On Sunday I returned from a week in Shanghai and Hangzhou. A remarkable trip that included daily meetings with government, academic, and clinical leaders. What did I learn?
In China, about 5% of the GDP is spent on healthcare per year compared to 16% in the US. Although there is wide variation in lifespan and other population health measures between rural and urban settings, there are few interesting observations about Chinese healthcare:
*It’s a single payer, publicly funded system that provides universal healthcare via a 14% payroll tax.
*There is a single national set of regulations and policies applied to all hospitals, clinics, and doctors
*There is a single set of national privacy laws
*Immunization is mandatory for the entire population
*There’s a single national healthcare identifier
EHRs are widely used in China, however they are optimized for episodes of care, using templates for capture of selected data elements specific to a disease i.e. hypertension, hepatitis, diabetes. The volume of patients is overwhelming – in one hospital I visited (Huashan), the dermatology clinic sees 4000 patients per day. The Chinese EHR enables clinics to document the basics of a problem specific encounter, facilitating extremely fast throughput. The downside of this is that there is not a longitudinal problem list, medication reconciliation, or coordination of care to avoid repeat testing.
