As complaints about the American fitnesscare formula increase due to its high level of capita costs, poor population fitness outcomes (life expectancy, infant mortality, etc. ), and its limited access, the comparison of our formula with those of other evolved countries has become increasingly common. become more and more frequent.
Many attempts have been made in recent years to rank countries’ fitness systems, but the most notable findings are that those rankings don’t agree even on the most important measures, let alone which countries have the most productive systems. . physical fitness.
To the extent that there is agreement on preferable national fitness systems, many ratings point to systems located in countries much smaller and with more homogeneous populations than the United States (which only ranks among the 10 most sensible of any country). primary assessments and stands out basically for its height of complexity and burden and, on the positive side, for its demonstrated capacity to innovate).
For example, Ezekiel Emanuel’s very clever e-book from 2020 (before the pandemic), Which Country Has the Best Healthcare in the World, concluded that the 4 systems are those of Germany, the Netherlands, Norway, and Taiwan.
This made me wonder how the American formula compares to those of countries as giant and heterogeneous as our nation. It made me think of China because it more than fits that description and because those two countries are the main political and economic powers in the world.
Additionally, the last company I ran as CEO, FastMed, had a joint venture spouse who opened clinics in China in the early style of the urgent care format we had in the United States. So I had the opportunity to learn more about care. medical in China through direct information from our spouse, as well as other reliable sources.
I’ll return to “FastMed China’s” experience shortly, but first, here is a brief overview of the Chinese healthcare system as I have come to understand it.
It is important to acknowledge at the outset that the challenge of providing healthcare to a country with a population of 1.4 billion is nothing short of monumental. To meet this challenge, China’s healthcare system has evolved significantly over the past 50 years to the point that roughly 95 percent of the population is covered by government-sponsored health insurance in a form generally referred to as single-payer (vs. roughly 92 percent of U.S. citizens currently covered by private and public health insurance).
With that said, there are significant gaps in access to care in China, particularly in its rural / inland areas that are home to roughly 40 percent of the country’s population. These gaps mainly result from the fact that China’s provinces have significant latitude in determining the scope of coverage, reimbursement rates, and patient obligations, and coverage gaps are rarely closed by private insurance, which is supported by less than five percent of the population. In addition, most of the best doctors and care are provided in hospitals located in the urban / coastal regions.
However, vaccines are now flexible for young people, and vaccination rates have reportedly exceeded 95% for all citizens since 2016.
There are also notable gaps in policy coverage through Chinese public fitness insurance, adding to the lack of policies for dental and vision care, intellectual fitness situations (which are highly stigmatized), and long-term care.
Long-term care is also not covered by public insurance in China. While they are also not covered in the US and many other developed countries, the lack of a policy for long-term care is especially problematic in China, as its traditional “one-child” policy has left the country with an aging population and not enough children for themselves. Fund the physical care formula or offer seniors the type of family-centered home care that was typical in the past.
The good news here is that older Chinese citizens sometimes appear fitter than similar cohorts in the United States. This is at least partly due to the fact (I think) that older Chinese citizens were not as exposed to ultra-processed foods. which caused this sharp increase. chronic disease in the United States and many other evolved countries. However, it turns out that the fitness of middle-aged Chinese citizens is negatively affected, as the arrival of Western food materials and the adoption of His eating behavior has been delayed yet not deterred.
One of the most obvious characteristics of China’s care delivery infrastructure is that it is extremely hospital-centric, with the vast majority of evidence-based care provided in hospitals (which are designated in three levels, with “Tier 3” hospitals being the most prestigious), and comparatively few primary and other ambulatory care sites (such as FastMed urgent care clinics). One of the effects of this is that access to quality care is restricted and thus long wait times for it are the norm.
In addition, since providing routine care in hospitals is generally more expensive than in ambulatory care settings, China does not have a particularly efficient delivery system (though China spends approximately 6 percent of its GDP on healthcare, compared to roughly 18 percent in the U.S., with now comparable rates of life expectancy and infant mortality).
This alone strains government budgets, but has also resulted in the need for Chinese citizens to supplement the “single payer” formula with significant out-of-pocket expenses (reportedly 30 percent or more of the cost of healthcare) to through maximum deductibles, co-payments and coinsurance, as well as policy limits beyond which patients must pay all charges.
Another notable feature is that the formula is riddled with corruption; It appears that recent government crackdowns have reduced the incidence. Most doctors are poorly paid (with a base salary of around $30,000 a year) and it is not unusual for Chinese providers to supplement their source of income by accepting bribes from patients to gain access to them and from pharmaceutical corporations to prescribe certain medications. medications.
The result of this endemic corruption is that there is significant distrust of doctors and violence against them is not uncommon. Distrust in providers is exacerbated by distrust in the fitness care formula in general, due to the government’s high-profile determination to gather fitness knowledge. on all of its citizens, which can outweigh much of the population fitness benefits that analysis of such a gigantic body of knowledge allows.
