In China, healthcare becomes the third rail

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By Andy Scott

SHANGHAI, Nov. 1 – Access Asia’s weekly update, which arrives in my inbox every Thursday morning in time to warm my heart with its wit and pedantic charm, had a very interesting take on the recent Party Congress.

The situation in China is starkly simple: lifestyle + environment + demographics = healthcare nightmare approaching. While the bulk of healthcare expenditure has been concentrated on urban areas, the rural healthcare system has to all intents and purposes broken down. But even the urban healthcare infrastructure is unable to cope with current demands placed upon it, and the decision of the NPC not to grasp the nettle of funding health will be compounded in the next few years, as the lifestyle + environment + demographics triple whammy hits in full force.

The coming bubble will include significantly higher rates of expensive-to-treat and often lifestyle-related afflictions including diabetes type 2, cancer (notably breast, colon, ovary, prostrate, endometrium, kidney and gallbladder), hypertension and coronary heart disease. Additionally, ailments related to environmental problems such as emphysema, lung cancer and acute respiratory infections are growing in terms of diagnosis rates. The bubble is then further expanded by the growing demand for treatment and care of an increasingly large elderly population. Add to these additional strains another (and perhaps far more severe) outbreak of a communicable disease such as SARS, and you have a potential total healthcare apocalypse, which the postponement of a serious healthcare policy by the NPC will leave China totally unprepared for. To be frank, the current healthcare system is unfit for purpose – the government knows it, healthcare professionals know it and many, many Chinese people also know it. Yet Hu dodged the issue.

Matthew Crabbe and Paul French are on to something here, the health care situation is indeed an imposing crisis, one that could severely undermine the party – if not collapse it. As we pointed out yesterday, the common Chinese person on the street cares little for the inner workings of the Party as long as they are left alone to make money. However, when the Party is seen as ignoring the needs of the population problems develop. Until now, most “mass incidents” – Beijing’s euphemism for public protests – have been over environmental issues and corrupt local politicians colluding with unscrupulous real estate speculators to steal land and property from the less enfranchised. But should healthcare become an issue, it will cut across a large swath of the society and effect both the rural poor and the growing urbanized “middle class.”

Remember that the rule Communist Party of China no longer absolute, the days of the cult of personalities – be that Mao or Deng – are gone. Bold edicts and visions – “to get rich is good,” “Communism is a hammer which we use to crush the enemy” – have been replaced by the tempered language of consensus and compromise. These competing interests make the health issue that much more potent is the years to come.

Judging by the recent Party Congress, President Hu Jintao is chiefly concerned with balancing the various political factions, rather than filling posts with qualified officials. “The concentration of decision-making powers in the hands of party apparatchiks runs counter to the doctrine of the “separation of party and government” first preached by late patriarch Deng Xiaoping in the mid-1980s,” writes Willy Lam. He goes on to note that although the promotion of officials from competing interests in the government may produce “socio-political stability, these goals may undercut tan equally important imperative like filling important posts with talented and experienced officers.”

If these political appointees are not up to their considerable tasks, Hu’s legacy and the ruling mandate of the CPC will come into question. With Madame Wu Yi now in retirement, who will Beijing turn to when they need something made right? This makes the lack of attention paid to areas like healthcare that much more troubling. As Access Asia pointed out, the future for many “may not be a harmonious old age for many, and spending decisions delayed now will simply add to the disharmony down the road.”