Whether China's healthcare costs are “expensive” or not needs to be analyzed from multiple perspectives, including the overall level of expenditure, the proportion of personal burden, the distribution of healthcare resources, and international comparisons, and it is not possible to make a simple generalization. The following is a description of the key perspectives:
Overall health care costs: faster growth rate, but the proportion of GDP is still lower than developed countries
China's total health care costs have maintained rapid growth in recent years, mainly due to population aging, advances in medical technology and rising health needs of the population.
. Total amount and growth rate : China's total health costs were about 458.6 billion yuan in 2000, increasing to 8.5 trillion yuan in 2022, an increase of nearly 18 times in 22 years, with a compound annual growth rate of about 14%.
. Percentage of GDP: In 2022, the proportion of total health expenditure to GDP will be 7.0% (average of OECD countries is about 9.8%, and the United States is as high as 17.1%), which is lower than that of developed countries but close to the level of middle-developed countries (e.g., France 9.0%, Germany 11.7%).
. Per capita level: In 2022, China's total per capita health expenditure will be about 6,010 yuan (about 660 U.S. dollars), much lower than that of developed countries such as the United States (13,000 U.S. dollars) and Japan (5,500 U.S. dollars), but higher than that of some developing countries (e.g., about 260 U.S. dollars in India). India about 260 U.S. dollars).
Conclusion: The overall cost growth rate is relatively fast, but the absolute value and the proportion of GDP are still at a medium level, and have not yet reached the level of “excessive burden”.
The proportion of personal burden: a significant decline, but structural differences are prominent
The proportion of individual out-of-pocket expenses to total health expenses is the core indicator of “expensive medical care”.
. Historical comparison: China's personal health expenditure accounted for 59% of total health expenditure in 2000 (government+social expenditure was only 41%), and will drop to 27.7% in 2022 (government expenditure 30.8%, social expenditure 41.5%), mainly thanks to the basic health insurance coverage (basic health insurance participation rate has stabilized at more than 95%).
. International comparisons : The 2021 data show that China's individual out-of-pocket share (27.7%) is lower than the global average (35%), but higher than that of OECD countries (about 20% on average), and more significantly higher than that of the United States (11%)-although the United States The actual individual direct payments may be underestimated due to the high level of commercial insurance coverage in the United States.
But note the structural differences :
. Regional differences : Individual out-of-pocket payments are likely to be higher in rural and less developed areas than in cities (e.g., per capita healthcare expenditures for urban and rural residents are $2,352 and $1,741, respectively, in 2022, but rural residents' incomes are only 37 percent of those in towns and cities).
. Burden of major diseases : The out-of-pocket expenses for major diseases such as cancer and cardiovascular and cerebrovascular diseases may be as high as 30%-50% (even with reimbursement from health insurance, some targeted drugs and imported consumables still require out-of-pocket expenses).
. Low-income groups: The proportion of medical expenditure to household income for disadvantaged groups such as low-income and special hardship cases may exceed 20% (the World Health Organization's definition of “catastrophic medical expenditure”). The World Health Organization defines “catastrophic medical expenditure” as a criterion), so they need to rely on medical assistance.
Conclusion: The personal burden of general outpatient care and common diseases has been significantly reduced, but major and chronic diseases and high-end medical services for high-income groups may still bring about high expenditure pressure.
“Value for money” in health care: technological advances and uneven distribution of resources go hand in hand
Perceived cost is also related to “quality of service”. China's healthcare system has made significant progress in terms of efficiency and technology, but the uneven distribution of resources has led to the co-existence of “difficult access” and “high costs”.
... Technological advances: the development and application of domestic innovative drugs (e.g. PD-1 inhibitors, CAR-T cell therapy) and high-end medical devices (e.g. surgical robots) have lowered some of the treatment costs; health insurance negotiations (e.g. “soul-cutting price”) have reduced the cost of treatment. “soul chopping”) have pushed down the prices of commonly used drugs and anti-cancer drugs significantly (e.g., the 700,000 yuan shot of spinal muscular atrophy drug was reduced to 33,000 yuan in 2022 after health insurance negotiations).
. Concentration of resources: High-quality medical resources (Tertiary hospitals, specialists) are highly concentrated in the eastern and central cities, while the service capacity of primary healthcare institutions (community hospitals, township health centers) is weak, resulting in patients “piling up in large hospitals”, which indirectly pushes up the prices of anticancer drugs. As a result, patients “pile up in big hospitals”, which indirectly pushes up the cost of consultation (e.g. transportation, accommodation, time cost).
Conclusion: The “cost-effectiveness” of basic medical care is gradually improving, but the scarcity of high-quality resources has exacerbated the cost pressure on some patients.
International comparison: comparable to developing countries, lower than developed countries
In terms of per capita medical expenditure, out-of-pocket expenses and other indicators, China is in the “upper middle range of developing countries, close to the lower limit of developed countries”:
. Per capita expenditure: In 2022, China will spend about 6,010 RMB, lower than Russia (about 8,000 RMB) and Brazil (about 11,000 RMB), but higher than India (about 2,600 RMB) and Vietnam (about 1,500 RMB).
. Out-of-pocket expenses: 27.7% in China, lower than India (50%) and Mexico (45%), but higher than Thailand (18%) and Malaysia (22%).
Conclusion: China's healthcare costs are within a “reasonable range” internationally, but compared to countries with similar levels of development, there is still some room for optimizing the burden on individuals.
Conclusion: Whether the cost is “expensive” needs to be viewed in different scenarios
. For the majority of the general public: After reimbursement of outpatient and inpatient expenses for common and frequent diseases through medical insurance, the burden on individuals is manageable (e.g., the out-of-pocket expenses for a general hospitalization are usually 20-40%), and the contradiction of “expensive medical treatment” has been significantly alleviated.
. For specific groups/scenarios: residents of major diseases, chronic diseases, high-end medical services (e.g. private hospitals, imported consumables) and low-income areas may still face high financial pressure.
In the future, the “affordability” of China's healthcare is expected to be further improved through the improvement of major disease insurance, medical assistance and other support mechanisms, the promotion of the sinking of high-quality medical resources, and the further control of drug prices.