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The Evolving Chinese Health Care System
http://www.100md.com 《新英格兰医药杂志》
     To the Editor: The otherwise excellent article by Blumenthal and Hsiao (Sept. 15 issue)1 overlooks three critical points regarding Western medicine in China. First, institutions such as ours serve as points of introduction for concepts such as infection control, pain management, peer review, palliative care, evidence-based medicine, quality control, and even primary care — this last being arguably the most cost-effective way of dealing with emerging diseases of industrialization and urbanization, as documented in the same issue of the Journal.2 I can personally vouch for ample experiences of this phenomenon during the severe acute respiratory syndrome epidemic, and it is also evident in the ongoing regular visits of groups of hospital, medical, and nursing directors.

    Second, that a small but growing minority of Chinese patients has access to compassionate and patient-centered care, adequate pain relief, and treatment with clean instruments should not be a point of indignation. The goal is to find a way to deliver the same standard of care to every patient. Finally, to dismiss Chinese physicians' access to advances in technology denies the scientific contribution of this highly skilled and talented group to the global understanding and progress of health and illness.3

    Artin Mahmoudi, M.D.

    United Family Hospitals and Clinics

    Beijing 100016, China

    References

    Blumenthal D, Hsiao W. Privatization and its discontents -- the evolving Chinese health care system. N Engl J Med 2005;353:1165-1170.

    He J, Gu D, Wu X, et al. Major causes of death among men and women in China. N Engl J Med 2005;353:1124-1134.

    Hou FF, Zhang X, Zhang GH, et al. Efficacy and safety of benazepril for advanced chronic renal insufficiency. N Engl J Med 2006;354:131-140.

    The authors reply: Dr. Mahmoudi suggests that private, investor-owned hospitals in China play an important part by introducing new forms of technology and approaches to service and by meeting the demands of a "growing minority" of affluent Chinese. However, the growth of a for-profit sector serving a society's elite leads inevitably to inequalities in service. The single greatest problem facing the Chinese health care system is how to reduce inequities by providing all citizens with basic protection against the cost of services and by making services of adequate quality available throughout the country's vast expanse. Furthermore, Dr. Mahmoudi assumes that an investor-owned sector that provides services modeled on the care provided in Western countries will necessarily be more efficient than that provided in the mainstream Chinese sector. That assumption remains to be tested. Certainly, experience with high-technology medicine in the United States suggests that it is plagued with inefficiencies related to the overuse of services. The struggling Chinese health care system can ill afford to replicate the inefficiencies found in much more affluent Western health sectors.

    David Blumenthal, M.D., M.P.P.

    Massachusetts General Hospital

    Boston, MA 02114

    William Hsiao, Ph.D.

    Harvard School of Public Health

    Boston, MA 02115