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Recently, many major American insurers have looked to international markets for new customers.  Thus far, major insurers have primarily targeted the booming expatriate market as their source for international customers, often times establishing field offices to better serve them.  A prime example of this trend is in China, where household names such as Aetna, UnitedHealth Group and Wellpoint have all recently established field offices.

The main reason for a growing expatriate segment in China is that various multi-national corporations are setting up shop to take advantage of China’s booming economic growth.  According to Martha Temple, president of Aetna global benefits, China is “…a real hotbed place for large U.S. multinational or multinational corporations [from other nations] to open or expand their offices.”  As a result, Insurance companies are cashing in by aggressively targeting expatriates.

However, with the slowdown of the US economy, and China experiencing social changes such as a booming middle and upper class, insurers are now pondering the decision of whether or not to offer insurance to Chinese citizens.  More and more Chinese are looking for western “luxuries” such as private health insurance as they experience and enjoy their newfound wealth.  Even though China has a basic national health insurance plan, many of the middle class and well-to-do nationals would opt to supplement the national insurance plan with private insurance to have a wider range of coverage.  And with a population over 4 times the size of the United States, China may be a much needed supplement to insurer’s US business.

Interestingly, foreign insurers within China must have a field office open in the country for two years before it may start selling its products, as required by the Chinese government.  Aetna, which only recently opened its China office, needless to say, will have a lot to think about in this period.  Possibilities of what to sell are diverse.  Insurers could opt to sell non-insurance products such as wealth management plans, or offer abbreviated services such as case management or diseases management insurance.  In any case, the outcome of these insurers’ decision will be an interesting one.

The Health Insurance Industry Convention is currently well underway in San Francisco this week and even though its only been one day record numbers of protesters are showing up to rally against the current healthcare system in the USA. This is occurring in the same week as the American Medical Association released its health insurance report card to individual insurers. All in all, it’s been a difficult week for American insurance companies.

Among the insurers rated by the report are companies like Aetna, Anthem BCBS, CIGNA, Coventry, Health Net, Humana, United Healthcare (UHC), and Medicare; and while the report has no ‘grades’ per-se, it does reveal some interesting facts about some of the country’s top insurance providers. The major focus of the report is with relation to how quickly doctors are receiving payment form insurers for services rendered to policyholders and the consensus is that most insurers are too slow.

According to some AMA members physicians are spending approximately 14% of their annual income simply to receive payment from insurance companies. And in the current economic climate, this is simply an issue that will not stand with the AMA. Paying out claims is a key issue, and failure to complete payments in a timely and efficient manner is resulting in a large amount of unrest among primary caregivers.

According to the AMA the worst offender when it comes to paying claims at the contracted rate is United Healthcare (UHC), with only 62% of all claims being paid, while Medicare was the best with a 98% completion record. While some insurers are able to follow through on Doctors payments with limited hassle many insurance companies are simply dropping the ball.

This is leading to a number of Doctors starting ‘boutique’ medical clinics in an effort to remove themselves from the world of insurance. With boutique clinics patients will typically pay a monthly, or annual, retainer under which they are entitled to 24/7 access to their caregiver. In addition to this Boutique medical practices are focusing on a more personalized form of medicine by only working with a limited number of patients, something which is paying off as many people in the USA are jumping ship and leaving the traditional system of healthcare.

There is a problem though, Boutique practices, due to the level of attention and care provided are only accessible by patients who are relatively wealthy, meaning that the majority of the American population is unable to use these services, which brings us back to the insurance companies. As mentioned previously, the Health Insurance Industry Convention has been rocked by large numbers of protesters clamoring for a single payer healthcare system. Single payer healthcare was supported by a number of politicians running in the presidential primary elections, most notably Senator Hillary Clinton, however with John McCain and Barrack Obama sealing their relative party nominations this proposal has a very limited chance of being established.

With the presidential election coming up in November the issue of healthcare is becoming ever more important to the American Public. With a number of proposals being floated to address the current problems in the system it is clear that there will have to be a fairly radical reassessment of healthcare in the US. According to the AMA this reassessment process should start with the insurance companies rather than with healthcare providers or the system as a whole.

