Healthcare issues in the Asian countries
- Background
In many parts of Africa, the healthcare sector is among the
weakest and most underdeveloped sectors of the economy. An African Health
Policy Centre Report, published in 2009 showed that only 20% of health
expenditure was assigned for essential services such as diagnosis and
treatment, while only 10% of health care spending was allocated for social care
(Sofa).1
In South Africa, there is a strong correlation between
poverty and low access to primary health care. Poor households tend to have
lower income levels and are more vulnerable to disease and other health conditions.2
Healthcare in South Africa is divided into four main
categories:
Primary – which refers to free medical care, including
doctor's visits, prescriptions, and medical examinations;
Secondary – includes public health services provided by
the government, such as child immunization and tuberculosis;
Tertiary or territorial care – covers hospital deliveries and
other health-related activities, including HIV/AIDS control;
Palliative care – refers to specialized treatment for
cancer patients and others with advanced diseases.3-4
South Africa’s Health Department has set out five key
priorities to improve the public health care system:
To provide universal access to medical care;
To enhance quality standards;
To reduce deaths due to preventable and treatable healthcare-related diseases;
To reduce maternal and child mortality;
To promote healthy lifestyles.
What are some underlying factors?
- The highest rate of infant mortality rates
South Africa has one of the world’s highest rate of infant
mortality rates (IMR) per 1,000 live births: 5.5 fatalities per 100 live births
in 2015 (source) 5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21. South Africa
also ranks third-worst in access to children's health services according to the
World Health Organization (WHO)
A major hurdle in improving health care delivery in South Africa
is limited financial resources such as human and capital resources. South
African private health expenditures in 2016 were R1.8 billion, and private
investment in hospitals accounted for less than 2% of all investments
(Source).7
How the Asian countries’ health care system has evolved over the years
South Africa has been struggling with various challenges
in its public health care system. First, a large percentage of hospital funding
comes from the provincial governments. As there is no single national
health care system, each province will provide funds under different levels. For
example, in KwaZulu Natal province, R2.7 billion was allocated to form the KwaZulu
Provincial Hospital trust. The trust’s budget is R4.3bn. These funds mainly
come from state resources. The government expects to pay 15% percent of total
liabilities from provincial taxes, but the actual share is much higher. Local
municipalities pay 20%. State agencies and health departments contribute about
25%, while local civil society and religious organizations contribute 33%
each. Some provinces have already started using donor financing in order to
finance infrastructural projects which can be used to improve health outcomes.
Source
In addition to the provincial level, South Africa has 12
regional and city municipal wards, representing 7 million people, and a
municipal council that serves 8 million people. City wards are composed of 48
wards. Although there are only 4 million people living in urban areas, South
Africa has some of the biggest cities in the world. San Francisco, Tokyo, and
New York have 50 million people. Source
The United States health care has undergone several
changes over the past few decades, especially during the last 25 years. It was
the end of WWII when the US underwent a radical change, which brought a whole new
approach to its health and lifestyle. President Lyndon Johnson initiated
comprehensive reforms and changed America’s attitude towards healthcare by
making sure that every American had access to affordable and competent medical
services. The Affordable Care Act (ACA) was enacted in 1973, which offered
coverage to more uninsured Americans and allowed an open enrollment period for
people to sign up for Medicare. In 1978 Medicare launched the Medicaid program
which covers most of the elderly population and expanded coverage to the poor and
minorities. It took until 1982 before Medicare paid for the entire cost of
treating those with pre-existing conditions. By 1990, nearly 65% of U.S.
citizens received medical insurance, which increased their access to health
insurance. Now about 83.2% of adults have health insurance, while 22.8% are
uninsured. In 2000, the overall uninsured population reached 13.8 million
people. However, only 23.8% of them were children, 4 million of whom lived on
Medicaid. Also, since then, Congress passed the Patient Protection and
Affordable Care Act (PACA), which made it an easier process for people who need
medical care to get it.
