Author: Medical Tourism Magazine
Nailing down the PERFECT healthcare system is a challenge every country faces; perfect may never be possible, but hopefully a system that works for the majority of people will be in the near future, on a global basis. With a booming 1.3 billion population China has modernized education and housing for all of those people, unfortunately healthcare hasn’t been able to keep pace with those developments. There have always been issues with quality and availability of healthcare, now due to China growing richer and becoming more and more modern the population are coming in contact with more diseases and heading towards a system that can’t currently support it. 
In the United States people decide whether to go to a hospital, minute clinic, specialist or general practitioner based on insurance and severity of illness. In China, the average person would go to a hospital for any condition; most services are centered at hospitals. China has 290,000 types of healthcare facilities, but hospitals are the main source for healthcare due to quality of care you could receive. Only 20,000 out of the 290,000 are classified as hospitals and are highly regulated. Most people don’t trust going anywhere else for serious illnesses.
Since the 1950’s the delivery of healthcare in China, has had a three-tier structure for rural and urban areas. The first-tier consisted of farmers who had a minimal amount of medical training; these were considered the primary care physicians. The second tier of care was commune health centers that were staffed by junior doctors. The communes were not equipped to handle large numbers of patients or serious illnesses. When serious illnesses would occur the second-tier would send them to the third-tier which was county hospitals, staffed with senior doctors. This system soon fell apart and healthcare became the responsibility of the local government. Not every region could afford adequate healthcare. The healthcare system has been revamped but still runs on the three-tier or Grade 1-3 structure.
Around five percent (1,200) of hospitals in China are Grade3; these have the best doctors, equipment and offer the best healthcare in China. Larger cities like Shanghai and Beijing host the majority of Grade 3 hospitals, smaller cities may have one or none at all. These hospitals have on average 500 or more beds, and they typically see anywhere from 3 to 4 thousand patients a day. Due to the high volume, it could take a whole day to be seen by a doctor, and a couple days after that before you are given a bed at the hospital if needed. Grade 3 hospitals are regulated by Ministers of Health (MOH) and must follow strict guidelines, which is why most people will only receive care from a Grade 3 facility.
Grade 1 and 2 facilities aren’t as high in traffic due to lack in quality of care, equipment and highly trained doctors. Grade 2 is the better option the doctors have more training and are regulated by MOH. Grade 1 is the bottom of the barrel for healthcare, and these are located all over China and are the most accessible. These facilities are barely utilized, people would rather travel miles and wait days to be seen by a qualified doctor. Grade 3 hospitals handled over 30% of healthcare in China in 2008, even though they only make-up five percent of hospitals in China.
IN THE NAME OF HEALTHCARE REFORM
Little to no health insurance has always been an issue in China, a lot of times it would rely on local governments or even out of pocket for the patients. While the issue has been improved gradually over the years, the process of a healthcare reform is still in place. The quality of care, system inefficiency and low health insurance coverage are problems in the process of being mended. In 2007 the total health expenditure was around $167 billion (U.S.), and the number has increased over the last few years.
Some medical practitioners in the U.S. use different forms of alternative medicine regularly and years ago China began using Western medicine along with Traditional medicine. In January 2011, HHS.gov announced that the U.S. and China will be working together to strengthen the contribution of U.S. companies to China’s healthcare reforms. The U.S.-China public private partnership on healthcare (PPPH) will focus on strengthening and enhancing cooperation in rural healthcare, personnel training, emergency response, medical information technology and management systems; through this they will also find ways to maintain and support the belief of traditional Chinese medicine. Though PPPH, the Chinese Ministry of Health will be consulted before any changes are made in order to stay within China’s health sector development priorities. There will be an office in Beijing with a full-time staff devoted to the functioning of this organization.
TRADITIONAL AND WESTERN MEDICINE
Healthcare in China is widely recognized as using Traditional Chinese Medicine (TCM), and rightfully so as it originated there, its first recorded history dates back to over 2,000 years ago. The more modern form of TCM that is taught in universities today was formed during the Revolution in 1911. Around this time China started to modernize and began incorporating Western medicine, which led to the government wanting to completely abolish the use of TCM. Due to the lack of Western practices and TCM being a less expensive form of healthcare it managed to keep its place in Chinas healthcare system. However, today it is practiced side by side with Western medicine.
“The main practice of healthcare in China today, is an integrated medical system that incorporates Western medicine with Traditional,” said Natasja Sproat registered Traditional Chinese Herbalist and Acupuncturist. “Many hospitals in China, like the one I trained in, in Shen Yang has a Western medical ward, an acupuncture ward with many styles of acupuncture used, and a gynecology and pediatrics ward that primarily uses herbal medicine, many doctors there are trained in both modern medicine and traditional,” she adds.
Each culture has different values and beliefs, for the Chinese how they practiced medicine was a major cultural difference compared to Western medicine. The Chinese perception is that humans are microcosms of the surrounding universe interconnected with nature and subject to its forces; therefore health and disease are dependent upon balancing the function.  The Chinese belief consists of key components for maintaining and balancing your health and each component is intertwined with one another. The Yin-yang theory consists of two opposing forces that complement each other and therefore shape the world and all living things. This theory is said to influence Qi, the life force that flows through the body and regulates a person’s spiritual, mental, emotional and physical health maintaining a balance is how one stays healthy. 
