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If you visit your doctor today and tell her about your symptoms, chances are she will take notes. On a notepad. Using paper and pencil. Seem a little old fashioned? That’s what lawmakers are thinking, too, and that’s why one act in particular passed along with Obamacare focuses solely on promoting electronic medical technology – it’s called the Health Information Technology for Economic and Clinical Health Act, or HITECH, for short.

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For those living in the Middle East, asthma and other respiratory problems continue to be a constant issue and topic of discussion. Statistics indicate that about 13% of adults and 25% of children in the United Arab Emirates suffer from a form of asthma. The World Asthma Foundation has released data suggesting that the number of people with asthma will increase by about 70% in the next 25 years in the region.

Some of the biggest factors contributing to these statistics are the annual sandstorms and the ongoing construction works taking place. The continuous construction in the area has created large amounts of dust and pollution in the air and PM10 levels, the measurement of small particles that can penetrate lungs and create respiratory problems, tend to be consistently high, often above the recommended level suggested by the World Health Organisation.

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Seeing as November is Alzheimer’s Disease Awareness Month, it’s only fitting that an intriguing discovery about Alzheimer’s and genetics was reported last month. The gene of particular interest to researchers is called TREM2, and people with a variant on that gene appear to have triple the risk of developing Alzheimer’s Disease. TREM2 may hold vital clues to late-onset Alzheimer’s, and some scientists are calling it the most important Alzheimer’s discovery in 20 years.

So, what exactly is the TREM2 gene, and why are people so excited about it? A normal brain (with a normal TREM2 gene) is helped by a good immune system; when brain inflammation (such as that which occurs in an individual with Alzheimer’s Disease) strikes, the immune system helps by sending in anti-inflammatory molecules called microglia cells. These cells are also useful to the brain due for their ability to clean up amyloid plaque, a dangerous build-up responsible for killing brain cells. Basically, imagine the microglia cell wearing an apron and holding a tiny feather duster.

With the TREM2 variant, however, these friendly microglia cells turn not only ineffective, but also calamitous. Now, instead of stopping inflammation, the cells release cytokines which actually produce inflammation. Whereas before microglia cells were bustling little workers, with the TREM2 variant they become lazy and stop cleaning plaque. This plaque can build up and destroy healthy brain cells; cell destruction plus inflammation is a sure recipe for decreased brain function and dementia-type symptoms.

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One of the signs that Dubai is continuing to show recovery after the 2008 Financial Crisis is through the growing health insurance industry. Many of the leading health insurance providers in the region  are all reporting increasing numbers of insurance quotes and information requests from people interested in obtaining medical insurance.

Globalsurance continues to expand its services and operations in the region, attributing the influx to more and more inquiries from new clients and expatriates that are relocating to Dubai.

Tim Slee, Global Sales Director for Bupa International commented on this growth:  “There is an exciting new level of increased activity across the Middle East, this increased interest has led to a strong conversion rate of international medical insurance sales in the UAE.” Bupa International has seen encouraging performances and maintains a strong presence in the region because of the diversified products they offer with their cooperation with Globalsurance.

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Thanksgiving means a lot of different things to a lot of different people. For some, it’s a hectic day of travel and family reunion; for others, it’s all about the big game and the even bigger turkey; but nearly everyone can agree that Thanksgiving is an absolutely excellent excuse to eat good food with good people.

Unfortunately, Thanksgiving is also a time when insurance claims spike. Due to just a few dangers associated with the holiday, that final Thursday in November can expect to see claimants file for house fires, road accidents, and personal injury. These issues are to be expected, what with hubbub and hassle in the kitchen, along with long car journeys and unexpected bouts of wintery weather. However, you may be surprised to learn what many firefighters as well as other health and safety workers deem Danger Number One on Thanksgiving – deep fat turkey fryers.

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When Barack Obama was re-elected to the White House this November, America was reminded that not only is Obama the first African-American to preside in the Oval Office, he is the first president to make health care a primary component of his presidential legacy.

Obama’s re-election will certainly have important and lasting effects on the Patient Protection and Affordable Care Act, better known as the ACA or simply Obamacare. Passed by Congress and approved by the Supreme Court during Obama’s first term in office, the American public has already seen plenty of positive changes thanks to Obamacare – 3.1 million young people are insured who otherwise would not be, Medicare patients are receiving better services in hospitals across the country, and for the first time in four years, the U.S. Census Bureau has reported a fall in the number of uninsured Americans.

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November 8th marked the official re-branding of the AXA Minmetals Ultracare International Medical Insurance Plan in China with a new, updated name, ICBC AXA Ultracare. The move comes after the shift in the majority shareholding from Minmetals to ICBC.

This change is only one of a few to have occurred in regard to the ICBC medical plan in China. Globalsurance CEO, Neil Raymond notes that these modifications are definitely steps in the right direction; “The ICBC AXA plan was the first true global health plan in China to be onshore and licensed, initially with RSA, then Minmetals and now finally ICBC. During this transition the plan has had its ups and downs but we feel very positive about the current changes,” he said.

Some of the other changes that have taken effect refer to plan benefits and premiums. These changes are seen as a positive shift by analysts at Globalsurance, and they maintain optimistic outlooks that this plan will continue to perform well.

