Saturday, 5 July 2014

Looks like Lancet editor Richard Horton was bamboozled by China's health minister Li Bin

by Michael Woodhead
A very disappointing commentary from Lancet editor Dr Richard Horton about his recent trip to China, where he met (again) health minister Li Bin.
He starts off with a slightly baffled (and disapproving) anecdote about the minister quoting free marketeer Adam Smith on the move to raise doctor's salaries (and presumably pay them according to what the market will bear rather than what patients can afford).  Without analysing this stunning bit of neo-liberal health policy from a Communist Party health minister, Richard Horton then plunges on by saying (without irony) that the west misunderstands China and treats it as a 'threat'. Instead, he says we should see China for the fragile state it really is, with precarious health reforms yet to bring real benefits to many of the people. And the west should provide support for China's health reforms.
Richard Horton says this was his second meeting with Li Bin - the last time she had just been appointed and had little to talk about (after replacing old lag Chen Zhu, who now heads up the influential doctor-lobby in the form of the Chinese Medical Association). On this second meeting, Li Bin apparently gushed about the progress made by her newly created National Health and Family Planing Commission. And Dr Horton repeats these claims uncritically. The expansion of health insurance (yes but it still doesn't cover even the basics), the family planning 'refinement' (revolution, more like, abandoning the one child policy), improvements in hospital management (what improvements?) and strengthening of public health services (again, what exactly? If anything, public health services have weakened with the continuing shift to income-generating activities).
Richard Horton repeats Li Bin's claim that the essential drugs list has been expanded - without mentioning that this has been a failure in making drugs affordable, because reputable manufacturers have simply stopped making drugs whose prices are capped at an unprofitable level ... he notes with approval the minister's remarks that drugs are too expensive (true) but fails to mention that this is due to the big markups imposed by hospital pharmacies, which are controlled by the local governments. The minister says there will be a zero markup policy, but fails to explain how hospitals will then meet the shortfall in funding this will create, as about 40% of hospital income comes from drug sales.
There is also approval for China's new 'zero tolerance' approach to corruption in healthcare, and yet in the same week we have seen a fraud investigator (and a fellow British citizen of Dr Horton's) jailed in China and about to undergo a secret trial for investigating corporate-government fraud in pharmaceutials and hospitals. It seems the Party will decide what is fraud and what it will and won't tolerate.
Richard Horton then praises Li Bin's standardisation of doctor training, again without asking how this will serve the most deprived areas of China that have relied on 'barefoot' village doctors and will be unable to attract and retain the new stream or more highly-qualified medical graduates.  At a time when the west is looking to use more physician assistants, China is phasing them out! And oddly, Richard Horton (or perhaps Li Bin) fails to mention one of the biggest changes in China - the move to create a primary care system and try get people to attend community health centres. This is shaping up to be  a huge reform, but seems to be unpopular with patients, who are still voting with their feet and going direct to hospitals. Perhaps that's why Li Bin kept quiet about it.
All in all, this is a very strange and sub-standard commentary from an international medical thought leader who is renowned for his interest in global health. If the NHS adopted the free market policies now being embraced by China, I'm sure Dr Horton would be penning furious editorials about deregulation and the shift to user-pays private clinics. Perhaps he has sucumbed to the usual Chinese tactic of flattery and self deprecation. The Lancet readers deserve more insightful and more critical reporting of healthcare in China.

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