'Ticking Time Bombs': China's health care system faces issues of access, quality and cost

WHARTON health care management professor Lawton R. Burns recently returned from Beijing, where he and Gordon G. Liu, professor of economics at Peking University's Guanghua School of Management, co-taught a four-day course on China's health care system. The course, attended by 20 Wharton students and 20 Peking University students, looked at such topics as quality and availability of care, the disparity between rural and urban health care, corruption in the delivery system, medical training and the needs of a growing elderly population.

Underlying some of China's most basic health care challenges is the "wide but shallow distribution of health insurance," says Burns. Recent reforms have extended health care to 95% of the population -- most of whom have never had insurance before -- a development that has caused serious strains on the delivery system. Now that consumers have access, "everyone wants to go to the major academic health centers, which means there are enormous lines starting early in the morning to get in and see a specialist," says Burns, who toured several health care facilities during his teaching week. Not everyone gets through the line, however, and people who do get in don't always get the results they want.

"People expect good care now, and when they don't receive it, they sometimes blame the doctors," notes Burns, adding that there have been cases of medical personnel physically attacked by dissatisfied patients.

For the Chinese government, the issue is cost: How do you fund health care for a new group of insured people, in both rural and urban areas, who had until recently been lacking coverage for even the most basic health care needs? "There is always a trade-off between increasing access to health care, and funding that access. It has to do with the 'Iron Triangle,'" says Burns, referring to a phrase that describes the three main cornerstones of health care: access, cost and quality. The difficulty comes when regulators try to improve all three, or even two, at once. "If you increase access, you increase cost. So how do you balance the two," especially when the expectations of newly insured consumers are rising so quickly?

More money, more prestige

The problem of access to quality care is especially acute in rural areas of China. "Physicians find big disparities in terms of income, status and access to technology in the countryside versus the city," says Burns, noting thatAdidas Nite Jogger