Counting 40 years： the number of medical and health institutions has increased from 170,000 to 987,000.
Coordinator: Zang Chunlei, Lu Zhongzheng
Cartography: Shen Yiling
Core reading
Health is the eternal pursuit of human beings. "Without the health of the whole people, there will be no overall well-off." Since the reform and opening up, China’s health and wellness undertakings have been accelerated, the medical and health service system has been continuously improved, the level of equalization of basic public health services has been steadily improved, and the overall strength of public health has reached a big step. The health level of Chinese residents has been continuously improved, and the main health indicators of residents are generally better than the average level of middle-and high-income countries.
76.7 years old
average life expectancy
The medical and health service system has been continuously improved, and medical and health resources have increased rapidly.
Internationally, the main indicators to measure the health level of a country’s residents are life expectancy per capita, infant mortality and maternal mortality.
China’s average life expectancy is constantly improving. He was 67.9 years old in 1981, 71.4 years old in 2000 and 76.7 years old in 2017. The infant mortality rate and maternal mortality rate decreased continuously, from 32.9&permil in 1990; And 88.9/100,000, down to 6.8&permil in 2017; And 19.6/100,000.
In 2014, China achieved the related indicators of maternal and child health in the United Nations Millennium Development Goals ahead of schedule. The Report on Success Factors of Maternal and Child Health published by the World Health Organization lists China as one of the 10 countries with high performance in maternal and child health, and promotes China’s experience to the world.
In May this year, the World Health Organization released World Health Statistics 2018 in Geneva. According to the data of 2016, China’s healthy life expectancy at birth surpassed that of the United States for the first time, with 68.7 years in China, higher than that of the United States. The global healthy life expectancy of infants at birth is 63.3 years.
Over the past 40 years, China’s medical and health service system has been continuously improved, medical and health resources have increased rapidly, and people’s access to services has improved significantly.
In terms of the number of medical staff, by the end of 2017, there were 3.39 million licensed (assistant) doctors and more than 3.8 million registered nurses in China, and the number of nurses per 1,000 population increased to 2.74, and the doctor-nurse ratio increased to 1∶1.1, which reversed the situation of the inverted doctor-nurse ratio.
Judging from the number of medical and health institutions, in 1978, the total number of medical and health institutions in China was 170,000; In 1990, it was 209,000; In 2000, it was 325,000; In 2017, it reached 987,000.
It is worth mentioning that private hospitals have developed rapidly. In 2017, there were 12,297 public hospitals in China, with 2.95 billion person-times, accounting for 85.8% of the total number of hospital visits; There are 18,759 private hospitals, with 490 million medical treatments, accounting for 14.2% of the total number of hospital treatments. By the end of 2017, among hospitals, public hospital beds accounted for 75.7% and private hospital beds accounted for 24.3%.
No.48
Global ranking of medical quality rises.
China has produced a number of superior medical technologies that have reached the international advanced level.
Not long ago, in the Reproductive Medicine Center of Peking University Third Hospital, medical staff celebrated the 30th birthday of Zheng Mengzhu, the first test-tube baby in mainland China. More than 30 years ago, Zheng Mengzhu was a cluster of tiny cells. Under the microscope, she first "met" Zhang Lizhu, a professor at the Third Hospital of Beijing Medical University. Today, she has become an employee of the Reproductive Center of the Third Hospital of Beijing Medical University.
2018 is 40 years since the birth of the first test-tube baby in the world and 30 years since the birth of the first test-tube baby in mainland China. The medical quality and technical level in China have been significantly improved. At present, the clinical pregnancy rate of assisted reproductive technology in China is about 40%, and the delivery rate of live infants is 30%— 35%, nearly 300 hospitals across the country can carry out assisted reproductive technology, and the number of test-tube babies exceeds 200,000 times every year. China has become the world’s largest country in assisted reproductive technology treatment, and assisted reproductive technology has reached the world’s advanced level, reaching the world’s leading level in some fields.