The European Union (EU) has a common approach to health
care. Each country has its own health care system based on the European Health Law.
Currently, it operates under the EU law known as the “General Medical
Conditions Directive” (GMC). This document sets goals for general health care
service provision. General physicians are legally hired to provide medical
advice and are responsible for providing diagnostic, therapeutic, preventive,
rehabilitative, palliative, family medical, environmental, occupational, and
psychosocial services. They are licensed to treat patients with chronic illnesses
and injuries. Source
China follows its communist party government model that
promotes private medicine. Private doctors have more autonomy in providing
health care and less governmental interference. Although private doctors can also
apply and receive permission to practice in China, many of them do contract
with hospitals to deal with their patient’s needs. Many businesses have
expanded around the country. There are more Chinese patients in foreign
hospitals. Public support for medical treatment has also grown dramatically in
China. More people believe in Chinese medicines instead of Western products,
which contributed to China achieving the top spot in a 2017 global survey.
Source
- Health care in China is divided into three main areas:
Public hospital – This consists of the largest number of
hospitals in the country and several government hospitals under the
jurisdiction of the central government. Most hospitals serve more than 40,000
patients per day. According to the Ministry of Public Health, Beijing alone has
more than 11,500 medical institutions. Of these, approximately 70 percent are
located within eight cities. About 90 percent of them are owned by the local
authorities of the cities where they are situated. Hospitals can be found on
every street and even have ambulances at the entrance. Source
Private hospital – This includes hospitals owned by
individuals. There are some privately owned hospitals in China, which are a mix
of small and big ones. Many patients go to a doctor because he knows him. The
largest private hospitals are located in Hong Kong and Shanghai. Source
Other places include community hospitals, psychiatric
hospitals,s, and rehabilitation centers. To improve the efficiency of health care in
China, Chinese hospitals now offer their services to other countries. Many of
these places are operating without licenses, but their staff will still be able
to provide consulting services in some cases. Source
- The future of China’s health care
As mentioned before, many initiatives are underway to make
health care accessible to more people and improve healthcare in China. One of
the latest actions is to build additional hospitals as well as expand existing
facilities. For instance, Jinan Children's and Family Hospital has begun
construction of a 120,000-square meter building in Jinan. In order to meet
increasing hospital demands, China plans to increase the number of clinical
specialties from the current four to six. The goal is to reach 150 extra
specialists, which will increase the number of doctors working in China’s
hospitals. Source
For this reason, China plans to spend $1.5 billion a year
on expanding its healthcare system, through programs such as the Digital
Platform Plan. Such efforts will result in the development of two new Central
Government Institutes for epidemic prevention and control in 2014 and the
National Center for Disease Control. Both institutes will develop innovative
technologies, scientific applications, and effective solutions that would become
useful in addressing epidemics and providing guidance and recommendations.
Source
The majority of these centers will function as teaching
and training centers, research centers, technical laboratories, and production
facilities for the public and private sectors. The new centers’ work will be
expected to contribute directly to international cooperation in the field of
epidemic prevention and control, public health management, laboratory medicine,
biostatistics, and so on. The Chinese government has dedicated millions of
dollars to the project, which can cater to the needs of domestic medical
students and other participants. Source
Finally, Chinese scientists continue developing
cutting-edge pharmaceuticals and therapies. During the same time, their
achievements have led to the achievement of the milestone of the commercialization
of the first COVID-19 vaccine and the approval for an average of seven vaccines.
Several potential candidates have gone through trials and trials on humans to
prove their safety and efficacy in preventing and fighting infection with the
virus. Source
China will also continue its active participation in
international discussions to discuss and develop the best international
guidelines for the use of technology in the healthcare industry. Technology
advancement is one of the important components in promoting an efficient and
systematic implementation of preventive measures. Allocating part of the budget
to fund research and development efforts is another way that can help solve
some of the problems faced by people during their daily lives.
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