China Preventive Health Services and U.S. Preventive Health Services

The objective of this study is to compare and contrast China preventive health services and U.S. preventive health services.

The work of Clarke (2010) reports that prevention “was a prominent feature of the health care reforms that took place in the late 1960s through the early 1970s. During that time strategies such as universal vaccination, promotion f lifestyle changes, population screenings, and safety regulations were introduced and became widely accepted as means to improve public health while reducing health care expenditures.” (p.3) The U.S. while one of the world’s richest and most technologically advanced nations, is experiencing a severe lack in meeting expectations for health status and the costs are reported as “alarmingly high.” (Clarke, 2011, p.3)

Specifically, the age-adjusted prevalence of obesity in the United States in 2007-2008 is reported to have been 33.8% overall, 32.2% among men and 35.5% among women.” (Clarke, 2011, p.3) In addition, 23.6 million Americans or 7.8% of the population are reported as having diabetes. More than 26 million Americans are reported to have chronic kidney disease with millions more reported to be at risk. The American Heart Association reports that 53.7% of men in the U.S. And 55.8% of women in the U.S. have developed hypertension by the time they are between 55 and 64 years of age.

In addition, at least fifty percent of cancer deaths “could be prevented by more systematic efforts to reduce tobacco use, improve diet and physical activity, and expand the use of established screening tests.” (Clarke, 2011, p.3) Preventive health care in China is reported as being a “40 billion yuan ($6.3 billion) annual industry in China…growing around 15% a year.” (Aldred, 2012, p.1)

I. Description of Group

The population of China is reported in the CIA Factbook to be 1,343,239,923. Of these 17.4% are between the ages of 0 and 14 years of age; 73.5% are between the ages of 15 and 64 years of age; and 9.1% are 65 years of age and over. There are reported to be 12.31 births per 1,000 population and 7.17 deaths per 1,000 populations. According to a U.S. News report by Robert Schlesinger the United States entered 2012 “with a population of roughly 312.8 million people.

II. Leading Morbidity and Mortality Indicators

The leading causes of death and disabilities in China are reported to include the number one cause of death and disability, which is stated to be cerebrovascular disease resulting in 17.7% of deaths and 6.5% of disabilities in China. It is reported that there are geographical differences “in disease control expenditure. Apart from the significant decline in government spending on disease control, there are significant geographical differences in disease control expenditure as a result of the financial decentralization.” (Claesen, Wang, and Hu, 2004)

Specifically reported is that the central government “…finances only the national hospitals, research institutes, and medical schools. Each province or county is responsible for its own public services, including health care education and welfare, thus, a prosperous locality is able to provide generous health care and a poor locality has to settle for less.” (Claesen, Wang, and Hu, 2004) The entire list of causes of death and disabilities in China is shown in the following table labeled Figure 1.

Figure 1 — Leading Causes of Death and Disability — Adjusted Life Years, China 2000

Source: Claesen, Wang, and Hu (2004)

The following table shows the proportion of total health expenditure by clinical and preventive services in China.

Figure 2 — Proportion of Total Health Expenditures by Clinical and Preventive Services

Source: Claesen, Wang, and Hu (2004)

In the United States, health care preventive services are scattered and applied randomly and the truth is that little can be found on actual preventive health care services. In 2010 the administration announced regulations that require new health insurance plans to provide free preventive care including the elimination of cost sharing requirements for these services. The report states that presently

“too many Americans do not get the high-quality preventive care they need to stay healthy, avoid or delay the onset of disease, lead productive lives, and reduce health care costs, Chronic diseases, such as heart disease, cancer, and diabetes, are responsible for 7 of 10 deaths among Americans each year and account for 75% of the nation’s health spending — and often are preventable.” (U.S. Department of Health and Human Services, 2010)

It is additionally reported that on a national basis, Americans use preventive services “at about t half the recommended rate. An estimated 11 million children and 59 million adults have private insurance that does not adequately cover immunization, for instance. Cost sharing, including deductibles, coinsurance, or copayments, has been found to reduce the likelihood that preventive services will be used.” (U.S. Department of Health and Human Services, 2010)