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When Hurricane Sandy struck the East Coast late last month, it left stunning devastation in its wake: Fire, flooding and explosions, severe property damage, and all this on top of everyday hassles such cancelled flights and the nearly week-long shut-down of public transportation.

During a natural disaster like Sandy, area residents of course face a number of risks not only to their property but also to their own health. To start, because a storm can affect public facilities such as chemical plants or sanitation works, there may be hazardous waste or a lack of access to clean drinking water. Flooding and debris can cause bodily harm, but also prevent the injured from seeking medical attention. In fact, simply being isolated during a storm can greatly harm the health of citizens trapped without sufficient food and water.

What’s more, those citizens who are already ill or medically dependent will often face an even greater challenge during a natural disaster. Seniors who are dependent on prescription drugs or in need of frequent dialysis, for example, will need to take extra steps during a storm to receive the medical treatments they depend on. Likewise, seniors living in a skilled nursing home must contend with a greater risk than most when forced to evacuate, and of course citizens young and old who depend on diabetic injections or medical equipment such as an oxygen machine will require additional assistance and care when a storm strikes.

Luckily, for those most in need as well as those in perfect health, the medical response to healthcare needs during Hurricane Sandy was largely determined to be a success. The U.S. Office of Health and Human Services (HHS) took many steps to insure a good level of care for the public, beginning with the immediate deployment of Fist Action Response Teams through the Public Health Service (PHS). Within three hours of the storm striking, this rapid-deployment branch of the PHS was headed to New York and New Jersey. These teams, as well as other HHS personnel who arrived later on, included nurses, doctors and pharmacists from across the country. The PHS was also careful to deploy professionals and volunteers experienced in the area of mental healthcare, to help combat some of the trauma of a disaster on the scale of Hurricane Sandy.

Those Public Health Service responders has a great impact on stymieing what medical issues they could following the hurricane. Teams set up shelters in local colleges and gyms, providing first aid and further medical assistance to those people unable to get to a hospital due to flooding, debris or personal injury. For people with greater healthcare needs, PHS members assisted them in moving to a hospital as soon as possible. At local shelters, PHS provided beds, generators, and the equipment necessary to create a hospital-like facility. PHS medical volunteers were absolutely essential in this situation, providing skilled nursing and all kinds of assistance to those in need of emergency as well as routine medical treatment. As of November 13^th, at least 1,000 HHS member still remain active, showing an admirable commitment on behalf of the department to following up on healthcare needs.

Besides the work of personnel, public health organizations assisted disaster victims through key waivers in healthcare policy. When the Secretary of Health and Human Services declared a public health emergency on the 31^st of October, she also signed off on a series of agreements to temporarily change the law. These policy changes were authorized to assure that the best healthcare possible reach those affected by the storm. For example, the law states that a doctor in New York will normally have to hold a New York medical license in order to practice in that state. During Hurricane Sandy, however, that policy was waived to assure that volunteer medics from out-of-state had free range to help patients. Similarly, requirements regarding the condition and pre-approval of a medical care facility were waived to ensure that appropriate treatment could legally be given in temporary shelters.

Changes in healthcare policy at a national level had especially important effects for Sandy victims enrolled in public insurance programs such as Medicare, Medicaid, and the Children’s Health Insurance Program. The Centers for Medicare and Medicaid Services approved important blanket policy waivers affecting New York and New Jersey – seniors no longer had to wait a required three days in a hospital before receiving coverage for a move to a skilled nursing facility, bed increases in hospitals were authorized without the need for a formal request, and emergency, unscheduled dialysis was deemed payable under a patient’s prospective insurance coverage. Many more waivers were instituted as well, and these policy alterations, along with acts such as the Emergency Prescription Assistance Program also activated by the HHS, insured that those on public health plans or with no insurance at all could still access the necessary healthcare.

It is also worthwhile to note also the role that the internet played in protecting the health and safety of citizens during the aftermath of Sandy, as well as before the storm had hit. Well-run and informative pages from the Department of Health and Human Services, the Centers for Medicare, Medicaid and Children’s Health Insurance and other public health organizations such as the Environmental Protection Agency kept East Coast residents up-to-date on the progress of the storm, and offered advice on what items to stockpile and how to avoid dangers such as electrical injury and unclean drinking water.

All in all, thanks to quick response on the ground as well as key policy decisions, public health officials and medical volunteers had a big impact on limiting the damages of Hurricane Sandy. The destruction and loss of life which did occur is a sad and unfortunate truth of how crushing a natural disaster can be. Hopefully, in the future, U.S. healthcare during such perilous natural events will continue this trend of fast response and smart policy-making, and overall safety will improve even more.

AXA Asia recently announced major plans to expand its services across Asia by doubling the scope of its regional health business by 2015. The company released a statement on October 29 highlighting its plans, indicating that they will further develop services in regional markets by improving and expanding on the products they offer and focusing on health capabilities on a regional and local level.

“AXA Asia also builds on the capabilities of the worldwide AXA Group, which is a top five international health player, offering healthcare solutions with a global reach,” according to the statement.

Health advertising campaigns have already started and are being aired in different countries in the region, including Hong Kong, Malaysia, Thailand and Indonesia.