With a number of insurers failing to meet their requirements towards primary healthcare providers it is clear that something must be done to address the system. When the domestic insurer who has the best record in settling claims is the one that is administered by the government then maybe it is worth looking at initiatives that would see the government prop up the local market. All that remains clear at the moment is that this crisis of care will not end anytime soon and that everyone in the American healthcare industry needs to be looking at viable options for the future. Whether this is in regards to improved claims handling, better insurance policy coverage, subsidies for prescribed medicines, or simply looking to lower the cost of healthcare, something must be done, otherwise there may not be the standard of quality healthcare that exists in the USA today.

You know it’s going to be a bad day in the healthcare industry when the chairman of the Federal Reserve, Bernard S. Bernanke, is predicting a massive rise in the cost of healthcare in the USA unless some serious measures to tackle the problem are introduced. At the same time as the Fed is struggling to come to grips on this ever worsening issue the Democratic and Republican presidential candidates are also starting to focus in on current healthcare policies and ways to change the present situation.

With the primaries over, and the presidential elections just round the corner, Barack Obama and John McCain are going to have to convince the voting public that they will be able to address the current healthcare crisis, and it may not be as easy as you think. Both these candidates know that their ability to offer a suitable solution may be the difference between winning and loosing a state. With that in mind we’re going to give you a brief rundown of the options and what they could mean if implemented.

The two main options on the table are:

Barack Obama’s Proposal

1.           A move to a paperless healthcare system where all patient records and health insurance documents would exist only in electronic form. This would be implemented along with quality disease prevention (as opposed to disease management), and ensuring portability of health insurance should a policyholder loose their job, and consequently their coverage.

John McCain’s Proposal

2.           Create tax breaks of up to $2,500 for individuals, and $5000 for families, who have purchased private health insurance. These tax breaks will occur each year, and while this would have a relatively limited impact on the number of uninsured individuals in the USA, it would create an incentive for private citizens to obtain their own health insurance rather than relying on their employer.

These two proposals aim to solve the current healthcare and insurance crisis in radically different ways. By removing paper from the healthcare industry Obama aims to eliminate one of the major sources of spending (namely paper) by moving everything to an electronic format. It’s easy to see how this simple proposal would save quite a bit of money, but there is a problem.

Electronic conversion is moving at a snails place in the USA; as it turns out, people like doing business on paper. In addition to this the amount of money being saved (an estimated $ 77 billion a year) is based off one survey, of which industry experts are not convinced about the accuracy. Disease prevention is always going to be less costly that disease management, but overhauling the current system to institute these reforms will be costly, and there is no guarantee that the implementation will have any effect at all.

By far the most promising part of this proposal, at least in the eyes of the American public, is the issue of health insurance portability should an individual loose his job, and subsequently their employment backed insurance. However, it is important to note that with the HIPPA and COBRA legislations the US government has already attempted, albeit not very successfully, to address this issue. Creating legislation to guarantee portability and renewability will always be an uphill battle, and may be harder than Obama realizes.

Citing immediate results may get Obama votes on this issue, but analysts are warning that even if these proposals are accepted by the government, the earliest changes to the system will happen approximately 5 years after the institution of the plan. This means that the USA would only see the benefit from these changes 1 year after the presidential term, and with the state of the healthcare system, this may be too long to ask of the average voter.

In terms of immediate impact the winner is clearly the tax break initiative proposed by John McCain. Creating a system whereby individuals would receive tax credit for any health insurance policy that they have purchased could be instituted immediately, which could give strength to the proposal in the eyes of the voting public. In addition to this McCain is not planning on upsetting the current free market system of healthcare in the USA, which would allow healthcare businesses to continue business as normal.

Critics of the McCain plan claim that this proposal would seriously undermine the American public’s ability to access healthcare as the policy would involve the removal of employer backed health insurance coverage. However, this is not the case at all. Under the tax break system suggested by McCain employees would still be entitled to job-sponsored insurance and this initiative would simply give a dollar for dollar tax rebate to any individual who had purchased medical insurance.