In 2017, The Lancet, a world-renowned medical magazine, ranked 195 countries and regions in terms of medical quality and accessibility. The results showed that during the 25 years from 1990 to 2015, China was one of the countries with the greatest progress in medical quality, and the ranking of medical quality and accessibility index increased from 110th to 60th, ranking third in the world. The gap in the quality of medical services between regions in China has narrowed from 6.7 in 1990 to 1.2 in 2015, far below the global gap of 20.1.
In 2018, The Lancet released the global ranking of medical quality and accessibility again. China’s ranking of medical quality and accessibility has increased from 60th in the world in 2015 to 48th in 2016, making great progress again.
At present, China has produced a number of superior medical technologies that have reached or led the international advanced level and have a demonstration and driving role in the world, which has promoted the improvement of the ability to diagnose and treat major diseases. For example, the ventricular assist device independently developed by Fuwai Hospital of China Academy of Medical Sciences fills the technical gap in the field of ventricular assist research and development in China; The related research results of Renji Hospital of Shanghai Jiaotong University on gastrointestinal vascular diseases became the only basis for the relevant guidelines of the American Gastroenterology Association in 2015. In 2017, China completed more than 16,000 organ transplant operations, accounting for 12.3% of the total organ transplant in the world in 2017, ranking second in the world. Quality indicators such as the survival rate of transplant recipients are also among the highest in the world. Taking heart transplantation as an example, the survival rates of patients at 1 year, 3 years and 5 years after operation can reach 93%, 90% and 85% in some hospitals respectively, which are higher than the world average of 85%, 79% and 73%.
Over 1.3 billion
Number of participants in the three basic medical insurance systems
Investment in health care continued to grow, and serious illness insurance for urban and rural residents was fully promoted.
"I didn’t expect to get such a big illness, and I spent less than 10,000 yuan." Wang Nengbao is a poor household in Dawan Village, Huashi Township, Jinzhai County, Anhui Province. Gastric cancer was detected in October 2017. He went to the First Affiliated Hospital of Anhui Medical University for surgery, and was hospitalized for 9 times. The medical expenses totaled 97,000 yuan, and the individual paid only 9,300 yuan.
Medical reform is a worldwide problem. As the largest developing country in the world, China faces more challenges than developed countries.
In April, 2009, the Central Committee of the Communist Party of China the State Council issued the Opinions on Deepening the Reform of Medical and Health System, which marked the official launch of a new round of medical reform. In 2016, the World Health Organization, the World Bank and other institutions believed that China had made rapid progress in achieving universal health coverage, the accessibility of basic medical and health services was more balanced, and the reform achievements attracted worldwide attention.
Over the past 40 years, the proportion of medical and health expenditure in China has gradually increased. The proportion of medical and health expenditure in GDP was 3% in 1978, 3.2% in 1988, 4.3% in 1998, 4.5% in 2008 and 6.2% in 2017. With the continuous growth of government and society’s investment in medical and health care, the structure of China’s total health expenditure has been continuously optimized. Since 2001, the proportion of personal health expenditure in total health expenditure has been declining, from 60.0% in 2001 to 28.8% in 2017.
In 1998, China began to establish basic medical insurance for urban workers. In 2003, a new rural cooperative medical system was established. In 2007, the basic medical insurance system for urban residents was established.
The financing and security level of basic medical insurance for urban and rural residents has been greatly improved. In 2003, the per capita financing level of the new rural cooperative medical system was only in 30 yuan. In 2016, China integrated the medical insurance for urban residents with the new rural cooperative medical system. The per capita financial subsidy standard for basic medical insurance for urban and rural residents was 420 yuan, and it was raised to 450 yuan in 2017. At the end of 2003, the population participating in the new rural cooperative medical system was 80 million; In 2008, the new rural cooperative medical system achieved full coverage, and the coverage rate of three basic medical insurance systems, namely, basic medical insurance for urban workers, basic medical insurance for urban residents and new rural cooperative medical system, was 87%. In 2017, China has woven the world’s largest universal basic medical security network, with more than 1.3 billion people participating in the three basic medical insurance systems, and the participation rate is stable at over 95%.