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AETNA is one of the latest insurers to reveal the new pricing points for their range of International Private Medical Insurance (IPMI) products. Together with BUPA, AETNA has also revealed an increase in the cost of its IPMI plans; with both companies providing similar adjustments levels (10% Aetna, 10.3% Bupa) that match the current global medical inflation trends and compensate for the increasing costs of medical treatment at major international hospitals.

Customers who have purchased plans after October 1^st 2012, or who will be renewing their policies after that date will have the adjusted premiums placed on their policy.

While the increase of 10 percent may seem steep, it is important to realize that this is actually lower than AETNA’s 5 year average 11.9 percent premium inflation rate; and is only higher than the increases the company placed on its premiums in 2010 and 2012 which were 9.9 and 8.2 percent respectively.

However, outside of the normal yearly adjustment of plan premiums in relation to heightened levels of global medical inflation AETNA has taken some welcome steps to provide more comprehensive protection to policyholders and their families.

Starting with the inclusion of Traditional Chinese Medicine benefits in the prescribed under both Inpatient and Outpatient medication Coverage, in addition to offering rehabilitation protection under those same benefits, AETNA has drastically improved its maternity package by including expanded coverage for a range of maternity and infant related treatments.

Under AETNA plans, as of October 1^st, they have extended the maternity coverage under the complications of pregnancy benefit where they will now offer post-natal check-ups for 6 weeks after the complicated birth. Furthermore, keeping with the family friendly developments, AETNA plans are now able to provide coverage for congenital anomalies in an infant up until the child has reached 12 months of age.

In a clear sign that the company is intending to attract more business from expatriate families around the world, AETNA has also improved the protection offered to dependents who are not infants by enabling coverage up until the age of 18 if the dependent is living with the policyholder, or up until the age of 26 if the dependent is enrolled in full time education.

Continuing the changes are a number of considerations which will enable even further flexibility to policyholders with an AETNA plan, including an extension of the claim submission deadline to 180 days after treatment – allowing for more give in relation to customer’s lives. However, AETNA plans will now limit Accidental Dental Treatment to one visit within 30 days of the initial accident or treatment which warranted the Dental care.

AETNA, which took over international insurance company Goodhealth, has shown with the update of its coverage offerings that it is committed to providing exceptional levels of protection to foreign nationals, and their families, whom are located around the world. While the average premium increase may, initially, seem high, the inclusion of a range of more innovative and comprehensive coverage should see the company well positioned to see success for the remainder of the year.

A recent publication from the Singapore Department of Statistics has stated that the city state has continued to see a year-over-year increase in its population from 5.18 million in 2011 to 5.31 million in 2012. However, the reality of the situation is that annual population growth has slowed from 3.5% to 2.5% and officials and academics in Singapore have recognized that the city may eventually run into the same aging population issues that have begun to effect other developed countries.

Read the full article here

 On Wednesday, pharmaceutical company Merck announced the results of a clinical trial it conducted for a new once-a-week pill for sufferers of Type II diabetes.

 Although the pill, currently named MK-3102, still has to go through Phase III trials before it can be submitted for government approvals, after 12 weeks of treatments patients who took varying doses of the drug showed a significant lowering of their blood sugar levels.

 As the once-a-week pill is poised to replace current treatments that include daily pills or injections, it is viable to examine the potential effects of its development, not only on the patients it will treat, but also the medical and insurance industries in general.

World Health Organization statistics state that there are currently 346 million people with diabetes worldwide, and that 90% of those people suffer from Type II diabetes.

According to WHO statistics the countries that have the greatest number of diabetes cases in the year 2000 were India with over 31 million, China with over 20 million and the United States with over 17 million. These countries do not even represent the nations with the highest per capita incidences of diabetes. That distinction belongs to countries such as Indonesia, Saudi Arabia, Libya and Iran.

In the country with the highest number of cases of diabetes, India, it is becoming more and more common for the upper class to develop diabetes. In contrast to developed countries like the United States, where lower income families are more prone to obesity due to eating low cost, low quality food, in India it is the rich that eat fattening foods, gain weight and then become diabetic.

Health insurance, however, is not common for people of any social class in India. Although the rich do have the ability to pay for their diabetes-related medical needs for a longer period of time, the long-term costs associated with the disease is crippling families financially. Middle-class diabetics in India can expect to spend 25 percent or more of their income on medical expenses. Even those with health insurance will find that policies generally do not cover diabetes.

Some insurance companies in India, no doubt recognizing the size of the market and the rise in demand, now offer specialized diabetes coverages that cost anywhere between US$900 to $9,000 per month. These providers are shirking the law of averages that would dictate that this type of coverage is not feasible in a country in which 1 out of 8 adults has diabetes and there is a continually rising rate of occurrence. The WHO predicts that people with diabetes in India will number nearly 80 million by 2030.

Certainly new medications that will allow patients to more easily control their diabetes would be welcome in cases such as India’s, but cost is going to be a major factor for acceptance of any new drug in a country that is still plagued by poverty in many areas.

Speaking on the new drug, Merck’s Head of Diabetes and Endocrinology, Nancy Thornberry, was quoted as saying, “We think this is going to be a very attractive choice for patients who have a high pill burden. Any attempt to simplify the regimen for those patients is helpful.”