There are several forms of alternative medicine; the most common ones are acupuncture and Chinese herbal medicine.
- Acupuncture- is performed by placing thin needles on certain parts of the body in order to break up the blockages and allow the normal flow of Qi, it is said to restore, the balance, thus restoring health to the mind and body.
- Chinese herbal medicine- herbs are given in the form of capsules, powders, teas or tinctures that are derived from plants, minerals and animal products.
Both have been proven to work, but its overall effectiveness is questioned, especially when used in the United States. Much of the research that’s been conducted that proves effectiveness was done in China in the 70s, 80s and 90s and doesn’t meet the standard in the West. However, the World Health Organization has a list of around 72 symptoms, clinically proved that acupuncture can treat.
As for Herbalism, “the effectiveness stands alone when we see more and more herbs used and sometimes patented by pharmaceutical companies,” said Sproat. “I recently went to hospital in Melbourne, Australia with malaria that I caught in India and was treated with Artemisia (Qing Hao), it was this herb that cured me,” she said.
ON THE ROAD
On April 15-20, the China Medical Tourism Company and the Ciming Group invited Medical Tourism Association Founder and President Renee-Marie Stephano to inspect health centers catering to medical tourists in Beijing and Shanghai. The tour included visits to Shanghai’s Dongfang Hospital, as well as the State Administration of Traditional Chinese Medicine and Ciming Health Check Group offices in Beijing. Ms. Stephano received a traditional Chinese medicine health check-up during her Beijing visit.
“I was very impressed by the Chinese medical facilities, not only the quality but also the combination of traditional Chinese and Western treatments available,” Ms. Stephano said. “Traditional Chinese Medicine gives China a strategic position in the global market because it’s unique.” “If China’s private-sector health system develops sufficiently, China could become a key destination for medical tourism,” she added.
The major urban centers of Beijing, Shanghai and Guangzhou have already attracted growing numbers of medical tourists due to high technology, affordability and quality of service. Also to note is Hainan Island which is currently being marketed for its natural beauty as therapeutic for foreign patients receiving treatment there. Finally, a new city called Harbour City in Pudong Shanghai, is in the process of development with the aim of being the first green and healthy city surrounding the largest manmade lake in the world.
According to a recent report from Global Times, Shanghai is expected to attract 50,000 to 100,000 foreign patients in the next three years, each spending an average of $10,000 to $15,000 per trip. Through a Medical Tourism Products and Promotion Platform that is supported by five municipal bureaus, Shanghai intends to boost its marketing this year in the global marketplace. “We offer a platform between patients and Shanghai hospitals,” said Dr. Yang Jian, the founder and CEO of China Medical Tourism Company and the person who is spearheading the platform in Shanghai. “Hospitals only take charge of the surgery, and we are responsible for the pre-and after-sales service on this platform, including the whole itinerary planning,” he added.
On a recent trip to Shanghai, Renée-Marie Stephano, President and Editor-in-Chief of Medical Tourism Magazine, extended a workshop to the stakeholders in the region with the assistance of Dr. Yang Jian. “The natural tourism industry in Shanghai, combined with the new platform for medical tourism, the high quality of healthcare and the combination of eastern and western medicine will provide for strong growth of international clientele to the region,” said Ms. Stephano. “The challenge will be the identification of competitive procedures and the effectuation of a strategy to look first to the existing patient flow of the facilities,” she added.
Some of these specialties have been identified as gamma knife therapy, traditional Chinese medicine and stem cell technology. According to Dr. Yang, every year, more than 300 Argentineans come to Shanghai for gamma knife surgery, which is banned in some countries. “We conduct nearly 30 consultations every month, and 10 percent of them end up making the trip,” Dr. Yang said.
One of the biggest concerns of the growth of international patient platforms is the sheer fact that most of the hospitals are at high capacity. Although the public hospitals in China are required to use 90% of their resources for local patients, Dr. Yang estimates that most of these facilities are still not using all of the remaining 10% of their resources for international patients, therefore diluting the concern for over capacitation.
During the workshop, Ms. Stephano was asked many questions about the common concerns of liability, over capacitation, transparency and accreditation. However it was clear that the providers in Shanghai see the development of medical tourism as a good opportunity to justify more development, create more jobs, generate revenue, and improve medical services for local as well as international patients.
Through the assistance of the National Institute for Traditional Chinese Medicine, a workshop was held in Beijing to discuss the opportunities unique to the city. In China, we are seeing a growth in patient numbers who seek all types of different procedures ranging from Traditional Chinese Medicine (TCM) to Orthopedics. Beijing is an ultra-modern, world-class city that continues to boom after hosting the 2008 Olympics, and Shanghai is arguably the most dynamic city in the world. In the upcoming month, through the assistance of the National Institute for Traditional Chinese Medicine, the Medical Tourism will assess the possibility of developing a regional office in Beijing to better assist with its program development and education programs.