This would, in McCain’s eyes, give the American public an incentive to go out and buy health insurance, which would in turn reduce corporate spending, and improve the overall quality of health insurance plans which in turn would increase the availability of healthcare. If there truly was a free and open market for health insurance established in the USA, rather than the fairly closed system that currently exists, then obviously consumers would choose to obtain the best plan at the best price, forcing the insurance industry to adjust accordingly by increasing the quality of the products that they supply. However, critics are unsure and claiming that this rebate proposal would continue to isolate sick Americans who at present are unable to obtain private insurance unless they are covered by their employer.

Both arguments have their critics and supporters, and both proposals recognize that there is a fundamental problem in the American healthcare system. With rapid medical inflation, millions of uninsured and underinsured citizens and pharmaceutical prices skyrocketing this is an issue that may play a very important role in the upcoming elections. But it’s up to the voting public to inform themselves and understand the subject. Is one of these plans the way forwards for healthcare and insurance in the USA? Only time will tell.

A recent study by Civic Exchange, a Hong Kong-based think tank, estimates that poor air quality is accountable for nearly 10,000 deaths a year in Hong Kong.  Furthermore, pollution costs the city billions of Yuan each year in loss of productivity, sickness, pressure on medical beds and premature death.  With findings like these, air pollution can no longer be viewed as only a nuisance.  In fact, air pollution in Hong Kong is approaching a health care crisis with huge public health and public spending implications.

On most days in Hong Kong, the air quality is so poor that views of such landmarks as Victoria Harbor, Central’s skyline and The Peak are hampered or not visible as a result of thick, grayish smog.  Where is this smog coming from?  Many negligent citizens like to attribute the harmful smog to the many factories just outside of Hong Kong, dotting the Pearl River Delta.  While this idea holds some weight, a look into published research findings shows that over half of the pollution in Hong Kong comes from local sources.  Hong Kong is heavily reliant on coal-fired power plants, old diesel trucks and diesel powered ships.  If you’ve walked around any district in Hong Kong, you know what I mean.  New construction seems to be eternally on-going.  And all of these activities bring dangerously high levels of nitrogen oxide and particulate matter to Hong Kong’s air.

And given all these visible and statistical trends, air quality improvement initiatives seem to take a back seat to goals for economic prosperity and ignorance.  For example, studies have shown that the Macau-Zhuhai-Hong Kong Bridge being built now will increase air pollution.  Increased traffic between Macau and Hong Kong and further infrastructure development necessary to handle this increase in traffic are all contributing factors.

While many citizens complain about the pollution, little seems to be done about it.  Hong Kong’s Chief Executive, Donald Tsang, clearly demonstrated ignorance to the issue when he made the following statement:

“The life expectancy in Hong Kong is among the highest in the world … you can come to only one conclusion: we have the most environmentally friendly place for people, for executives, for Hong Kong people to live.”

While Hong Kong’s life expectancy may be high, data shows that this will decline rapidly if the air pollution problem is not addressed.  Tsang’s comments show that Hong Kong’s leaders are not fully committed to environmental issues.  In late 2006, the World Health Organization updated its air quality guidelines and ever since then local academics have pushed to have Hong Kong meet these guidelines.  Hong Kong Secretary for Environment, Transport, and Works naively stated:

“We’d rather prefer more practical and reachable targets that can be implemented with a strict timetable.”

With 90,000 hospital admissions and nearly 10,000 deaths a year being blamed on air pollution, Hong Kong will never be a truly global and modern city unless air pollution is brought down to reasonable levels.

We’ve talked quite a bit about the worrying amount of uninsured individuals in the USA, and while we’ve mentioned underinsurance the focus has more been on the plight of individuals with no insurance whatsoever rather than policyholders whose plans are not overly comprehensive. A recent study, however, has shown that the number of underinsured Americans has increased a staggering 60% from 2003 to 2007. This is equivalent to almost 25 million Americans, and in a bizarre twist, many of these individuals are in the middle to high income ranges.

But what’s the issue? Many commentators will say that these underinsured individuals, while not being comprehensively covered by an insurance policy, still have some protection, and due to their above average incomes will be able to contribute towards the cost of any medical treatment that they receive with very little trouble. This may have been true 20 odd years ago, but in the modern world this could be considered slightly delusional.

