China's healthcare system is significantly different from that of the United States, each with its own strengths and challenges, and it is impossible to make a simple determination of “better” when it comes to access, equity, cost, quality, efficiency, and other dimensions of the healthcare system. The following is a comparison of the key dimensions:
1. Accessibility: China's coverage is wider, while the United States has gaps.
China: Through the “universal health insurance” system (integration of urban workers' health insurance, urban and rural residents' health insurance, and the New Rural Cooperative Medical Insurance), coverage of more than 95% of the population has basically been realized (2022 data). The network of primary healthcare institutions (community health service centers and township health centers) covers both urban and rural areas, providing basic medical care and public health services (e.g., vaccinations, chronic disease management), thus solving the historic problem of “difficulty in accessing medical care”.
United States: No universal healthcare coverage, relies on commercial insurance (54% of the population), government healthcare (about 34% covered by Medicare/Medicaid) and out-of-pocket expenses. About 26 million Americans (8%) are uninsured (Kaiser Family Foundation data, 2022), and low-income groups and minorities (e.g., African-Americans, Latinos) often delay seeking care due to cost, with emergency room care becoming a “last resort” for some.
2. Equity: China narrows the gap, but the United States has wide disparities
China: In the past, medical resources were highly concentrated in large cities, but in recent years, through policies such as hierarchical diagnosis and treatment (strengthening the grassroots), the “county hospital capacity enhancement program”, and “peer-to-peer support”, high-quality resources have been pushed downward. For example, in 2022, the rate of consultation within counties will exceed 90%, the proportion of grassroots consultation and treatment will stabilize at around 50%, and the urban-rural and regional disparities will be gradually narrowed.
The United States: medical resources are highly tied to economic levels, with top hospitals (e.g., Mayo Clinic, Johns Hopkins) concentrated in affluent areas, and low-income groups (especially African-Americans and Latinos) facing “geographic segregation” - high-quality hospitals are located in affluent white neighborhoods Minorities are less likely to have access to high-quality services. Studies have shown that low-income groups experience 20-30% worse outcomes for the same disease than higher-income groups (JAMA).
3. Costs: Less burdensome in China, highest in the world in the US
China: total health costs in 2022 will account for about 7% of GDP (17.1% in the U.S.), with per capita healthcare expenditures of about 5,900 yuan (about $850), of which individual out-of-pocket payments will be about 27% (government and social expenditures will account for 73%). Basic health insurance reimbursement ratio: about 70%-90% for employee health insurance, about 50%-70% for resident health insurance, and major disease insurance to further reduce out-of-pocket pressure.
United States: per capita healthcare expenditure of $12,914 in 2022 (OECD data), the highest in the world. Despite insurance, individuals are still responsible for premiums, deductibles (average individual annual deductible ~$1,763), co-payment ratios, etc., ~30% of adults delay medical care due to costs (2023 KFF survey), and medical debt is one of the main causes of bankruptcy in the US.
4. Quality: U.S. leading in high-end, China solid in basic medical care
The United States: a global leader in innovative medical technology, treatment of difficult and critical illnesses, and drug research and development (e.g., targeted cancer therapy, organ transplantation, precision medicine). Top hospitals (e.g., MD Anderson Cancer Center) are often at the top of specialty rankings, and clinical research results (e.g., clinical trials of new drugs) account for more than 30% of the world. However, the quality of routine medical care varies, and some primary care physicians may over-test or reject high-risk patients due to commercial insurance billing rules.
China: The capacity of basic medical care (e.g., management of common and chronic diseases) and public health (e.g., prevention and control of infectious diseases) has been significantly improved. 2022 data show that the standardized management rate of hypertension and diabetes patients has reached 72% and 67%, respectively, and that grassroots institutions are able to carry out diagnosis and treatment of more than 200 types of common diseases. However, there is still a gap between China and the United States in the field of high-end medical technology (such as original drugs and precision medical devices) and complex surgery (such as organ transplantation), and the efficiency of clinical research translation needs to be improved.
5. Efficiency: China's system is more efficient, while the U.S. is dragged down by commercial insurance.
China: the public healthcare system is dominated by the government-led resource allocation and unified payment (health insurance) to reduce intermediate links, and high efficiency of emergency response (e.g., large-scale nucleic acid testing and vaccination in the early stage of the new crown epidemic). However, there is a “siphon effect” (concentration of patients) in some of the large hospitals, resulting in idle resources at the grassroots level and overcrowding in tertiary hospitals.
The United States: the fragmented system led by commercial insurance leads to high administrative costs (about 25% of medical expenditure on insurance management and bill processing), patients need multiple referrals, repeated examinations; non-emergency surgery waiting time is long (eg, hip replacement average waiting time of 11 weeks, the average OECD countries 6 weeks), but the emergency response speed is faster (hospitals are not allowed to refuse to diagnose patients with acute illnesses under the law).
6. Conclusion: each has its own advantages and disadvantages, and demand determines the experience
. For low-income/vulnerable groups: China's universal coverage and low out-of-pocket costs are more advantageous; the U.S. may face the dilemma of “not being able to afford to see a doctor” due to the lack of health insurance or high out-of-pocket costs.
. For high-income/critically ill patients: high-end technology and innovative therapies may be superior in the U.S., but at a high cost; China's top hospitals (e.g., Peking Union Medical College, Shanghai Ruijin) are close to the international top level, and at a lower cost.
. Future trends: China is improving the quality of primary care and promoting the development of innovative drugs; the United States is trying to expand coverage through Obamacare, but there is more resistance.
Conclusion: The goals of the two healthcare systems are different (China focuses on equity and access, while the US focuses on market innovation), so it is not possible to directly compare “good and bad”, but rather need to be assessed in the context of the health needs of specific populations and their financial capabilities.