Thursday, August 12, 2010

One Compelling Example of Health Care Reform

Good NY Times article on some of the problems with China's hospitals.  I've done some academic reading on the subject as well, one thing I found remarkable is how quickly China developed some problems with its health care system that are very like some problems facing the US but that aren't faced by countries that have universal health care.  There are a lot of very obvious reasons why China isn't a good choice for comparison, even in a single sector, but the independent development of problems such as over-treatment and over-investment of capital intensive medical goods adds to my belief that there are systemic issues that prevent any non-universal health care system from operating efficiently.  Of course, I don't believe outcomes nearly as bad as China's are possible under any institutional reform imaginable in the US but the case does present a warning.  I'll quote the most relevant passages below, I'd encourage you to read the full article.

Doctors and nurses say the strains in the relations between them and patients’ relatives are often the result of unrealistic expectations by poor families who, having traveled far and exhausted their savings on care, expect medical miracles.
But the violence also reflects much wider discontent with China’s public health care system. Although the government, under Communist leadership, once offered rudimentary health care at nominal prices, it pulled back in the 1990s, leaving hospitals largely to fend for themselves in the new market economy.
By 2000, the World Health Organization ranked China’s health system as one of the world’s most inequitable, 188th among 191 nations. Nearly two of every five sick people went untreated. Only one in 10 had health insurance.
The article also relates some fairly dramatic results once the state realized just how bad outcomes were and decided to intervene again.  There's still a very long way to go for China before their system is comparable in quality to ours but its worth questioning if some of the mechanisms that led to problems in China would be present here if we tried to privatize even more of the system.


  1. Well, we kind of ducked that bullet, didn't we? This might be an unfair stereotype but it often feels like the Chinese government sees people as raw commodities.

  2. Doug,

    I tend to agree about the Chinese governing party. It's probably a flaw in the Marxist worldview, if only you manage capital just so everything else will fall into place. People get lost in this kind of thinking.

    We did kind of duck a bullet, we're well past the point where this kind of rapid privatization is an option. I think it's unfortunate the Chinese case was never brought up during the health care debates but the case is probably far too nuanced and complex to be used in national debate. It does make me question if some people that claim to know about the subject actually have enough grounding in a sufficient number and variety of real world cases to have the faintest clue about how to apply their theories to reality.