share-introduction to chinese
TRANSCRIPT
A Brief Introduction to Medical Education and Healthcare System in
China
Can Ding
First-hand Data Sources Can Ding • Trained in western medicine in Tongji Medical College
founded initially by a German doctor
• ~5y Experience in Tongji Hospital
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cucurbit
Chinese Medicine vs Western Medicine
Arise from the different culture environments
Medical Education
Rod of Asclepius
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Chinese Medicine vs Western Medicine
Medical Education
Karl Theodor Jaspers----
East: natural way, harmony
West: logic, ration, reasoning process
“vom Ursprung und Ziel der Geschichte“
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Chinese Medicines
• Han medicine---“Traditional Chinese medicine”
Medical Education
1887
Can Ding [email protected]
Chinese Medicines
• Han medicine---“Traditional Chinese medicine”
• Mongolia medicine
Medical Education
1887
Can Ding [email protected]
Chinese Medicines
• Han medicine---“Traditional Chinese medicine”
• Mongolia medicine
• Tibetan medicine
• and many others branches
Medical Education
1887
Can Ding [email protected]
Chinese Medicines
• Han medicine---“Traditional Chinese medicine”
• Mongolia medicine
• Tibetan medicine
• and many others branches
Medical Education
1887
Separately formed and developed in over 2000 years • Concepts: by different ethic groups • Treatments: Diseases (local geographical feature),
Meds (biological resources) Can Ding [email protected]
Apprentice
• one-for-one
• Several subjects
• start at age 12~16, even at 9
• Various duration
Medical Education
http://www.chenfeihong.com/a/taiji/jiaoliantuandui/20140328/292.html Can Ding [email protected]
Learning the medicaments
(Herbs and more) ~ 1 years
1. Memorize prescriptions and rhymes
2. Fundamental theories
3. Study the ancient books, classics
Herbs Theory
Medical Education
Apprentice in Medicine
Stand-by Observation
1. Observe how “Shifu” exams patient
2. Copy the prescriptions for patients
Practice and Graduate
1. Exam and prescribe under supervision
2. Approved by “Shifu” and graduate
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Pro
Hand-on teaching
Individual training
good for practical learning
Apprentice Training
Medical Education
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Pro
Hand-on teaching
Individual training
good for practical learning
Contra
Apprentice Training
Medical Education
Limited amount of apprentices
Various training quality and no control
“valuable experiences are exclusively for son (inherits same family name)”
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Western Medical Education
• American system --- 8 year MD
• British system –6 year education
…
Medical Education
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Western Medical Education
• German system - Diploma
Medical Education
Erlich Paulun Charité Alumnus
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Medical Education
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And now?
Unbalanced college quality Shortage of good students … …
• 5/6 year Bachelor
• 7 year Diploma/Master
• 8-year MD
Medical Education
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And now?
Unbalanced college quality Shortage of good students … …
• 5/6 year Bachelor
• 7 year Diploma/Master
• 8-year MD
Reforms!
Part II : Healthcare system
RMB as currency ! 1Euro = 7.3 RMB
Healthcare system
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Health Insurance system
Healthcare system
Workers
Residents
peasants
without
“Cooperative Health Insurance” For peasants 735 million
“ Health Insurance for Employee” 280 million
“Health Insurance For Residents”
310 million
Can Ding [email protected] til 2014 Nov
Health Insurance system
Healthcare system
Workers
Residents
peasants
without
“Cooperative Health Insurance” For peasants 735 million
“ Health Insurance for Employee” 280 million
“Health Insurance For Residents”
310 million
Can Ding [email protected] til 2014 Nov
95% ! 75 million without!!
Hospital Hierarchy
categorized into 3 different levels
Source: https://www.hqms.org.cn/usp/roster/index.jsp
• Level 3: in big cities, huge size
• Level 2: Intermediate size
• Level 1: smallest size, in small towns and communities in cities
Healthcare system
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Examples
Tongji Hospital, Wuhan
Level 1 hospital–
In a small town in the middle of china
Healthcare system
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Stone Gate Town
http://www.spz.gov.cn/look.asp?vid=12
309 square kilometers, including 51 villages, 2 main communities, with 80,000 inhabitants.
Healthcare system
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Station
Ambulance
70 – 100 visits per day
70 beds; 40 – 60 beds daily in use
Healthcare system
• 104 Staffs in total.
• monthly income: Seniors ¥3000 – ¥4500, juniors ¥ 2000 – ¥3000
(AVG peasant monthly income in 2011-- ¥700 )
Hospital in Town
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1960s 1970s
Children: malnutrition, malaria, epidemic meningitis, etc. Adults: Filariasis, Schistosomiasis, TB, etc.
Hypertension DM Calculi TB
Healthcare system
Prevention and Treatment Tasks
1980s 1990s 2000..
Calculi
Hypertension
HBV hepatitis Hemorrhagic fever with renal syndrome
HAV- associated hepatitis
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Station
Ambulant Visit
o Basic medicaments: get 40% back, max. ¥20 per day, ¥500 per year. (Drug cost in one day max ¥50 , one year ¥1250)
o Examinations: co-pay o Medical Treatments: max. ¥7 per day
o ¥200 Deducible o < 2000 : 80% back of basic
med, bedding, Examinations o > 2000 : lower than 80%
“Cooperative Health Insurance” for peasants
Healthcare system
Annual fee: ¥70 per year
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per visit cost: ¥5 – ¥100
Tongji Hospital
Healthcare system
http://ge.tjh.com.cn/Index.shtml
German Website
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Station
Ambulance
3.8 Million visits
4000 beds; 154 000 stationary patients 61 000 OP
Healthcare system
Tongji Hospital
2013
• 6000 Staffs in total.
• Tremendous actual work are carried by PJs and training doctors.
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Health Insurance system
Healthcare system
“ Health Insurance for Employees” 280 million
• “Employed”, governmental officers, teachers and those, whose employers willing to pay
• 6% of income by employer, 2% by employee • Ambulance: co-pay. Station: ~70% back
“Health Insurance For Residents” 310 million
• Enterprise Employees, unemployed, elderly, children, etc.
• Annual fee: ¥160 – ¥660. • Ambulance: co-pay. Station: ~ 50% back
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TOO COMPLICATED!!
Station
220 beds in total; Station brutto ¥234 206 613.28 ¥50557.57 per patient Dr. W as junior attending ---20 beds
Healthcare system
Tongji Hospital
2013 Department of orthopedics
ref. AVG annual income in Wuhan ¥52 387 in 2013
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Senior
Attending
Residents/Trainings
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Part I : Medical Education Traditional apprenticeship extinct. Inequitable, diverse range of colleges
Part II : Healthcare system resource are distributed unevenly
www.ppthi-hoo.com Can Ding [email protected]