As for its healthcare, the main Beijing United Family Hospital is located in Beijing’s Lido area northeast of the city. Beijing United Family Hospital and Clinics (BJU), the flagship facility of China’s first and largest foreign-invested international healthcare group, United Family Healthcare (UFH), is one of China’s only two truly full-service international standard hospitals — the other is its sister, Shanghai United Family Hospital and Clinics (SHU). BJU has internationally recognized and certified doctors from 15 different countries and regions, including the U.S., U.K., Australia, Belgium, China, Malaysia, Hong Kong and Canada, and a fully English-speaking, 180-strong nursing staff treating patients from over 110 countries every month.
To date, Beijing United Family Hospital has been a medical destination for patients from areas in East Asia where premium medical care is unavailable, such as eastern Russia, Mongolia, Khazakhstan, Turkmenistan, Tajikistan, some South Asian countries and elsewhere in the region. Additionally, the majority of patients continue to come from Beijing’s expatriate community, representing over 110 different countries and living, working or studying in China for short or more permanent stays.
AN EYE INTO THE FUTURE
Dr. Yang Jian estimates that in 2012, China should have 200,000 medical tourists each year with an average expenditure of $10,000 per patient per visit, despite the fact that medical tourism seems almost non-existent in China. The founder and chief executive officer of China Medical Tourism and Shanghai Medical Tourism Products & Promotion Platform (SHMTPPP) knows that China has to deal with tough competitors such as India, Thailand, Singapore, South Korea, Malaysia, and the Philippines.
“Foreign patients are interested in coming to China, but they don’t know who to get in touch with as there are no readily available numbers or names to contact,” said Dr. Yang. Another problem is bringing the stakeholders together to generate one voice and one vision for the region because each group has different interests. “At the beginning, we asked ourselves how to bring all parties – hospitals, travel agents, airlines, trade offices, and even translators – onto the same page as us,” explained Dr. Yang.
And thus, SHMTPPP was born. The marketing group set up offices in Los Angeles (LA) and Jakarta, hoping to lure overseas Chinese to Shanghai for medical purposes. It is estimated that there are 1 million Chinese residing in LA and 2 million in Jakarta. “The fact that there are 40 million overseas Chinese globally made us realize that we should take full advantage of this window of opportunity,” said Dr. Yang.
SHMTPPP will act as a comprehensive concierge, organizing everything from before the patient arrives to well after the patient leaves. What about the savings? Dr. Yang estimates that a coronary bypass is about 40% less in China than in the US and so the uninsured marketplace as well as the insurance and employer marketplace is of primary consideration for the platform development in China. Compared with other competitive countries, the pricing in China is equated to those of Thailand, less than Singapore and more than India. This gives it a competitive advantage. Dr. Yang predicts that due to high quality of care, combined services and affordability, it could grow by as much as 100 or 200 percent annually during the initial three years.
 Podcast by Kent Kedl, China Healthcare Land of Opportunity, technomicasia.com/blog/2009/08/30/china-health-care-the-land-of-opportunity/
 Podcast by Kent Kedl
 An Economic Analysis of Health Care in China by Gregory C. Chow, Princeton University (http://www.princeton.edu/ceps/workingpapers/132chow.pdf)
 Podcast by Kent Kedl
 Podcast by Kent Kedl
 International Society for Pharmacoeconomics and Outcomes Research, (.ispor.org/htaroadmaps/ChinaMD.asp#1)
 American National Standard Institute (purifymind.com/HistoryMed.htm)
 National Institutes of Health, (nccam.nih.gov/health/whatiscam/chinesemed.htm)
 National Institutes of Health and documented in the Huang Di Nei Jing the Chinese medicine text
About the Authors
Renee-Marie Stephano is the President of the Medical Tourism Association™ . Ms. Stephano is also the Editor-in-Chief of the Medical Tourism Magazine and Health Tourism Magazine.
Having a background in international marketing and relations, health law and litigation, she provides a valuable service to the Medical Tourism Association™ in these fields. Ms. Stephano speaks regularly at international healthcare conferences on the Legal Issues Surrounding Medical Tourism and in the United States to employer groups, insurance groups and physician associations. Renee-Marie consults international government ministries, private sector organizations and NGO’s about the growth of the global healthcare industry and accreditation, providing marketing assistance to promote their countries high quality of care. Ms. Stephano works with governments and healthcare clusters in the development of their Medical Tourism Initiatives. Ms. Stephano recently is the co-author of three books : “Developing an International Patient Center: A Guide to Creating the Best Patient Experience”, the book “The Medical Tourism Facilitator: A Best Practices Guide to Healthcare Facilitation for International Patients” and the book: “Medical Tourism ~ An International Healthcare Guide For Insurers, Employers and Governments”
Olivia Goodwin serves as communications coordinator for Medical Tourism Association. She travels around networking and developing ideas for Medical Tourism Magazine and the Association. Olivia holds a degree in Multimedia Journalism from Florida Atlantic University. She may be reached at [email protected]