China and the NHS - A Healthcare Collaboration
In January 2019, the UK and China signed over £500 million (4,338,855,495 RMB) of healthcare and life science deals, launching a number of collaborations between UK healthcare companies and their Chinese partners. In 2017, the UK’s National Health Service (NHS) partnered with the Rongqiao Group to build a new hospital in Fuzhou, Fujian province, which will specialise in elderly, cancer and heart care.
These efforts represent a new business venture being undertaken by the two partner countries, in which the UK government and private sector is working with their Chinese partners to help build a healthcare service for its citizens by learning from the strengths and weaknesses of the current UK system. But does such a collaboration make sense for these two very different countries?
What is the NHS?
The NHS is the UK’s free-at-point-of-delivery health service provided to all UK residents, composed of NHS England, NHS Scotland, NHS Wales, and the Health and Social Care (HSC) in Northern Ireland. Each service is politically accountable to their respective government, and is on average 98.8% funded from general taxation and National Insurance contributions (the remainder covered by patient charges). Approximately 10% of national GDP is spent on healthcare, the majority of which is spent in the public sector. Together, the four National Health Services employed 1.6 million people in 2015–16 with a budget of £136.7 billion (the total UK health sector workforce was 2.2 million).
What does the UK and China have in common?
The founding principles of a comprehensive, universal, and free at the point of delivery service hint at a similarity between China and the UK – a socialist attitude towards the care and wellbeing of the population and the principle of looking after people based on their needs, not their financial wealth. In fact, China and the UK share many goals - this includes providing services for a rapidly growing elderly population, as well as services to deal with increasingly prevalent non-communicable diseases (e.g. diabetes, respiratory conditions, cancer and dementia). These changing healthcare needs place big demands on the healthcare systems and infrastructure of both countries. Healthcare reforms in China seek to create “safe, effective, convenient and affordable” healthcare to both rural and urban residents by 2020 – a path China is currently on since their established of nearly universal insurance coverage. China’s collaboration with the UK’s public and private healthcare sector is in essence a strategy to improve the quality and choice of healthcare services in China as the country continues to grow and develop.
What challenges does China face?
Importantly, China’s needs are in some ways quite different to the UK’s. China’s current focus is on the provision of hospitals and their efficient running. Outside of the Tier 1 cities, healthcare infrastructure in China urgently requires modernisation, complicated by rapidly evolving healthcare needs of the population. Long-standing conditions in the West, such as cancer, obesity, diabetes and heart disease, are only now becoming common in China. This poses new challenges on healthcare infrastructure and businesses – the UK’s experience dealing in these challenges is one the reasons why a cross-cultural collaboration is so valuable. A big cultural difference is that 90% of interactions with doctors in China take place in hospitals, whereas in the UK 90% take place in a primary care (community located, e.g. GP surgery, counsellors) or setting. These differing patient needs have a big impact on how systems are developed, and are a key consideration that must be dealt with sensitively when collaborating on infrastructure development.
How do the UK and China differ?
Interestingly, studies show that Chinese people have a different approach to health and illness than their Western partners. Jovchelovitch and Gervais argue that traditional beliefs, (e.g. balance and harmony) are still held as core values, and indeed in the UK, Chinese people are more likely to use alternative medicines. This is largely rooted in a different view of Chinese and Western medicine - Chau and Yu’s research highlighted that some Chinese women believed that Chinese and Western medicine were only effective in the right circumstances (Chinese for the prevention of illness/restoration of health, Western for curing disease). In this way, the two forms of medicine do not necessarily clash, but it is important to appreciate patient attitudes to each when entering business ventures that concern their delivery. The beliefs affect consumer behaviour - some prefer mainstream services; some favour traditional medicine; others use both. This is a core difference to UK healthcare trends, where a much greater emphasis is placed on Western treatment. Nonetheless, the Chinese healthcare sector is rapidly growing, with spending projected to grow to $1 trillion in 2020, thanks to a very large market for pharmaceuticals, medical products and consumer health.
It has also recently been shown that lower levels of certain diseases exist among Chinese populations. The 2004 Health Survey for England showed that long-standing illness was just over 20% among Chinese citizens, compared to 43% in the general population. Only 5.3% of Chinese persons suffered from cardiovascular disease, compared to 13% in the general population. These trends are important to consider when designing healthcare provisions and infrastructure.
Chinese consumers are also becoming more sensitive to their health – the concept of ‘healthy’ is actually quite subjective – and this must also be considered when attempting to offer new healthcare services. Consumer trend analysis shows that many Chinese consumers are increasingly concerned about their health, diet and exercise, fuelling a fitness trend. This contrasts with increased obesity rates in China – 30% of Chinese adults are overweight (approximately 320 million) and 6% are obese, which led to the government announcing its “Healthy China 2030 plan” in 2016, to promote better diet, exercise and access to healthcare services. These attitudes and patient needs should be carefully considered when designing healthcare services in the commercial and public sector.
Will the future Chinese healthcare system look like the UK’s NHS? Probably not. But it is interesting to watch China build theirs armed with the strengths and weaknesses of the UK’s. Though principle may unite the two country’s attitudes, size, population trends, and infrastructure certainly call for different approaches.