The work of Maciosek, et al. (2008) relates that a greater level of use of preventive services in health care in the United States could well serve to save lives and to do so with very little in the way of cost for such services. Preventive services that have the most potential in saving life years are stated to include such as “childhood immunization series, smoking cessation advice and assistance, discussion of daily aspirin use to prevent cardiovascular disease and breast and colorectal cancer screening.” (Maciosek, et al., 2008) Reported as clinical preventive services that produce the most in net medical savings from the perspective of the budget are those of “childhood immunization series, pneumococcal immunization for adults, discussion of daily aspirin use, smoking cessation advice and assistance, vision screening in older adults, alcohol screening and brief advice, and obesity screening.” (Maciosek, et al., 2008)

It is related that the health services system in China has been affected by the “re-organization, financing, and management of public health services have resulted in “inefficiencies stated to be “partly due to the lack of clarity in functions and duplication between the tiers. The overlap of roles and responsibilities is in particularly evident in those activities that generate user charges.” (Maciosek, et al., 2008)

In addition, due to decentralized management, the CDC at each level is reported to implement only the policies that the affiliated government authority set at the same level but “has no administrative supervisory mandate for the subordinated provincial CDC.” (Maciosek, et al., 2008) Also a primary challenge is the staff low quality in the CDC system resulting in inefficiencies in operations as has been witnessed during times of crises. The fourth challenge is reported as the “incompleteness of reimbursement mechanisms.” (Maciosek, et al., 2008)

IV. Implications for Multicultural and Global Health

It is clear that neither China nor the United States is well positioned for ensuring that all individuals are on the receiving end of effective preventive health services geared toward early detection of disease and that neither the health services system of China nor the United States is structured in a way that can ensure preventive health care services are equally available to all individuals. If these two countries do not manage to implement preventive health care services at a greater level of access for all individuals it is likely that the health care costs related to disease treatment will exceed the imagination of what preventive health care services would cost. Furthermore, the spread of disease in either of these countries would affect a large population resulting in many needless deaths and disabilities due to lack of preventive health care services.

Bibliography

China (2012) CIA Factbook. Retrieved from: https://www.cia.gov/library/publications/the-world-factbook/geos//ch.html

Claeson, M, Wang, H., and Hu, S. (2004) A Critical Review of Public Health in China. Retrieved from: http://siteresources.worldbank.org/INTEAPREGTOPHEANUT/Resources/publichealth,09-13-04.pdf

Eggleston, K. et al. (2008) Health Service Delivery in China: A Literature Review. Health Economics. 17: 159-165. Retrieved from: http://unpan1.un.org/intradoc/groups/public/documents/un-dpadm/unpan042436.pdf

Maciosek, MV (2008) Greater Use of Preventive Services in U.S. Health Care Could Save Lives at Little or no Cost. Health Affairs, Sept. 2010. Retrieved from: http://doh.state.fl.us/AlternateSites/KidCare/council/12-3-10/12-3-10_KCC-Agenda.pdf

News Release (2010) Administration Announces Regulations Requiring New Health Insurance Plans to Provide Free Preventive Care. 14 Jul 2010. Retrieved from: http://www.hhs.gov/news/press/2010pres/07/20100714a.html

Recommended Preventive Services (2010) Healthcare.gov. Retrieved from: http://www.healthcare.gov/law/resources/regulations/prevention/recommendations.html

Schlesinger, R. (2012) U.S. Population 2012: Nearly 313 Million People. U.S. News. Retrieved from: http://www.usnews.com/opinion/blogs/robert-schlesinger/2011/12/30/us-population-2012-nearly-313-million-people

Schlesinger, R. (2012) U.S. Population 202: Nearly 313 Million People. U.S. News. Retrieved from: http://www.usnews.com/opinion/blogs/robert-schlesinger/2011/12/30/us-population-2012-nearly-313-million-people