In the United States, the American Diabetes Association reports that in 2007 diabetes carried a total direct medical cost of US$116 billion, which comes to an average of over $6,500 per case to be covered by individuals and their insurers.

Currently it can be difficult, if not practically impossible, for an individual to obtain health insurance coverage to cover a chronic condition like Type II diabetes because it is considered a pre-existing condition. However, in the United States, starting in 2014, insurance companies will no longer be legally allowed to refuse coverage to children and adults based on the presence of pre-existing conditions. This change is based on the provisions of the Patient Protection and Affordable Care Act signed into law by President Barack Obama.

As this change is going to force insurance providers to accept high-risk customers in much greater numbers, it will be important for them to find low cost solutions to chronic ailments like Type II diabetes since the Act also denies insurance providers the ability to charge more based on whether a customer is sick or not.

Currently, Merck’s Type II diabetes pill offerings, Januvia and Janumet, are on track to account for US$6 billion in sales in 2012, but with new competition on the horizon and the US government alleging a connection between Januvia/Janumet and pancreatitis in its users, it is understandable that Merck would be interested in finding a replacement for its current offerings and push to quickly move MK-3102 forward.

According to biotechnology and pharmaceuticals analyst, Jon LeCroy, M.D., he expects MK-3102 to launch in 2015 and have worldwide sales of US$450 million in 2016. This figure pales in comparison to current sales of Januvia and Janumet, but whether the difference is related to a lower cost for the new drug, or simply due to low availability, remains to be seen. LeCroy also added that the drug “could become a mega-blockbuster.”

As MK-3102 is not yet on the market, it is only possible to look at new drugs in general and the medical savings that are associated with their use. Dr. Frank Lichtenberg of Columbia Business School, who has won numerous awards for his research on the economic impact of various drugs, states that “the reduction in nondrug spending from using newer drugs is 122 percent larger than the increase in drug spending.”

Seeing as Merck’s new drug would drastically reduce the frequency with which patients would take medication, combined with the potential for some Type II diabetes sufferers to be able to switch from injections to oral medication for treatment, it is easy to imagine that savings could be significant to insurers and policyholders globally. If not immediately in the cost of the drug, then in the other costs surrounding the disease.

The insurance industry seems to be going through a lull. Things are quiet, with few major news events, no major catastrophes rocking the industry and a general sense of calm. How much of this is merely the swimming duck effect, with the appearance of calm on the surface, but energetic kicking happening under the water remains to be seen – but there is certainly a lot going on behind closed doors.

In Europe, the insurance industry is still working hard to effect amendments to Solvency II. As far as it is concerned, the proposed legislation is still far from the final draft, even after almost 10 years of planning and negotiating. Solvency II is going to force the industry to implement measures that will simply become an extra burden, with proposed capital requirements completely out of proportion to actual risks.  One example often cited by opponents of the current version of the legislation, is that of Hurricane Katrina in 2005, which caused widespread damage resulting in US$40 billion of claims. While this was the most expensive mega-catastrophe in recent years, the insurance industry was able to absorb this hit and recover rather quickly.

Indeed, according to a recent report published by the Universities of Leeds and Edinburgh, the expected financial losses linked to natural catastrophes such as hurricanes and earthquakes are not of the magnitude to “justify substantially high capital holdings against catastrophe underwriting risk.” The report focused on U.S. insurers, but the findings apply to all those potentially affected by the regulations.

While negotiators and lobbyists in Europe and North America are working feverishly to keep the insurance industry as legally unfettered as possible, the sales and marketing departments also have their work cut out for them.
The current economic climate is putting a lot of pressure on insurance premiums, with many Europeans currently underinsured when it comes to life cover. One of the main reasons for underinsurance is that the products are seen to be expensive, and customers are looking much more closely at what they are spending their hard earned pennies on. This trend can safely be extrapolated to other types of insurance, as the economy is affecting individuals as well as businesses and organisations of all types and sizes. In the life cover market alone, Swiss Re calculated that the protection gap amounts to EUR10,000 billion across the 14 EU countries. This gap is basically the difference between projected amounts of money needed by dependents in the event of a person’s untimely death, and the financial provisions put in place to cover such an event.

In light of this, there is much work to be done to develop innovative products that offer clients an attractive deal. With such a stagnant economy, sales teams are going to have to work not only harder, but much more intelligently to improve their figures. There is certainly untapped potential in the European market, but without new products and bold strategies, only a small percentage of this potential will be realized. Insurers in the USA and EU are facing a lot of legislative uncertainty, especially so in America, as the government rolls out a raft of healthcare and health insurance changes, along with new taxes and regulation for insurers and re-insurers on the horizon. There is certainly a long uphill struggle ahead, but opportunity is often found in the midst of adversity. Although the demand for insurance will not be going away anytime soon, the nature of the business is changing somewhat, and insurers will need to adapt to stay in the game.

