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1、Comparison of health care system between Britain and in ChinaThesis: The health care system is benefiting the British citizens and burdening the British government while health care system in China is burdening patients and profiting hospitals.Outline:A. Brief introduction to health care system both
2、 in Britain and ChinaB. Health care system in Britain a) Public health care system: National Health Servicesfree and extensive, includes1. Family health services2. Services provided by midwives, health visitors and district nurses3. Hospital and specialist services4. Personal social services offered
3、 by voluntary sectorb) Private health care system: Private Medical Insurancefaster and better, covering1. Curable, short-term illness2. Injury excluding GP services, chronic conditions, or conditions that individual had prior to taking out the insurancec) Characteristic of the system and the problem
4、: Well-developed and comprehensive, but weightyC. Health care system in Chinaunder reform and unbalanced a) Basic medical-care system in urban, covers:1. Clinical treatment2. Emergency treatment excluding treatment for accident injury3. Drug fee at the appointed pharmacy4. Part of the fee-for-servic
5、e in hospitalb) Cooperative medical care system in rural, covers: basic medical expensesc) Private medical insurancee) Characteristic of the system and the problem: Developing and under continuous reform, but unbalancedD. Two factors lead to the main differences in the health care systems of the two
6、 countries:a). finance: public vs. privateb). management: government vs. hospitalE. Conclusion: government shall establish suitable pattern of funding and introduce efficient mechanism to better the health care system.Comparison of Health Care System between Britain and China“Poor healthy people are
7、 better than the wealthy.” This Chinese old saying becomes popular in recent years in China. Maybe in some peoples understandings, this saying tells us the importance of healthy, however, in Chinese social context, it is implying the extremely costliness for seeing a doctor. Chinese people are suffe
8、ring from increasing expenditure on medical care and hospital are profiting highly by charging patients very high price. Thus many people envy the National Health Service in Britain under which everybody enjoy a series of free medical services provided by the government. Nevertheless, British govern
9、ment is facing a problem similar to the difficulty Chinese people encountering. Tremendous expenditure on the National Health Service becomes a burden on the government. The general situation is that in Britain the health care system is benefiting the citizens and burdening the government while in C
10、hina the health care system burdening the patients and profiting hospitals. To show how and why this conclusion is drawn, more details will be discussed in the following parts.First of all, in order to know about how different the two systems provide for the medical needs of their citizens, introduc
11、tions to both systems will be made respectively here. In Britain, the health care system is better known as the NHS (National Health Service). TheNationalHealthService Act of 1946 established this socialized health-care system that went into effect in 1948 and provides a whole range of free medical
12、services for all British citizens regardless of income. 1Such services include family health services, community services provided by midwives, health visitors and district nurses, also hospital and specialist services, as well as personal social services offered by voluntary sector. In specific, fa
13、mily services are given to patients by the General Practitioners, dentists, opticians and pharmacists. They remain the first point of contact that most people have with the NHS. Midwives provide care and support to women throughout pregnancy, birth and the postnatal period. Health visitors are respo
14、nsible for the preventive care and health promotion of family, especially with young children. District nurses give cares to people in need at home or elsewhere outside hospital. Midwives, health visitors and district nurses are all working closely with GPs. As for hospital services, clinical specia
15、lties supported by other services such as anesthetics, pathology and radiology are offered in district general hospitals and some hospitals provide services covering more than one regional district. For specialist services, they are given in specialist hospitals like Hospital for Sick Children and N
16、ational Hospital for Neurology and Neurosurgery. Specialist treatment with the training of medical students and international research are combined in these hospitals. The last but not least, is the personal social services provided by voluntary organizations dealing with children, elderly, people o
17、f ethnic minorities as well as people with mental illness, disability or suffering from HIV/AIDS or the misuse of alcohol or drug. Apart from public health-care, there is also private medical treatment in private hospital or NHS hospital pay-beds covered by health insurance schemes. The Private Medi
18、cal Insurance is a supplementary scheme subscribed primarily by individuals to guarantee faster access to health care, particularly the specialist and in some cases to guarantee better health care facilities. PMI covers curable, short-term illness or injury excluding GP services, chronic conditions
19、or conditions that individual had prior to taking out the insurance. By the end of 2000, 6.88 million British people, approximately 11.5 percent of the population, were covered by PMI. . We can see from the above that British health-care system is characterized by the combination of public and priva
20、te provision, which is mainly based on the mixed economy. This mixed structure of the health-care system provides British people for their needs of medical care. On one hand, although some charges were introduced for prescriptions, dentures, and eyeglasses because of the recent changed policy of the
21、 British government, the public medical services mentioned above come free of charge, which means peoples health is secured on the whole. On the other hand, for those who can afford the private health-care, it can offer them more efficient or maybe better services and also help easing the burden on
22、the NHS. Therefore this mature heath care system is benefiting the British people and many of them oppose changes of it. However this system is based on the large sum of money funding by the government mainly through general taxation, so one major problem is that the increasing cost of the medical s
23、ervices becomes a burden to the British government. Compared with the well-developed health care system in Britain and the comprehensive services it provides, Chinas health care system is still under constant reform and the medical services are of high price and unfairly distributed. In the past, li
24、ke British people, Chinese people also enjoyed free medical treatment at public expenses. However with the further deepening of the reform of economy system, health care system needed to change with the economic reform. During recent years, Chinese government has been introducing reforms of the heal
