What are the Chinese government’s objectives for the development of its healthcare system? How do these ambitions affect its interaction with U.S. and other foreign healthcare markets? And what policy recommendations should lawmakers consider regarding the development of China's healthcare system and its implications for U.S. national interests? These are some of the questions that APARC Deputy Director and Asia Health Policy Program Director Karen Eggleston discussed in her testimony before the U.S.-China Economic and Security Review Commission on May 7, 2020.
Watch Eggleston’s testimony (start time 23:25]
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Chaired by Dr. Robin Cleveland, the commission’s hearing, “China’s Evolving Healthcare Ecosystem: Challenges and Opportunities,” focused on China's domestic healthcare infrastructure and its use of technology in the light of the COVID-19 pandemic. The commission listened as Eggleston reviewed the strides China has made in its national health reforms and highlighted the many challenges its health system now faces. “It is in the interest of Americans and Chinese to have a strong, resilient healthcare system in China,” she said. “The United States should reemphasize scientific, evidence-based health policy and regulation, and encourage China to do so as well.”
The commission’s mandate is to investigate and submit to Congress an annual report on the national security implications of the bilateral trade and economic relationship between the United States and China and to provide recommendations to Congress for legislative action.
Ambitious Goals, Complex Challenges
Reforms over the past two decades, noted Eggleston, have brought China’s health system closer to a level of reliability and accessibility commensurate with the country’s dramatic economic growth. The government has already achieved its goal of providing universal health coverage and has made significant progress in many of the areas outlined in its “Healthy China 2030” blueprint, including tackling health disparities between regional and urban/rural population subgroups and building a more comprehensive and higher quality health service delivery system.
Still, China faces many daunting challenges, from dealing with COVID-19 and its aftermath to other urgent and lingering needs, such as tackling its looming demographic crisis and promoting healthy aging, addressing patient-provider tensions and trust, and changing provider payment to promote “value” rather than volume. If China is to make its investments in universal health coverage and rapid medical spending growth sustainable, said Eggleston, then it must build an infrastructure that increases health system efficiency, strengthens primary care, reforms provider payment system, and protects the most vulnerable from illness-induced poverty.
Technology and COVID-19 Response
Like other countries, China’s government and private sector have utilized various technologies in response to the COVID-19 crisis, such as telemedicine, “internet-plus” healthcare, and contact tracing applications, and are deploying digital and biotechnologies in efforts focused on epidemic mentoring and on treatment and vaccine development. Eggleston noted that the response to COVID-19 “will leave an indelible mark on health policies for decades to come,” not only in terms of technology adoption but also organizational innovation. One would hope to see future prioritization in resource allocation and renewed investment in the diagnosis and treatment of health system weaknesses, she added.
Recommendations for Congress
In all our policies and interactions, Eggleston concluded her testimony, we should remember that China is large and diverse, that local government agencies are those that make many important decisions in health policies as in other policies, and that the “Chinese people” are not synonymous with any given leader. “Avoid politicizing the COVID-19 pandemic and other health and humanitarian issues,” she noted. “In other geopolitical considerations in bilateral US-China relations, uphold U.S. interests while encouraging the PRC to be active as a globally responsible stakeholder.”
The U.S. government should encourage China and its scientists and firms to work collaboratively with multilateral efforts to prevent and control future pandemics, she argued. Specific recommended actions include supporting efforts to strengthen primary care and population health interventions with proven cost-effectiveness; sharing experiences with regional, community-based efforts to address the social determinants of health and promote multisector policies for healthy aging; encouraging public-private collaborative governance arrangements to strengthen the health sector in China; promoting transparent peer review of research and international collaboration between Chinese and American scientists, medical educators, health systems researchers, and technology developers; and collaborating with Chinese counterparts to address regional issues of population health importance, such as health problems in the DPRK and integration of public health priorities into China’s Belt and Road Initiative.