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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

Can Ding dingcangut@gmail.com

What do U want to know ?

Can Ding dingcangut@gmail.com

Part I : Medical Education

Part II : Healthcare system

Can Ding dingcangut@gmail.com

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“

Can Ding dingcangut@gmail.com

Medical Education

1887

Can Ding dingcangut@gmail.com

Chinese Medicines

• Han medicine---“Traditional Chinese medicine”

Medical Education

1887

Can Ding dingcangut@gmail.com

Chinese Medicines

• Han medicine---“Traditional Chinese medicine”

• Mongolia medicine

Medical Education

1887

Can Ding dingcangut@gmail.com

Chinese Medicines

• Han medicine---“Traditional Chinese medicine”

• Mongolia medicine

• Tibetan medicine

• and many others branches

Medical Education

1887

Can Ding dingcangut@gmail.com

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 dingcangut@gmail.com

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 dingcangut@gmail.com

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

Can Ding dingcangut@gmail.com

Pro

Hand-on teaching

Individual training

good for practical learning

Apprentice Training

Medical Education

Can Ding dingcangut@gmail.com

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)”

Can Ding dingcangut@gmail.com

After War Colonies – big cities

Medical Education

Can Ding dingcangut@gmail.com

Top Medical Colleges Nowadays

Medical Education

Can Ding dingcangut@gmail.com

Western Medical Education

• American system --- 8 year MD

• British system –6 year education

Medical Education

Can Ding dingcangut@gmail.com

Western Medical Education

• German system - Diploma

Medical Education

Erlich Paulun Charité Alumnus

Can Ding dingcangut@gmail.com

Medical Education

Can Ding dingcangut@gmail.com

And now?

Unbalanced college quality Shortage of good students … …

• 5/6 year Bachelor

• 7 year Diploma/Master

• 8-year MD

Medical Education

Can Ding dingcangut@gmail.com

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

Can Ding dingcangut@gmail.com

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 dingcangut@gmail.com 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 dingcangut@gmail.com 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

Can Ding dingcangut@gmail.com

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

Can Ding dingcangut@gmail.com

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.

Can Ding dingcangut@gmail.com

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

Can Ding dingcangut@gmail.com

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

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Acknowledgement Thanks to all friends!

Town Hospital Tongji Hospital

www.ppthi-hoo.com Can Ding dingcangut@gmail.com