25、th care system. As situations in urban and rural areas are different, two main medical schemes are established accordingly.In urban area, a basic medical-care system was introduced in late 1990s. Employees and work units are compelled to contribute a sum according to personal salaries and the total
26、salaries paid by employers. The money contributed by employees and 50% of that paid by employers goes to personal account for each employee for their general medical expenses, which includes clinical treatment, emergency treatment excluding treatment for accident injury, drug fee at the appointed ph
27、armacy, part of the fee-for-service in hospital. The other 50% forms the general medical fund to cover most of the cost of treatment for serious illness. But compared with the scaring medical cost, the coverage of this system is still not enough.In rural area, the government has introduced a new co-
28、operative medical scheme (NCMS). Residents and local and central governments share the basic medical cost. However, one major problem is that the current level of insurance coverage is so small that farmers will still end up paying the bulk of their health care costs out of their pockets. Also the s
29、cope of its coverage is very limited. In October 2005, China Daily reported on a co-operative scheme in one county dedicated to providing catastrophic care as a supplement to NCMS. This is encouraging news, but in most rural areas a more extensive medical insurance scheme has yet to be introduced. B
30、esides the above two major yet not so successful, there is also private medical insurance for people not covered in those two systems, such as those working in private or joint venture business, or students (university students are different because they still enjoy free medical care supported by th
31、e state.). However, the private medical insurance is not as well-developed as that in Britain; consequently there is still reluctance to join the private insurance. Although the change of the old health care system is a way to adapting to a rapidly changing world, and the process of reform in the sy
32、stem seems to be continue, as a matter of fact, even the state officials admit that the current reform of the health care system is unsuccessful. As we have mentioned above, firstly the services offered in the health care system are limited; secondly the system is unbalanced, which is mirrored in on
33、e aspect by the high price of medical treatment contradicting with small amount of money contribute to the health care system. This unbalance mainly results in the heavy burden of medical expenditure upon the citizens, especially on the farmers with low-income in the rural areas. From the table belo
34、w, we can see that, the average total income per hospital has increased by about 60% in four years. Total medical expenses per outpatient and inpatient also increased dramatically. It shows that after reforms, people have to pay even more medical fee. After analyzing the main difference in the healt
35、h care systems between Britain and China, lets see what the main factors that lead to the differences are. The two main factors are finance and management. In Britain, health service is mainly paid for through general taxation (82%), the NHS element of National Insurance contributions (12.1%), charg
36、es to the cost of certain items (2.3%), funs from voluntary sources and revenue by taking private patients. The following chart can show us more clearly how the expenditure on health makes up in Britain and China.In Britain: General Government expenditureon health as % of total expenditureon health,
37、 200285% 85%Private expenditure onhealth as % of total expenditure on health, 200215%In ChinaPrivate expenditure on health as % of total expenditure on health, 200266.3 General Government expenditure on health as % of total expenditure on health, 200233.7 %Public Health Expenditure (PHE) is the sum
38、of outlays on health paid for by taxes, social security contributions and external resources (without double-counting the government transfers to social security and extra-budgetary funds).Private Expenditure on Health (PvtHE) comprises the outlays of insurers and third-party payers other than socia
39、l security, mandated employer health services and other enterprise provided health services, non-profit institutions and non-governmental organizations financed health care, private investments in medical care facilities and household out-of-pocket spending.(Definition by the World Health Organizati
40、on)Obviously, the percentage of the private expenditure on health of total expenditure on health in China is much higher than that in Britain that is 66.3% in China comparing with 15% in Britain. The public expenditure on health as percentage of total expenditure on health is 33.7% in China compared
41、 with 85% in Britain. That means the Chinese people paying their medical care through contribution to the health insurance schemes and private spending while British government paying for most citizens medical services. That is why at the beginning we are saying that the health care system in Britai
42、n is burdening the government while that in China is burdening the people.As for the management of the health care system, British government established the three-tire administration system including community health care system, district hospital and comprehensive hospital covering all specialists
43、 and more than one district, which provides the citizens extensive and good services. The health care institutions were owned and administered by the government. As this system put too much pressure on the governments finance, in recent decades, market mechanism is introduced in the reforms. Governm
44、ent transfers the right of management to the special management company or the fund organizations so that competition is brought into the system, and then medical expenditure and cost of management are reduced. By contrast, management of the health care system in China reflects the lack of quality c
45、ontrol mechanisms and the perverse incentives hospitals face. The government finances the basic costs of health facilities to the public, and allows public health agencies to raise additional revenues from patients. In efforts to keep basic care affordable, the government sets the price of basic car
46、e below cost, and allows hospitals to earn profits on drugs and high-technology care. The result is that hospitals end up creating demand for high-margin care. After comparing the funding, management of the health care systems and provisions offered to the medical needs of the citizens in two countr
47、ies, we can see the gap between the two countries. What pattern of funding shall be established? What is the mechanism that needed to be created? Maybe these are two very important questions should be seriously considered when China is carrying out reforms of the health care system. Reference:1. Mic
48、rosoft Encarta 20062. “health care in Britain” (From “Britain 1997” Central Office of Information, London) Communicative English for Chinese Learner, Book,Page6423. Contemporary British Culture and Society (revised edition) Chapter 11 Welfare4. “National Health Service” Economist Dec. 8th 2005 editi
49、on5. “Market forces have left patients hurting” Economist Nov 17th 2005 edition6. “Where are the patients?” Economist Aug 19th 2004 edition7. “Why Britains Conservatives Support a Socialist Health Care System” pdf www.healthaffairs.org8. “Reform health finance” China Daily 11/26/2005 page49. “Nations health ca