Emerging markets offer a whole lot of new opportunity, albeit with some risk and a lot of uncertainty. As the global shift eastward continues, money is flooding into Eastern Europe and Asia, which means access to a whole new set of customers, along with new cultures and completely different environments. Traditional insurance is doing very well in the developing world, and insurers are using strategies such as bancassurance very successfully to help them penetrate these new markets. However, because of the flexible and entrepreneurial nature of emerging markets, where many things are still in flux, traditional insurance companies are also having to face new challenges on a regular basis. Developing countries are not afraid to try something new, and have the luxury of being able to draw on the experience of more developed countries and businesses. For instance, there is a lot of interest being shown into using captive insurance as a solution to risk management and financing, especially based on the experience of large companies like BP in dealing with large scale disasters like the Deepwater Horizon spill in 2010.

Another area where there is a lot of upheaval and change in developing countries is in the area of healthcare. In 2011, the WHO’s 193 Member States committed themselves to reforming their health financing systems to move towards universal health coverage. The goal of universal health coverage is that all people can use the health services they need without being exposed to the financial hardship often associated with paying for them.
In the developing world, where a large majority of people live on a subsistence basis, very few can ever afford any kind of healthcare, yet these are precisely the people who need assistance and public provision of healthcare services.
Developing nations face this problem almost universally, and much work is being done to study possible ways to finance universal healthcare and to develop models that provide a better bang for their buck.

Currently, public healthcare is provided based on variations of two basic strategies.
In the first type, a country provides universal healthcare based on a single risk pool, of which all eligible people are members, and funds its system through general taxes. Usually, in this kind of system, healthcare is provided by publicly owned facilities. The NHS in the UK is a good example of this strategy.

In the second type of system, a government provides healthcare to its nationals via mostly private providers, and funds the system through payroll taxes. The government essentially pays for private healthcare on behalf of its citizens. There are usually a few different risk pools, which means that different classes of citizens pay differently and possibly also receive different treatment. The German system works according to these principles.

At the moment, a majority of developing countries have public health systems that use multiple risk pools, but the current trend is definitely towards broader and larger risk pools. Many feel that consolidating pools mean lower administrative costs and less fragmented and possibly unequal treatment. The general consensus is that bringing everyone into one pool can make healthcare more equitable because everyone is entitled to the same set of benefits.

The role of the private healthcare industry varies, but in a majority of developing nations, private services are incorporated into their systems, with the state buying private care for their citizens when the public services cannot provide the necessary treatment.
This would be the best system from the perspective of the patient, as excluding the private sector from a universal healthcare system generally produces double standards, where the poor go to publicly funded facilities and receive basic care, while the rich can afford the very best treatment in private hospitals and clinics.

Developing nations have a their work cut out for them, but at the same time they have a huge advantage with “greenfield” development opportunities – unhindered by archaic and inefficient systems, and generally, a public healthcare system which can only really improve.

Of course, the biggest concern when talking about health services anywhere in the world revolves around finances. Many countries remain uncertain as to how to finance universal health coverage. Medical services have an amazing capacity to consume budgets, and universal coverage seems to be simply unaffordable to many.

Pre-paid schemes such as health insurance, provide one solution to this problem. The WHO hold the view that health insurance and other prepaid health financing mechanisms, are a key route to universal coverage. Every year, out-of-pocket payments force millions of people into poverty. Larger risk pools, combined with a larger percentage of the population contributing to a healthcare fund, would make it affordable for most developing countries to extend a basic standard of care to all their citizens, and even provide subsidies for more advanced services at private facilities on a more limited basis. Increasing taxes or funneling revenue from national resources like oil or minerals for the specific purpose of providing improved healthcare is not a hard sell, as long as citizens eventually feel they get what they pay for. Not all countries will be able to start with a full range of medical services, but getting the ball rolling through pilot programs and incremental extension of public healthcare will mean that they can grow their systems in a controlled fashion, experimenting with new solutions and strategies as they go. Assuming that health ministers can keep their departments on course and free from the ubiquitous bureaucracy, the goals of universal health coverage might just be within their reach.

Ever since the Renaissance, Western science has become increasingly sceptical of traditional medicine. It seems, however, that the tide may be turning, as scientific exploration is adding more credibility to the pharmacology behind Eastern medicine, one study at a time.

A recent report published in the Archives of Internal Medicine this week gives a detailed analysis of 29 studies carried out involving almost 18,000 patients in the USA and Europe on the effect of acupuncture on chronic pain. The trials compared acupuncture with patients who had no treatment, and those who had a pseudo treatment, through incorrect use of acupuncture by inserting needles in incorrect positions and depths.

The results showed that patients who had acupuncture reported at least a 50% decrease in their pain, compared to 43% for the faked treatment and 30% for no treatment. However, given the marginal increase in reported positive outcome of real acupuncture over sham acupuncture and other concerns over methodology, some doctors remain unconvinced.

The precise physical mechanism by which acupuncture works has not yet been established, with a majority of Western scientists and medical practitioners still attributing its effectiveness to the stimulation of nerves, muscles and connective tissue to boost blood flow and encourage release of the body’s natural painkillers.
Eastern philosophy, on the other hand, not hampered by the limitations of naturalistic thinking, explains acupuncture in terms of restoring balance to the energy flow in the human body, with needles inserted in specific areas on the body to alter or ‘tune’ the flow.

