Alice Song / Sun Staff Photographer

Prof. Karen Eggleston of Stanford delivers a lecture on difficulties facing the Chinese healthcare system.

October 1, 2018

Stanford Professor: Chinese Healthcare is a ‘Chicken and an Egg’ Problem

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On Monday, coincidentally the National Day of the People’s Republic of China, Prof. Karen Eggleston, Asia-Pacific studies, Stanford University, warned attendees that there is no “easy solution” to the inherent issues of China’s rapidly booming health care system.

Eggleston is a Senior Fellow at the Freeman Spogli Institute for International Studies at Stanford and director of the Stanford Asia Health Policy Program. Her research is Pan-Asian and draws on her experience living in China and South Korea for a number of years.

In the talk, Eggleston delved into the efforts the Chinese government has been making to improve health care and the difficulties the government faces. She focused on China’s complex attempt at a level of basic health coverage across all of China, encompassing both rural and urban areas.

“[China’s policy] is one of the largest health insurance expansions the world has ever seen,” Eggleston said.

There’s no easy solution and even trying to collect data about the health care in China is difficult, Eggleston argued, as rural areas and migrant populations make data collection challenging.

Eggleston repeatedly contrasted the differences between rural China and urban China, where the class and health care access divide is enormous.

“China’s huge. What works in Shanghai might not work in rural Bei Zhou, so you have to think about all of those differences,” Eggleston said.

Access to quality healthcare and education also drastically differ between geographic regions, and many doctors in rural areas only have a high school education, Eggleston said.

For that reason, many rural patients don’t trust their village doctor, and instead travel to hospitals with better reputations, she continued.

“It’s a chicken and an egg in trying to strengthen primary care,” Eggleston said.

Issues in the Chinese health care system do not only stem from geographic disparities, Eggleston argued — historic roles of doctors also play a role in distorting quality care.

Traditionally, Chinese doctors made money by selling the drugs they gave their patients, stemming from when medicine largely consisted of traditional herbal remedies. In the modern day, this creates problems with over-prescribing as doctors continue to make money by the volume of drugs they prescribe.

Eggleston described a study exploring profit-related prescribing, in which researchers trained healthy students to display symptoms of illness and go to a doctor. In 60 percent of cases, doctors prescribed antibiotics when the illness displayed did not need antibiotics.

Elderly care is also a developing issue with China’s aging population, according to Eggleston. Most elderly people are being taken care of by family, but as the number of dependents increases, the working population will have to bear more of the burden, she said.

“If you talk to households in China [where] they’re struggling with [taking care of the elderly], it is a lot,” Eggleston said, “You really have to feel for these families.”

The Chinese health care system is burdened by demographic differences and controversies such as bribes through “red money bags” and faulty children’s vaccines, Eggleston said.

As for the future, she said, “we have to find what works.”