Adam Powell, PhD, is a trained healthcare economist with expertise in health IT and health reforms. He is also the President of Payer + Provider, a consulting firm “by Doctors of medicine and research.” Payer + Provider is one of the organizers of the Intercollegiate US-China Healthcare Conference I’ll be attending and reporting from this weekend. (If you’ve ever wondered what a consulting team full of Harvard and MIT MDs and PhDs would look like, see Payer+Provider’s team page here.)
Dr. Powell recently published an article at the Fair Observer, “Chinese and American Healthcare Systems: A Comparison”. The article highlights three common threads running through China’s and America’s recent health reform efforts:
While both reforms were created in part to increase access to health insurance, they were created for differing reasons and do so in different ways. After comparing the two reforms and their resulting healthcare systems, three general themes emerge; healthcare systems are influenced by national objectives, the structure of the government, and economic conditions.
(emphasis mine). It then goes on to explain how each of the three factors listed above manifests itself in the plans of each particular country. On how national objectives impact each country’s health reforms he says;
China was motivated to increase access to health insurance in part because people were saving a large proportion of their incomes in order to protect themselves from medical losses…Meanwhile, in the US, a major factor motivating the reform was the desire to increase the number of people with health insurance in order to encourage people to seek preventive treatment and to reduce the burden on providers caused by people receiving care without paying for it.
China’s recent health insurance reforms have primarily focused on people living in rural areas and on people living in urban areas not working for large employers, while America’s reforms have focused on employed people, low-income people, and children. One reason that the reforms have addressed different demographics is that the two nations slice their populations differently when thinking about health insurance.
China and the United States have drastically different per capita GDP – approximately $8,000 in China, and approximately $48,000 in the US. As incomes are lower in China, there is a greater need for affordable care – the average health insurance premium of a family in the US costs more than the average household income of a family in China.
…the first tier of the system (with the greatest rate of reimbursement) consists of providers without formal medical school training. As more formally trained providers do not appear until patients reach higher tiers of the system, a large number of basic problems can be handled at a lower cost. Meanwhile, in the US, licensure requirements limit the ability of less-trained people to practice medicine unsupervised.
…local conditions play a central role in determining the structure of a nation’s healthcare system. While international comparisons are frequently made on nations’ cost, quality, and level of access to healthcare, it is often not possible for healthcare systems to be transplanted from one nation to another. Healthcare systems are a product of the nations that build them, and their design must accommodate the national objectives, government structure, and economic conditions of the nation in which they exist.
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