It seems that Traditional Chinese Medicine (TCM) is undergoing a kind of renaissance of its own. Not only is it making great strides in acceptability in the West, but it has been receiving a lot of new found appreciation and attention in China, where TCM has been the de facto source of primary healthcare for more than a millennium.
TCM has received less promotion in China during the last 50 years, with the State’s focus on providing Western style medical services mostly through large public hospitals, leaving very little support and funding for any other forms of medical care. A mix of tradition, affordability and availability have enabled TCM to survive and even flourish, especially in rural areas, where public healthcare has been hard to come by.
That is all about to change. Just this week, the Chinese vice minister of health, Wang Guoqiang, announced a national campaign to promote TCM services at grassroots levels. According to figures provided by the ministry, almost 76% of community health centres provide some form of TCM, although there are concerns about the service quality as there is no official grading systems for TCM practitioners.
The campaign will aim to enable 95% of community health centres, and 90% of those at village or town level, to offer TCM services by 2015. This will require training of at least 15,000 TCM clinicians for hospitals at the town/county level, and 30,000 general TCM practitioners at the community level.
The campaign follows a national crackdown on the use of substandard or fake materials in TCM, which focused on improving awareness of and testing for heavy metal ions, pesticides and aflatoxins.

In Beijing, education authorities are publishing new textbooks on TCM, and will be distributing them to secondary schools before the end of the year.
There is no obligation on Beijing schools to teach TCM as a subject, but for those teachers who would like to be qualified to teach TCM, the the city administration for traditional Chinese medicine is offering courses to prepare teachers to deliver the subject. On top of completing this course, teachers will also be required to have experience teaching Chinese History, language, and biology.

“China’s education system is rather Westernized,” said Mao Jialing, director of the Cultural Research and Propagation Center of Traditional Chinese Medicine at the Beijing University of Chinese Medicine. Western thinking tends to break everything down into small parts and deal with each part one at a time. This means that in school, students learn mathematics, physics and chemistry as completely separate subjects. This mindset affects Western medicine also, meaning there is an inordinate focus on individuals problems, often to the detriment of the health of the rest of the body.
“The logic inherent in traditional Chinese medicine and traditional Chinese culture is quite different,” he said. “We do not pay an inordinate amount of attention to a particular body part that is diseased, but instead place emphasis on the general state of a person’s health.”
“There are circumstances that Western medicine cannot deal with,” he said. “For example, chemotherapy will destroy the immune systems of some cancer patients and kill them faster than their tumors.”

According to Ju Baozhao, a professor of traditional Chinese medicine studies at Liaoning University of Traditional Chinese Medicine, the ancient methods still provide good ways to cure chronic disorders. He said people who use TCM to treat some chronic disorders will find that it is both effective and saves them a lot of money. Even though TCM is generally quite low cost, the industry in China  is currently valued at USD 50 billion, and estimates are that it will triple in value by 2015.

The TCM renaissance is not limited to China. A lot of effort is being made to raise understanding and lower suspicions of TCM internationally.

Last month, a database providing a link between TCM herbs and their active chemical ingredients, along with translation into Western terminology was unveiled. The Chem-TCM database is the most comprehensive of its kind, linking and translating more than 12,000 chemicals found in more than 300 Chinese herbs.
TCM remedies have rarely been used as a basis for developing new medicines because their complexity have made registering with Western regulatory agencies difficult. The information provided by the TCM-Chem database is sure to make this process easier, and should significantly boost the credibility and acceptance of TCM-based remedies in the West.

While this database will go a long way towards removing TCM from the realm of fantasy in the minds of traditional Western health professionals, the holistic nature of TCM should not be forgotten, as merely turning traditional cures into modern drugs will remove the expertise of the TCM practitioner, which, in the traditional mindset, is crucial to the whole process of providing effective treatment.

In the Netherlands, a TCM medicine has been approved for sale in an EU country for the first time ever. Di’ao Xin Xue Kang, a well-known herbal medicine produced by the Chengdu-based Di’ao Group, received marketing authorization from the Medicines Evaluation Board of the Netherlands, making it the first herbal medicine approved as a therapeutic drug from anywhere outside the EU.
“This is an important step for TCM to enter mainstream markets of developed countries,” Chinese Health Minister, Chen Zhu, said at a news conference organized by the Chinese Academy of Sciences in Beijing on Wednesday.

Traditional Chinese medicines were banned by the EU in May 2011, to prevent unlicensed herbal medicines to be sold as food supplements. The successful registration of Xin Xue Kang follows two years of research to identify the active ingredients in the medicine. Xin Xue Kang contains only a single TCM herb, and this was why it was chosen to be the first to be registered. Most other traditional medicines contain a complex mix of herbs, which makes identification of all the active ingredients very difficult. Ongoing research into the active ingredients of TCM remedies, as well as availability of new resources like the TCM-Chem database, will hopefully speed up this process for future registrations of more complex medicines.

It is hoped that the heightened interest in TCM, and the increasing research into active ingredients, will yield a host of new medicines; marrying millennia of traditional experience with modern manufacturing and testing methods.

Chinese pharmaceutical companies are also pushing beyond the traditional boundaries and are working hard to gain a foothold in the Western mainstream. One such company, Tianjin based Tasly Group Co. Ltd, has partnered with local governments and universities to promote TCM in places like Europe, North America and South Africa. It recently opened a TCM exhibition facility in South Africa to help local people gain an understanding of TCM, its philosophy and its history, and is currently completing another such facility in Maryland in the USA.

