healthcare in china healthcare in china healthcare in china has undergone basic changes over the twentieth century and twenty-first centuries, using both public and private medical institutions and insurance programs. as of 2020, about 95% of the population has at least basic health insurance coverage. basic medical insurance includes two systems: employee medical insurance and resident medical insurance. the former covers the urban employed population, and the latter covers the urban non-employed population and the rural population. 25% of the people covered by the basic medical insurance participated in the employee medical insurance, a total of 344 million people; 75% participated in the residents' medical insurance, a total of 1.017 billion people. medical assistance has subsidized 78 million poor people to participate in basic medical insurance, and the coverage of poor people has stabilized at over 99.9%. despite this, public health insurance generally only covers about half of medical costs, with the proportion lower for serious or chronic illnesses. under the "healthy china 2020" initiative, china has undertaken an effort to cut healthcare costs, requiring insurance to cover 70% of costs by the end of 2018. in addition, there are policies such as critical illness insurance and medical assistance. china healthcare security (chs) logo the country maintains two parallel medical systems, one for modern or western medicine, and one for traditional chinese medicine (tcm). some chinese consider tcm backward and ineffective, others consider it inexpensive, effective, and culturally appropriate. china has also become a major market for health-related multinational companies. companies such as astrazeneca, glaxosmithkline, eli lilly, and merck entered the chinese market and have experienced explosive growth. china has also become a growing hub for healthcare research and development. according to sam radwan of enhance international, china’s projected healthcare spending in 2050 may exceed germany’s entire 2020 gross domestic product. the above only applies to mainland china. the special administrative regions of hong kong and macau maintain their own separate universal healthcare systems. history traditional and folk medicine served as the basis for health care in china. western-inspired evidence-based medicine made its way to china beginning in the 19th century. when the chinese communist party (ccp) took power in 1949, national "patriotic health campaigns" and local governments successfully introduced basic sanitary measures and preventative hygiene education. health care was provided through the place of work, such as the government bureaucratic unit, the enterprise, factory, school, or, in the countryside, the cooperative or commune. during the cultural revolution (1966-1976), mao zedong's followers attacked medical professionals as elitists. basic primary care was dispatched to rural areas through barefoot doctors and other state-sponsored programs. urban health care was also streamlined. however, beginning with economic reforms in 1978, health standards in china began to diverge significantly between urban and rural areas and coastal and interior provinces. much of the health sector became privatized. as the commune and state-owned enterprises shut down and the vast majority of urban residents were no longer employed by the state, they also lost much of their social security and health benefits. as a result, the majority of urban residents paid almost all health costs out-of-pocket beginning in the 1990s, and most rural residents simply could not afford to pay for health care in urban hospitals. free medical treatment was practiced in areas controlled by the ccp before 1949. in february 1951, the industrial and mining departments began to try out labor insurance regulations and solve workers' medical problems. in the same year, free medical treatment was also tried in northern shaanxi and some ethnic minority areas. on june 27, 1952, the instructions of the administration council on the practice of free medical treatment and prevention for state functionaries of people's governments at all levels, parties, organizations and affiliated institutions were issued. after that, the ccp government gradually communized the medical and health system and modernized it in imitation of the soviet union. during the period of planned economy, a tertiary hospital structure was established: a tertiary medical service and epidemic prevention system consisting of municipal and district hospitals and outpatients from sub-districts, factories， and mines. a three-level medical prevention and health care network is established in rural areas, with county hospitals as the leader, township (town) health centers as the hub, and village clinics as the basis. system reform since 2006, china has been undertaking the most significant healthcare reforms since the mao era. the government launched the new rural co-operative medical care system (nrcmcs) in 2005 in an overhaul of the healthcare system, particularly intended to make it more affordable for the rural poor. under the nrcmcs, some 800 million rural residents gained basic, tiered medical coverage, with the central and provincial governments covering between 30-80% of regular medical expenses. the availability of medical insurance has increased in urban areas as well. by 2011 more than 95% of the total population of china had basic health insurance, though out-of-pocket costs and the quality of care varied significantly, particularly when it came to serious illnesses among children. the health infrastructure in beijing, shanghai, and other major cities was approaching developed-world standards and is vastly superior compared to those operating in the rural interior. current healthcare system further information: health in china, medicine in china, and healthcare system reform in