With the levels medical inflation during the 1990’s and early 21^st century, specifically in the USA, it is no longer possible for moderately wealthy individuals or families to afford out-of-pocket payments for healthcare. In fact the inability to pay for medical costs has become the number one cause of personal bankruptcy in the USA. The issue is that despite the country having some of the best healthcare services in the world, a large portion of the population is completely unable to afford any treatment.

Now an onlooker may say, sure – but that’s individuals with no insurance – people who have insurance should be able to afford this coverage. And they would be right; to a point. The study defined underinsurance as anyone who has an annual health insurance but still contributes 10% of annual income towards medical costs, and whose deductibles were equal to a further 5% of their annual income. Low income individuals who spent 5% of their income on health insurance or deductibles also qualified for this bracket.

Think about that for a second, in the midst of a global credit crisis and worsening economic fortunes for the average American citizen, many of these individuals are spending between 10 and 15 % of their total annual income on healthcare, and for many of these people this is without having ever seen a doctor! Compound the actual deductibles and co-pays on top of this and the situation starts to look extremely grim indeed.

With medical inflation reaching levels never seen before many domestic insurance companies are scaling back coverage, without also scaling back premiums. This is understandable, however it leaves the average policyholder woefully unprotected. International insurance companies are realizing, however, that increased coverage is most definitely needed as the costs continue to rise. A great example of this would be seen with IHI Danmark’s travel insurance; over the last year IHI saw the increased need that travelers have for comprehensive protection and raised the overall maximum benefit of the policy to ‘Unlimited’. This means that under the new IHI travel policy there is no coverage limit, and this move has seen the company increase the number of policyholders obtaining these short term travel medical insurance policies.

Now obviously the above example would only work for individuals who are planning on being outside of their home country for a period of time, but the idea is clear. In a time when domestic health insurance companies in the USA are scaling back coverage a number of international insurers are going in the opposite direction and providing more.

The point is this, increasing premiums and healthcare costs in conjunction with lowered coverage is leading to more and more Americans finding themselves in a position where they are simply unable to access, or afford, the healthcare that they need. With a 60% increase in the number of underinsured Americans in the last 4 years, and the total number of Americans who are either uninsured or underinsured at 75,000,000, its not hard to see how this situation will worsen in the years to come.

The United Kingdom is often cited by supporters of universal healthcare coverage as being the epitome of a national healthcare service, and while it is true that Great Britain is able to provide British citizens with quality healthcare services for little to no cost, the picture is not as rosy as it may seem at first glance.

While the National Health Service still has the biggest share of the healthcare services in Britain, there is an increasing trend of individuals choosing to separate themselves from the government services by obtaining private medical insurance. One of the more staggering statistics, for a country with an internationally lauded healthcare service, is that the number of individuals who have private health insurance has exceeded 6 million for the first time in 5 years.

This comes as the British government is considering tax reforms that would see young British workers contribute to a new social security initiative benefiting the nation’s elderly. Following on from this comes the fact that a growing number of young professionals in the UK are moving ever further away from government provided services, choosing instead to obtain private medical coverage and insurance.

 

 

So what’s going on?

Younger people in the UK are beginning to become disenfranchised with the current system. Poor response times, large amounts of paper work, and a general all pervading sense of bureaucracy have served to disillusion large amounts of the population away from this previously ‘lauded’ system.

According to the Association of British Insurers (ABI) more companies than ever before are taking out private medical insurance in a bid to offer competitive benefits packages to prospective employees, and if the national service was all that it is cracked up to be, then this would not be a serious issue.

However, the fact that BUPA, the UK’s largest provider of health insurance, recognized 20% growth in sales during 2007 should attest to the fact that no longer can the UK simply rely on the medical service as it exists today.

In addition to the NHS’ bureaucracy there is a serious lack in qualified medical professionals, such as nurses, large amounts of overcrowding, poorly maintained treatment facilities and a virtual mountain to climb for treatment access. Is it any wonder that more and more individuals are choosing to go private over this public behemoth? And the situation won’t improve for the NHS, especially if a proposed imitative to give tax credit to organizations that provide private medical coverage to their employees goes through; a proposal remarkably similar to one made by Representative Ron Paul in the USA.