In addition, classical Chinese medicine (“TCM”) is still prescribed, specifically at the village level, and reports from the World Health Organization state that this occurs in 30-50% of all cases. Although the efficacy of these remedies (adding acupuncture, herbal remedies, and cupping) is subsidized in some cases through thousands of years of experience, very few of them have undergone the kind of clinical rigor and large-scale clinical trials that are necessary. Prescription drugs and other forms of remedy in the United States.
At the same time, overprescription of drugs is not unusual in China, and the Chinese pharmaceutical market is currently the largest in the world. However, they are still far behind the United States, which accounts for about forty-five percent of global pharmaceutical spending. with only four% of its population.
In fairness, it appears that China’s National Health Commission (a government department that was formed to shift responsibility for healthcare from the CCP) is making a concerted effort to understand and address the system’s shortcomings by, for example, beginning to encourage more physicians to practice in outpatient and ambulatory care settings.
However, the existing formula is constrained by significant structural, cultural and behavioural disruptions that obstruct innovation, and the government says it is open to privatisation to stimulate innovation and investment; Until very recently, his policies have been ambivalent in this regard.
When I became CEO of FastMed in 2017, I was intrigued to see that the company had recently signed a joint venture with a company based in Austin, Texas, to open and operate urgent care clinics in China modeled after FastMed’s clinics in the U. S. U. S.
Although I thought the idea had merit given my knowledge of China’s style of hospital care and the resulting long wait times for medical care, I became concerned about the potential diversion of resources from our number one goal of developing FastMed nationally.
However, I am pleased to learn that the spouse of the joint venture (Pacific Springboard) was led by an old friend, former colleague, and entrepreneur named Frank Krasovec, who had a great and successful experience doing business in China.
I was also encouraged that the company’s leadership team included a very able former FastMed operations executive named Cindy Stefanko, who I had contacted early on in my tenure for background on FastMed’s aggressive expansion in Texas. Because of the resulting faith in our partner, we elected to continue supporting the JV, though under new terms in which FastMed would convey many aspects of its operating model in return for equity but would not invest financially.
Now, nearly eight years later, I recently caught up with the CEO of Family First Medical, Dr. Neil Smith, who reported that they had changed their clinics’ name in 2024 from FastMed to avoid stigma related to an American brand, and that they now operate four clinics in Shanghai and Guangzhou, with two more clinics opening in 2025.
While this is wonderful news, it raises the apparent question of why it took so long. The reaction says a lot about the situations that demand innovation in China, as well as about the government’s preference to evolve its formula to achieve the 4 pillars of a “Healthy China 2030”: equity and results; Transformation of health formulas; Technology and Innovation; and environmental sustainability.
As for Family First Medical, Smith reports that early and repeated delays in opening FastMed clinics were similar to the difficulty in obtaining government licenses and the requirement that all clinics operated through foreign entities must have a Chinese partner.
Behind those obstacles was the government’s concern that foreign entities would divert doctors and other fitness personnel (which was already in short supply) from the public fitness formula and thus exacerbate its well-known access and quality disorders. Although the requirement of a domestic spouse still made it possible to discharge licenses, the leverage it gave to Chinese spouses made it more difficult for foreign entities to succeed financially.
However, Smith says authorities, sensing a desire to expand non-hospital primary care provision, have recently removed the requirement for a Chinese spouse and are now actively encouraging companies that operate outpatient clinics like Family First Medical to open them. by granting licenses. in just two months.
He reports that patient volumes are generally strong, though Chinese citizens have yet to completely overcome their longstanding bias towards hospital-based care, and that most of their patients must pay cash because public insurance reimbursements are too low for ambulatory care providers to depend upon. However, Smith also states that while in the early years, 60 percent of their patients were foreign visitors and ex-pats, today 90 percent are Chinese citizens.
Most of this progress appears to be progress, and it’s a credit to Chinese government regulators who have identified the need for more outpatient care and FastMed China investors who have stayed the course long enough to start making a return. of the investment. .
So, is China’s health formula different from ours?
By some common outcome measures, it is comparable, although significantly cheaper on a capita basis. On the other hand, it suffers from challenges (common in many single-payer systems), quality challenges, high costs, and consistent and persistent disparities between the care presented to citizens living in rural spaces and those living in rural spaces. urban ones (which is also a developing challenge in the United States).
Perhaps the most remarkable thing about the Chinese formula is the progress that has been made. When Mao and the Communist Party came into force in 1949, life expectancy was 35 to 40 years. Today, its maximum has doubled to 77 years, which is comparable to life expectancy in the United States.
In addition, there are signs that the Chinese healthcare system is continuing to evolve in ways that will improve the health of its massive population in the years ahead.
I think our formula is theirs today, but I bet China will close the gap in the future, as China demonstrates in fitness care, as it has in many other areas, that it has the capacity, the resources and the determination. to continually improve.
China and the United States, however, present not unusual problems, such as aging populations affected by chronic diseases, as well as significantly demanding situations when it comes to financing expensive new remedies and long-term care.
In this regard, our two countries are in the same boat and our respective leaders will have to adapt to meet the growing desires for physical attention and the growing expectations of their citizens.