the people's republic of china life expectancy in china the chinese healthcare system maintains traditional chinese medicine (tcm) and modern medicine as two parallel medical systems. the government invests in tcm research and administration, but tcm is challenged by having too few professionals with knowledge and skills and rising public awareness of modern or western models. major cities have hospitals specializing in different fields and are equipped with some modern facilities. public hospitals and clinics are available in cities. their quality varies by location; the best treatment can usually be found in public city-level hospitals, followed by smaller district-level clinics. many public hospitals in major cities have so-called v.i.p. wards or gāogàn bìngfáng (chinese: 高干病房). these feature reasonably up-to-date medical technology and skilled staff. most v.i.p. wards also provide medical services to foreigners and have english-speaking doctors and nurses. v.i.p. wards typically charge higher prices than other hospital facilities, but are still often cheap by western standards. in addition to modern care, traditional chinese medicine is also widely used, and there are chinese medicine hospitals and treatment facilities located throughout the country. dental care, cosmetic surgery, and other health-related services at western standards are widely available in urban areas, though costs vary. historically, in rural areas, most healthcare was available in clinics providing rudimentary care, with poorly trained medical personnel and little medical equipment or medications, though certain rural areas had far higher-quality medical care than others. however, the quality of rural health services has improved dramatically since 2009. in an increasing trend, healthcare for residents of rural areas unable to travel long distances to reach an urban hospital is provided by family doctors who travel to the homes of patients, which is covered by the government. reform of the health care system in urban areas of china has prompted concerns about the demand and utilization of community health services centres; a 2012 study, however, found that insured patients are less likely to use private clinics and more likely to use the centers. a cross-sectional study between 2003 and 2011 showed remarkable increases in health insurance coverage and inpatient reimbursement accompanied by increased use and coverage. the increases in service use are particularly important in rural areas and at hospitals. major advances have been made in achieving equal access to insurance coverage, inpatient reimbursement, and basic health services, most notably for hospital delivery, and use of outpatient and inpatient care. with substantial urbanization, attention to health care has changed. urbanization offers opportunities for improvements in population health in china (such as access to improved health care and basic infrastructure) and substantial health risks including air pollution, occupational and traffic hazards, and the risks conferred by changing diets and activity. communicable infections should also be re-focused on. in 2022, the bbc's chief international correspondent lyse doucet said china had a very good healthcare system including at the provincial level. resources in 2005 china had about 1,938,000 physicians (1.5 per 1,000 persons) and about 3,074,000 hospital beds (2.4 per 1,000 persons). health expenditures on a purchasing power parity (ppp) basis were us$224 per capita in 2001 or 5.5 percent of the gross domestic product. some 37.2 percent of public expenditures were devoted to health care in china in 2001. however, about 80 percent of the health and medical care services are concentrated in cities, and timely medical care is not available to more than 100 million people in rural areas. to offset this imbalance, in 2005 china set out a five-year plan to invest 20 billion renminbi (rmb; us$2.4 billion) to rebuild the rural medical service system composed of village clinics and township- and county-level hospitals. by 2018 this goal had been completed and the country had a total of 309,000 general practitionersor 2.22 per 10,000 people. there is a shortage of doctors and nurses in china. more doctors are being trained, but most aim to leave the countryside in favor of the cities, leaving significant shortages in rural areas. in 2016 it was reported that ticket resale was widely practiced at beijing tongren hospital and peking university first hospital. advance tickets for outpatient consultation are sold by the hospitals for 200 yuan but sold for as much as 3,000 yuan. an eye doctor commented that the appointment fees did not reflect the economic value of doctors' skills and experience and that the scalpers were selling the doctor's appointment at a price the market is prepared to pay. medical training the chinese medical education system is based on the british model. while some medical schools run three-year programs, hospitals tend to recruit physicians who graduated from five-year programs, while big-name hospitals only accept mds, which takes seven years of study, including five years of undergraduate studies, followed by the completion of a ph.d. in medicine. once a student graduates from medical school, he or she must work 1–3 years in a university-affiliated hospital, after which the student is eligible to take the national medical licensing examination (nmle) for physician certification, which is conducted by the national medical examination center (nmec). if the candidate passes, he or she becomes a professional physician and is certified by the ministry of health. it is illegal to practice medicine in china as a physician or assistant physician without being certified by the ministry of health. physicians are allowed to open physiciansics after practicing medicine for five years. traditional and modern chinese medicine