Overview
Healthcare in China is majority owned and operated by the state. Private sector providers such as hospitals and clinics account for only 14% of hospital beds and serve less than 10% of patients nationwide. Many of the private hospitals today in the country are small and provide specialized services but people visit the public hospital because the fees of the private clinics are so high and must be paid all out of pocket. While the demand for healthcare services surges, the supply of doctors is inadequate. As of 2012, China had 1.8 doctors per 100 people compared to 2 to 4.3 in OECD countries.
What happens if you need to see a doctor?
When you need to see a doctor, you have a choice of either going to a public or private hospital or clinic. Due to the consulting fee, some of insulin is covered by social insurance in the public hospitals. Private clinics charge more fees. Because of this, eighty percent of people with type 1 diabetes choose to go to the public hospitals. Unfortunately, the doctor to patient ratio is very low.
Who decides what medicines a doctor can prescribe?
Drug regulatory authority has the control over deciding what drugs can be prescribed by the doctors. However, there are no national guidelines on when and how to prescribe specific drugs. It is largely based on the trainings that the doctors receive during their studies or otherwise. The Chinese Diabetes Society (opens in a new tab) (CDS) is dedicated to improving diabetes care for people with type 1 diabetes through education and good clinical practice. CDS members have organized a national program to train medical professionals in the management of type 1 diabetes. The CDS Guideline for diagnosis and treatment of diabetic ketoacidosis in childhood type 1 diabetes and consensus of insulin treatment in childhood type 1 diabetes were developed in 2009 and 2010, respectively. CDS has made education one of its priorities. A CDS task-force, which was founded in 2003, focuses on enhancing and extending training for diabetes educators and certifying those who are qualified.
Practically, what is it like to live with type 1 diabetes in China?
The personal financial burden of disease management is high. For example, throughout most of the country, glucose test strips and disposable insulin pen lancets are not reimbursed. As result, people with type 1 diabetes reportedly are using the disposable needles for several days. Meanwhile, special care for people with type 1 diabetes is available only in the large clinical centers located in major cities. The type 1 diabetes management capabilities of primary and secondary healthcare centers are still very limited. Even in the larger clinics, standards of care for type 1 diabetes have not been well implemented throughout. Moreover, the way in which people with type 1 diabetes are identified remains an area for serious attention. There are multiple reports of misdiagnoses of type 1 diabetes leading to fatalities.
Discrimination against people with type 1 diabetes is also a serious problem in China. For instance, people with type 1 diabetes face great difficulties accessing higher education and employment. This social unfairness not only has a negative impact on personal lives, it hinders disease management. For example, in order to hide their condition, many students and employees with type 1 diabetes never test blood glucose and inject insulin at school or the work place, making intensive glucose control impossible.
What about getting admitted to hospital?
If you are going to a public sector hospital, you will need to pay for your bed and some of the medications. You might also need to pay for some specific procedures. If you are going to a private hospital, everything needs to be paid for out of pocket.
How does diabetes care and technology vary throughout the country?
Currently there are pumps and CGM available only in major cities of China. However, the cost of these items is very high and the average person with type 1 diabetes cannot afford them. As mentioned above special care for people with type 1 diabetes is available only in the large clinical centers located in major cities so if you live in a rural area you are out of luck.
Traditional Chinese medicine (TCM) is a system of healing that originated thousands of years ago and is used in various parts of the country. It has evolved into a well-developed, coherent system of medicine that uses several modalities to treat and prevent illness. Unlike Western medicine, TCM is not concerned with measuring and monitoring blood glucose levels in diabetic patients. Treatment is individualized and geared toward assessing and treating the symptoms that compose patterns of deficiency and disharmony. TCM does not offer a cure for diabetes, but instead aims to optimize the body’s ability to function normally. As people with type 1 diabetes, we need to be careful and not be convinced to stop taking insulin or pills. However, it is believed that we can use TCM to help us stabilize our blood sugar and possibly reduce our medications.
Thank you to the lovely Mary Shi from China for helping us with information about living with diabetes in China.
Last updated 2018