And all of this comes at the same time as politicians on the other side of the Atlantic are becoming increasingly vocal about the need for the implementation of a Universal healthcare system.

There are no hard and fast answers when considering health. However the trends in recent years, especially in countries like the UK which provide free medical treatment, are worth following.

According to a recent New York Times article, America has an estimated 48 million uninsured citizens and this number may soon increase due to the economic downturn being felt across the country right now. Not only is this downturn pushing people out of being insured, but it is also dramatically affecting the insured population.

An increasing reality for many of the 158 million citizens that are insured through their employers is that medical costs are becoming unaffordable. Rising prices for food and gasoline are making many Americans think twice about their spending on health care. From another perspective, rising insurance premiums, narrower coverage, and bigger deductible and co-pay requirements are pushing health care prices through the roof. It follows that many insured Americans are not financially prepared for the costs of emergency room visits and necessary surgeries. They are choosing to pay for food and gasoline over necessary doctor visits.

According to consulting and accounting firm Deloitte, nearly one fifth of the average household’s spending goes to health care. Since 2001, health care premiums for families have risen to $3,300 from $1,800 while incomes have not increased enough to cover this change. Another survey by Deloitte points out that less than 10% of American feel they are financially prepared for their future health care needs.

Employers are also feeling the effects of a soft economy. Expenses for health care are skyrocketing and as a result, many employers are passing on these increased costs to their employees. Many have begun pushing for consumer-driven plans where lower premiums come in the form of higher annual deductibles. According to the New York Times article, nearly 6 million Americans are now enrolled in such plans.

With Presidential Elections coming later this year, it should be very interesting to see what remedies each candidate puts for and how the nation responds.

Its no secret that the American healthcare system has some serious issues, from massive underinsurance to high treatment costs, the general outlook is pretty grim, which is why the issue has been a key point in the presidential election race. However, despite the rosy promises from the 3 main candidates the problems are about to get a whole lot worse. The issue is this, 78 million baby boomers (individuals who were born between 1946 and 1964) across the USA are about to reach retirement age and are entering a geriatric healthcare system that is simply not prepared for the patient load that it is about to receive.

As individuals age their propensity for developing a serious illness or chronic condition rise enormously, it is a simple truth that older people need more medical care than younger individuals. With this being common knowledge one would assume that the healthcare system would have adequately prepared for this eventuality, yet the reverse is true; doctors, medical facilities, and most importantly the domestic insurance industry, do not have access to the services required by geriatric patients.

An example of this upcoming fiasco can clearly be seen in California, where state legislature estimates that there is only one specialist geriatric doctor for every 4000 patients over the age of 65. In a situation like that there are going to be some serious problems, mainly pertaining to availability of treatment and quality of care especially when taking into account that a majority of these geriatric ‘specialists’ have received only rudimentary training and that doctors who have been trained in geriatric care are quickly moving to different specialties in search of better pay.

Add to this, already grim scenario, the shortfall in social security, the limited coverage offered by Medicare, and future budget cuts (expected to begin in July of this year), and essentially you are left with a healthcare system that is leaving a large proportion of Americans without the coverage, or treatment, that they deserve, but it doesn’t end there. As the healthcare system struggles to address the problem with the baby boomers other parts of the population will have services denied to them.

So what are the options? How can the system possibly cope with a patient load of this magnitude that will require constant care and attention without suffering? A good start would probably be to totally re-examine the system as it exists today. With millions of individuals either underinsured or with no insurance coverage whatsoever, the highest costs associated with medical treatment in the world, doctors with insufficient training, a high patient to doctor ratio, and a patient load that will increase every year, especially with regards to care intensive conditions (approximately 18% of the baby boomer population, or 14 million people, are expected to develop Alzheimer’s in their lifetime), it is difficult to see what can be done to resolve the matter of a system that is unable to cope with the burdens required of it.

One of the proposed solutions in to create a universal healthcare system that would be heavily subsidized by the government, however with the myriad of problems that currently exist in the system (namely healthcare in the USA being incredibly over burdened already) a universal healthcare service would be incredibly hard to implement. Add to this the wide ranging medical budget cuts, and it becomes evident that there is simply no room to create a national healthcare service providing low-cost, available care, despite the fact that this is tremendously appealing to the American public.