Tasly also purchased a research and manufacturing facility in Maryland, where it intends to produce its flagship Tasly Danshen Plus Capsule, a drug that protects the heart and helps it function, with ingredients such as Notoginseng and other traditional Chinese herbs. The drug is currently in the process of obtaining FDA certification.

Traditional Chinese medicine has been around for longer than just about any other form of medicine, and touches on elements of the human being that Western science has a hard time even accepting the existence of. Energy fields, Qi, internal ‘fire’ and all the associated treatments are often hard for scientists to take seriously, however, studies are adding more and more credibility to the pharmacological basis of TCM.
A marriage between Eastern and Western mindsets, allowing for the respective strengths to complement each other, is an exciting prospect. Western study and detailed analysis of TCM will hopefully weed out those treatments that not only rip off the customer, but do significant harm to the environment. Rhino horn and tiger products are pertinent examples of this. At the very least, one hopes that alternatives to these products will be developed, and in the process save many other species from extinction.
As TCM gains momentum it will be interesting to see if it begins to make inroads into Western treatment regimens, whether through the pharmacology of the ingredients used, or in the worldview itself. With the Chinese government also stepping up its efforts to monitor TCM ingredients and incorporate it into the national healthcare infrastructure, it will be worth watching whether TCM can become a cost-effective way to provide healthcare, especially since it is already deeply ingrained in Chinese rural life.

While the attention of the financial world is fixated on the unfolding European crisis, there is a sleeping dragon some 5,000 kilometers away about to wreak chaos around the world. The dragon is China, the world’s most populous country and the world’s second largest economy. The problem has been festering for years and has been somewhat controlled through governmental stimulus money but this problem can no longer be delayed – the slowdown in the economy is becoming a pressing concern for people around the world. The effects of this recession could be disastrous and would affect healthcare and international health insurance worldwide.

The Chinese government is reporting 7% – 8% Gross Domestic Product (GDP) growth this year,  so how could the Chinese economy be in a recession? Many experts agree that China could be deceptive about their GDP numbers. As reported by Reuters, WikiLeaks revealed that in 2007, during discussions with Clark Randt, the US Ambassador to China at the time, Li Keqiang (head of the Communist Party in 2007) hinted at the fact that China’s GDP figures were not necessarily based on real data.

This should not come as a surprise. The country is a totalitarian state controlled by the Communist Party of China. To the government of China, maintaining a strong public image to both its own citizens and the rest of the world is very important. Fortunately, investors and citizens can turn to more reliable data which can also confirm whether or not China’s economy is slowing down or entering a recession.

Many economists and investors use other sets of data to help determine the strength of an economy, aside from the GDP. Even if there was truth behind China’s GDP growth numbers, GDP itself may not be a good indicator of economic health in the sense that it does not take into account the general financial state of the typical citizen.

One data set that other financial analysts look towards is the Purchasing Managers’ Index (PMI). The PMI is an index composed of five indicators which come from purchasing managers in a given country. This gives diversified results and provides a good sample of the economic industries. The indicators included are; production levels, new orders, supplier deliveries, inventories and employment level, with each indicator having a different weight. Purchasing managers will indicate whether their indicators are better, worse, or the same than the previous month. The index is then reported on a scale of 0 to 100, with anything higher than 50 indicating that the economy is in growth, and anything lower indicating the economy is slowing down in growth or is in recession. A number lower than 42 indicates that a recession is either occurring or is close to doing so.

The index focuses on manufacturing, and while the Chinese economy may not be solely based on manufacturing, a large portion of it is, and recessions traditionally affect manufacturing first. Even more so, factory output is significant in China because the economy has used its cost effective labour to become the world’s factory, accounting for a large portion of China’s overall GDP.

For China, there are two PMI numbers: one released by HSBC, conducted by Markit, and one that is sponsored by the state and is the official figure released by China. Both numbers are within tenths of percentage points of each other and it is important to note that the difference between the two numbers is due to the composition of the surveys – China’s numbers focus on larger corporations, while HSBC’s numbers take into account small and medium sized enterprises (SME). As SME’s may be more representative of the general population, it seems wiser to take these into consideration. Despite their differences, both figures indicate a below 50 reading, indicating that the industry is contracting, but not yet in a recession.

Another indicator is the amount of loans being granted or applied for. China’s banks recently indicated that they may miss their loan targets for 2012, something that has never been missed in the past seven years. Banks have a heavy dependency on the SME market for loans, not because of their loan amounts, but because of their volume. This points to a slowdown in China’s economy as the fact that businesses do not require loans may indicate that there is no need to expand, or an incapability to expand. It could also indicate a business’s inability to acquire the loan due to its poor financial standing. SME’s health is crucial to the financial health of China’s citizens as SMEs make up the vast majority of the total contribution to GDP and employment. Poor SME health could therefore indicate that the overall state of the economy is in a terrible condition.

Electricity consumption could also be used as an economic barometer. If GDP increases, then electricity consumption should follow as electricity use will generally increase in from higher productivity. However, China’s electricity consumption and demand has slowed over the past few months, which seems to contradict China’s picture of continuing high GDP growth. It does, however, coincide with the PMI indication that things in China may be slowing down. China is actively spending to reduce its energy consumption in spite of this, and analysts still agree that factory consumption of power is slowing.

