within the healthcare system?
The hospitals have developed some kind of “feedback box” for patients, or have some surveys to particular patients, or via patient associations. Some hospital have set special department to meet patients to listen to their voices. Public media will play a key role in monitoring and encouraging hospitals to listen to patients voices.
The Health Authority will also ask hospitals to listen to patients voices.
What is the level of awareness of Patient Safety amongst the health professionals and Leaders?
It has been increasingly recognized. The Health Authority calls on all hospitals that patient safety is the guarantee of the quality of healthcare service. It should be the priority and should be the main or longstanding theme for hospitals in the quality of management and quality control. So they are educated.
But there is a big difference between the countryside and the cities because of education levels, lack of information etc.
How are patients included in the healthcare system?
It is different in different cases and for different people. If I have job, my healthcare cost will be partly paid by my work unit (social health insurance), some amount will be paid by my commercial insurance and some will be paid by myself. If I have no job, I will pay my own if I do not have commercial insurance. In the countryside, most areas people will pay their own health cost though the situation is changing.
What are the patient safety priorities for China?
As a developing or transitional country where healthcare expenditure is lower compared with the western countries ($261 per capita, per year ), there are many priorities facing healthcare. It is interesting that at the beginning of this year, I submitted a funding proposal to National Nature Science Foundation of China, the biggest foundation in the country on the topic of “ Advocating for Patients for Patient Safety and Cultivating a Harmonious Social Environment between Doctors and Patients”, I just got the feedback from the foundation while responding to these questions, the proposal is not approved though it is “very important, very meaningful, and innovative”, but “patient safety is a system project, it is very difficult to launch only patient for patient safety before the whole system is matured”.
So under these circumstances, standardization of national policy, improvement of healthcare insurance system and management of medicine will be priorities in patient safety
What are the biggest challenges to brining about change in China and making healthcare safer?
We still have a large population unevenly distributed in cities and the countryside and limited private and public healthcare resources.
Mingming Zhang from China was one of two of the participants selected to attend the Global Patients for Patient Safety Workshop in November 2005 from the Western Pacific region (WPR).
This article appeared in the September 2006 edition of "Patients for Patient Safety News".
Source: Rachel Heath
WHO Patients for Patient Safety Project Manager
International Alliance of Patients' Organizations
703 The Chandlery
50 Westminster Bridge Road
London SE1 7QY
Tel: +44 20 7721 7549
Fax: +44 20 7721 7596
Patients for Patient Safety is an action area of WHO World Alliance for Patient Safety.
It aims to promote active patient involvement in the work of the Alliance and patient safety worldwide. Independent, project support arrangements are provided through the offices of the International Alliance of Patients' Organizations in London. There is also active collaboration through the World Alliance with a wide range of patient, consumer and patient safety organizations.
For more information, visit the Patients for Patient Safety website at http://www.who.int/patientsafety/patients_for_patient/en/
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