One, potentially, workable idea would be to subsidize the primary physicians as on of the major factors contributing to this situation arising is the extremely poor pay that frontline medical staff receive (half of the medical professionals providing care for the elderly receive less than US$ 9.56 an hour). If this is not workable, then perhaps low cost training could be used as an incentive to bring more qualified professionals to the field, as the training and qualification structure exists right now many doctors and nurses have to undergo extensive testing and, in some states, more than 150 hours on the job practice in order to be considered ‘geriatric qualified’; that’s a lot to ask for such poor reimbursement.

However, when looking at the reasons for this crisis and how it developed, a large amount of the blame seems to lay with Medicare, Medicaid, and the rest of the low-cost, ‘budget’, government backed insurers. By not providing quality coverage, creating absurdly low limits, and placing long lists of exclusions on many policies, these organizations don’t seem to have the interests of their policyholders, or the American public, at heart. Many elderly patients require care from a team, rather than just one medical professional, yet this extremely valuable service is not an included benefit under a Medicare plan, depriving these older policyholders the treatment that they need.

There is no easy or quick fix for the present medical nightmare that is about to hit the USA, all the proposed solutions, and even the possible solutions, will require a large amount of money and a complete shift in the way that Americans obtain their healthcare. All that can be done now is to wait for the major problems to start and address them as they happen, that or purchase an insurance policy from a company not linked to the US government.

In recent years, China has been facing a health care crisis in its rural regions. During China’s great Cultural Revolution and the several decades following it, rural health care was in prime form. Nine out of ten country people had access to subsidized health clinics run by government sponsored doctors. From 1952 to 1982, the infant mortality rate fell from 200 per 1,000 live births to only 34. Average life expectancy increased nearly doubled from 35 years of age to 68 years of age.

However, after an age of great development in health care, progress in rural China seems to be reversing. China’s nationwide push towards capitalist ideals has been a large cause of this. While China’s cities are developing at incredible speeds, rural China is being left in the dust. But ignoring these rural areas may end up hurting China as a whole if not dealt with soon.

Today, 79% of rural residents have little or no health insurance. With new capitalistic ideals, China’s hospitals have been told that they now need to finance a larger portion of their expenses themselves (previously, hospitals were heavily subsidized by the government). To cope with this, hospitals are increasing fees for their patients. It follows that out-of-pocket spending for country residents on health care is sky-high.

It is no doubt that China’s economy has been booming. A look at almost any economic measure shows significant progress. For the past 20 years, average annual GDP growth has been a stunning 9.7%. According to the World Bank, China has lifted 400 million people out of poverty in the past two decades.

The trends in economic prosperity and health insurance coverage are on a crash course and it looks as if China’s health care problems could overpower China’s economic growth. Many rural residents who fall ill choose not to seek necessary medical attention. This choice is dangerous and often lethal. Oftentimes, many residents who do chose to seek medical care do so at the expense of living above the poverty line. In other words, the out-of-pocket expenses the rural residents pay, when ill, put them back below poverty. There have been numerous reports of rural citizens using education, food, and living expenses towards medical bills.

Furthermore, the traditional Chinese way of borrowing money from friends and family to pay for expensive medical conditions could become difficult. The working population, alike much of the developed world, is ageing fast and according to some predictions, China will have only two working people per person over 60 years old in 2040 – in other words, there will be fewer working people to borrow from. Currently there are 6.4 people for every person over 60 years old. According to a report by the Centre for Strategic and International Studies, China may be the first country to grow old before it becomes rich.

These obstacles have nation-wide, and even global, health implications too. Many epidemics such as SARS, Bird Flu, and HIV are not easily contained in rural China directly because these areas lack proper health care. In a worst case scenario, it is imaginable that these diseases could become more widespread internationally as a result of poor containment in rural China.

The most effective way to curb this dilemma is to offer affordable health insurance in rural China. Increases in national economic prosperity and development can only take China so far. Full development into a mature and well-developed country requires a comfortable lifestyle for all of its citizens, or at least accessibility to it. The inability for so many residents to pay for their own health care and well being does not make for a comfortable lifestyle. Thus providing adequate healthcare to all of its citizens is one area China will need to master before it can be labeled well-developed.

