December 1, 2010 / 4:22 AM / 9 years ago

China's healthcare plans bump against rural skills gap

DONGYANG, China (Reuters) - Doctor Liu Youhong made do for decades with two years of rudimentary medical training, enough to meet villagers’ basic needs in his untidy rural corner of the eastern province of Jiangsu.

A victim injured from an accident receives medical treatment at a hospital in Shenzhen, Guangdong province June 29, 2010. REUTERS/China Daily

But now, the dearth of skilled medical doctors in areas such as Dongyang is proving a major stumbling block to ambitious plans to offer basic health care to hundreds of millions in rural China.

This skills gap has already forced China to slow purchases of medical equipment for the newly built clinics that are a pillar of its $125 billion healthcare reforms.

“The single biggest issue today is still the skill level of practicing officials in rural areas,” said Gao Zhan, whose company, Haoyisheng, trains rural doctors.

“Purchasing equipment is quick and easy. Education and training is not a simple issue that can be directly solved by money,” added Gao, whose company name means “good doctor.”

China is now using its new-found prosperity to try and extend health insurance and basic health care to all of its people, to replace the dismantled “iron rice bowl” which once promised cradle-to-grave security for industrial workers.

The healthcare reforms are also key for boosting domestic consumption, which would in turn feed into the government’s goal of reducing the economy’s dependence on export earnings, as many Chinese currently set aside a large chunk of their savings for private healthcare costs.

The reform involves a massive build-out of clinics in the countryside, suburbs and urban neighborhoods, designed to treat the simplest ailments locally and keep patients from flooding the specialized city hospitals.

Foreign medical equipment makers such as GE and Philips Electronics have seized the opportunity to outfit China’s 1,000 top tier hospitals, while Chinese manufacturers like Mindray Medical International see a boon in tenders to supply diagnostics, lights or ultrasound machines to 2,000 new or refurbished county hospitals.

Still, new buildings and shiny equipment aren’t enough.

Despite huge need and willingness to spend, medical skills and standards are still so thin in China that Mindray must look to export markets for 60 percent of its revenues.

“The current problem is that the central government has discovered that a lot of local hospitals have equipment, but not the people to operate them,” said Xu Hang, Mindray’s founder and chief executive, who believes the first wave of medical reform spending in China has already crested.

“They’ll need to take a pause, to make sure the equipment is being used.”


Rising wealth in the brown brick farmhouses of Dongyang village has brought chronic diseases that Liu can’t treat and funding for new equipment that Liu can’t operate.

“In the past when farmers were poor, most people came with diarrhea, but now as we are wealthier people have chronic diseases like diabetes or cancer — many times more than before,” Liu said, before seeing to the morning queue of elderly patients at his spartan clinic.

The government’s new insurance scheme gives villagers a discount on drugs and treatments in return for annual payments of as little as $3 a year. Affordable medicine plus the impact of richer food and widespread pollution are creating a flood of patients that exceed the rural doctors’ simple skills.

Some foreign drug firms, such as Merck & Co, have bid to be included in the essential drug list of affordable drugs, though others feel there is better money to be made by supplying the growing ranks of middle class Chinese who can afford private hospitals and branded drugs.

“China has 700 million farmers. If they had high blood pressure before, they just lived with it, and would only see the doctor if they had a stroke. They would live with diabetes without seeing a doctor unless they got gangrene in the foot,” said Zhang Fumin, director of the China Rural Medical Academy, a training organization.

“But with the health care reform their medical bills will drop dramatically and you will see drug demand from this group emerge.”

Rural doctors may be able to do simple first aid, but are flummoxed by an EKG readout or properly diagnosing chronic diseases, said Gao of Haoyisheng.

His group runs the China Rural Medical Academy and other programs under contract from the Ministry of Health to train rural doctors.

They supplement classes in county centers with online learning and a network of specialists that can assist with interpreting results once the doctor correctly wields a new diagnostic tool.

More than 300,000 village doctors in 18 provinces have passed through its doors.

The healthcare reform has brought another opportunity for Liu, the barefoot doctor in Jiangsu with uneven teeth and a calm, professional manner.

He and two partners have started their own dispensary in Dongyang, so that newly insured patients don’t need to travel to the county seat to get their drugs.

Now 64 and with no plans to retire, he embodies another looming human resources problem that could stymie health care advocates long after China’s skills gap is addressed.

Barefoot doctors can be trained up, but few fully educated doctors or nurses will want to move to the hard-scrabble countryside after the current generation is too old to work.

Editing by Miral Fahmy

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