In 2004, China established a national network direct reporting system for infectious diseases and public health emergencies, and the average reporting time of information was shortened from 5 days to 4 hours. At present, the infectious disease information reporting system covers nearly 71,000 medical institutions and has more than 160,000 users. A national, provincial, municipal and county-level laboratory testing network has been established, and laboratories such as influenza, polio, measles and Japanese encephalitis of China CDC have become reference laboratories of the World Health Organization. At present, China has the ability to detect more than 300 pathogens within 72 hours.
5.81 million
Poverty-stricken households returning to poverty due to illness realize poverty alleviation.
Health poverty alleviation "roots out the disease", and comprehensively implement the three-year attack on health poverty alleviation.
Echinococcosis is a parasitic disease with high incidence in western pastoral areas, and it is also one of the diseases with the heaviest economic burden for farmers and herdsmen. In Gemeng Township, shiqu county, Ganzi Tibetan Autonomous Prefecture, Sichuan Province, the Nize family of three had suffered from echinococcosis. Two years ago, his daughter was transferred to the state people’s hospital for free surgery, and he and his wife also received free medication. The whole family did not spend a penny on treatment. Now, their health has improved, and Nize can work in the fields again.
In order to make the poor people "see the disease, see the disease, and see the disease well", on the basis of approving the poverty caused by illness and returning to poverty due to illness in rural areas, China has made precise policies and classified treatments in accordance with the principles of centralized treatment of a batch of serious diseases, contract service management of a batch of chronic diseases, and protection of a batch of serious diseases, effectively reducing the number of people who are poor due to illness and returning to poverty due to illness, and making progress in health poverty alleviation. At present, 5.81 million poverty-stricken households in China have been lifted out of poverty due to illness, and the progress is basically synchronized with the overall progress of poverty-stricken households in the country.
In 2012, China began to pilot the serious illness insurance system for urban and rural residents. By the end of 2016, the serious illness insurance for urban and rural residents was fully promoted to achieve full coverage. At present, it has covered 1.05 billion urban and rural residents’ basic medical insurance participants.
Since 2016, China has implemented a tilted medical security policy for the poor, and the deductible line of the new rural cooperative medical insurance for serious illness has been reduced by 50%, and the proportion of reimbursement for hospitalization expenses within the policy has increased by more than 5 percentage points; Special medical security measures were taken for the poor. In 2017, the average out-of-pocket proportion of medical expenses for the poor nationwide was 16%, down by 27 percentage points from 2016.
For seriously ill patients, nine kinds of serious diseases, such as congenital heart disease and leukemia in children, have been selected as the first batch of special treatments for treating diseases, and 189,000 people have been treated so far; For patients with chronic diseases, priority has been given to the implementation of family doctor contract services to provide standardized management and health services for key chronic diseases such as hypertension and diabetes; For seriously ill patients, implement the government’s bottom-up safeguard measures. By the end of 2017, 8.04 million of the 8.49 million poor people who had been verified to be in need of treatment had been admitted to hospital or enjoyed contract services, covering nearly 95% of patients with serious diseases and chronic diseases.
In July this year, the National Health and Wellness Commission and the the State Council Poverty Alleviation Office announced that in the next three years, they will take unconventional measures to comprehensively implement the three-year attack on poverty alleviation through health, and resolutely do not let health problems become a "roadblock" for people to get rich and run a well-off life. China will focus on deep poverty-stricken areas and weak links in health care services, increase policy supply and input support, innovate systems and transformation mechanisms, combine prevention and control, and move forward the barriers to ensure that poor people enjoy basic medical and health services and prevent poverty due to illness and return to poverty due to illness.