Xiamen is one of the oldest trading ports in China. First used by Europeans in 1541, it was the primary source of Chinese tea to the west. When China went through a period of isolation it was Xiamen, along with 4 other major cities in China, which reopened the country with the Treaty of Nanjing following the Opium wars in 1842. All of this has contributed to the global feel of the city and is one of the reasons that in this new age of Chinese prosperity more and more foreign nationals are choosing to relocate to Xiamen on a permanent basis as expatriates.

One of the major concerns facing many individuals who have newly arrived in Xiamen is in regards to the state of healthcare in the city. As a Special Economic Zone (SEZ) Xiamen has some major differences from the rest of the PRC, mainly with regards to the standard of living and the way that the local economy works, however the healthcare system in the city works along very similar lines to the system of care throughout the rest of the country with only a few minor differences.

Public health is a major concern in China. Since the founding of the People’s Republic the provision of quality healthcare to all citizens has been a major concern for the government. The main emphasis of the Chinese healthcare system has always been towards preventative care, and this is no different in Xiamen. With stress being placed on adequate sewage services and primary care points, the Xiamen healthcare service aims to prevent disease before it starts. Sanitation, hygiene, and the irradiation of the four major Chinese ‘pests’ (mosquitoes, rats, flies, and sparrows) have all contributed the health of the Xiamen population as it exists today.

Despite a number of failed public health initiatives, including the unsuccessful ‘barefoot doctor’ scheme, many of China’s major cities have managed to provide healthcare services on par with a majority of 1^st world countries. In Xiamen, partly due to its status as an SEZ and the fact that so many expatriates reside there year round, the city has realized the development of a number of VIP medical institutions, known colloquially as gaogan binfang. While these ‘VIP’ hospitals and medical clinics do not typically offer services that are easily affordable by many Xiamen residents, they will provide the services and treatments demanded by expatriates throughout the city, although at a much higher cost than any of the cities many public hospitals.

Chinese hospitals are all ranked based on the quality of treatment and the types of services that they provide. The ranking system will assign a number (1 – 3) to a medical facility, and under this ranking a hospital or clinic with the number 3 attached to it will always offer the best services; a rank of 1 is extremely low, and these facilities may not offer services outside of immediate emergency care. Under this numerical ranking system each hospital will also receive a letter grade of A through C, 3A hospitals will always provide the best medical services while 3C hospitals will still provide good, if slightly limited, care.

Xiamen has over 1000 medical facilities, although not all of these will be able to cater to foreign patients, mainly due to language barriers. In order to resolve this situation Zhongshan Hospital created a special ward specifically targeting foreign nationals with doctors and nurses who are fluent in English and afford patients fast and efficient care. In addition to this the Xiamen Chinese People’s Liberation Army Hospital also has an excellent reputation among the Xiamen expatriate community, especially with regards to maternity and dental treatment.

For foreign nationals in China the local healthcare system essentially boils down to finding a medical facility that is trustworthy and able to provide a high standard of care. Some of the better medical facilities in the city catering to expatriate needs are:

Zhongshan Hospital

201 – 206 Hubin Nan Lu

Tel: 2212328

Email: admin@xmzsh.com

Xiamen #1 Hospital

Zhenhai Lu, #10 Gujie

Tel: 2137275

Email: yb@xmfh.com

Chinese People’s Liberation Army Hospital

94 – 96 Wenyuan Lu

Tel: 6335500

Email: info@xm174.com

Xiamen University Hospital

172 University Road

Tel: 2186203

Outside of these main medical facilities are a number of primary care (out-patient) clinics, and every neighborhood will have a number of doctors providing out-patient services. In addition to this Xiamen is able to provide Traditional Chinese Medicine (TCM) treatment and there will typically be a traditional ‘pharmacist’ or practitioner in every district.

Healthcare in China can be a scary proposition to expatriates who have recently arrived in the country; however the country is able to provide world class healthcare services. For anyone arriving in Xiamen, get involved in the community and find the medical facility that is right for you and your loved ones, it could be a more important choice than you realize.

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