Finally, rail cargo volume can also point to changes in actual production. Rail cargo volume for China has been declining and while there are many seasonal highs and lows, the lows for the past few months have been significantly lower than historical values. Moreover, analysts have indicated that the decrease in rail cargo volume is comparable to the amount of decrease that happened during the 2008 financial crisis, which causes alarm for many who are monitoring these stats.

There are some significant consequences that can arise if China were to enter a recession. The effects of its recession could be comparable to those of America’s recession as China is the second largest economy in the world. Although a weakened Chinese Yuan as a result of the recession may encourage foreigners to outsource from China, the lowered demand from foreign companies is what contributed to the Chinese downturn – the deepening Global Recession may continue to produce lower demand for Chinese products even after the Yuan is lowered.

While the Yuan lowers, imports will decrease, compounding the effect of lowered imports due to lowered production levels. This can have significant effects around the world as China is one of the largest importers for many different minerals and raw materials, used often in their manufacturing industries.

As the Chinese economy worsens, general prices in China may increase due to lower demand and lower quantities will be sold as a result. Moreover, prices may increase because imports could become more expensive due to the weakened Chinese Yuan. Businesses may exit the market because profits are not as high anymore and may reach an unsustainable state.

In recessions, government spending is cut in order to maintain proper budgets for more essential and important aspects. As such, subsidized healthcare is usually one of the first departments to receive cuts. China currently offers a progressive subsidized healthcare system whereby the small and local clinics / hospitals receive a sizable subsidization and larger more specialized hospitals receive significantly less subsidization.

Once cuts are put in place, healthcare receives cuts, and the chances of people not being able to pay for their healthcare needs increases; costs of healthcare in emergency situations can represent significant amounts. Due to the higher relative costs of healthcare, health insurance in turn could end up costing more. This is because of the way health insurance premiums are calculated: what are the chances of a certain person requiring healthcare and how much would it cost if they do? A recession can push up the cost of healthcare and the cost of health insurance.

After the recession, because of citizens’ poor financial health, demand for health insurance will be lowered. As such, many small local health insurance companies may be forced to exit the industry as well, which could see some people at loss because of lack of coverage.

Acquiring an international health insurance policy in China now, before the recession takes place, is much more attractive. If you currently have health insurance, it is a safe way to hedge your bets against the Chinese recession since your plan will remain at its current price for rest of the term, as well as any financial problems which might occur in the future.

How long might this recession go on for and just how deep into the economy could it reach? This is a difficult question to answer. If the 2007/2008 recession is anything to go by, a recession in China could pull the world into a depression. The Global Recession still hasn’t concluded yet and is on the brink of further collapse.

As a sort of safety net, the Chinese government has set aside hundreds of billions of dollars in stimulus money in the event that action is required. This money will go towards cost saving measures for both the government and the average citizen, such as incentives for purchasing energy saving air-conditioners.

The real question at hand is not about the possibility of China going into an economic downturn – the real question is whether it will be a soft landing or a hard one. Some analysts think that it will be soft and that China is well equipped and large enough to absorb some of the loss. Some analysts, however, feel that their recovery from the previous 2007/2008 recession was too manufactured and that it wasn’t a sustained recovery – they are afraid that there will be widespread damage across the globe especially with the European crisis still unfolding. Whether it is a soft of a hard landing, many feel that this downturn is inevitable and fast on its way.

China announced last week that they plan to increase healthcare spending to more than USD 1 trillion by 2020. This is a lot of money, but a closer look at the current state of public health in China and the obstacles to further improvement, will help shed some light on this announcement.

We recently posted an article covering the state of China’s health services, the “successfully completed” improvement projects and the calls by Vice-Premier Li Keqiang for China to continue pushing forward with healthcare improvements.

At the time, the major focus of improvement to healthcare in China had been to increase affordability and accessibility of health services so that at least 95% of Chinese would be able to avail themselves of public healthcare services without having to incur significant out of pocket expenses.

A lot of these improvement efforts have had some effect, and many more Chinese (especially in rural areas) now have access to a host of medical treatments which they may not have known existed only a few months ago. This is certainly a good thing, but this massive increase in the eligible patient pool has had some unintended consequences. Patient intakes in city hospitals have surged; at many city hospitals patients queue up overnight to get a ticket to see a doctor and even then it is usually only for 5 minutes worth of consultation, due to the huge backlog. Touts are common, and people often pay massive amounts to buy a space in the front of the line.

One unexpected issue has been that of unrealistic patient expectations. Uneducated patients are arriving at the hospital believing that the high-tech and expensive treatments can cure just about anything, and they do not understand the limitations of current medical technology. This is compounded by the fact that people expect money to buy solutions, and when a family has just spent a large part of their life savings on some treatment, only for the sick person to then die anyway, the family draw the conclusions that it must be that they have been cheated somehow. In addition, patients who have worked or studied abroad have seen what is possible and now have higher expectations than what the overburdened system can deliver, leaving only more dissatisfaction and frustration.

Chinese doctors were already overworked and underpaid before these latest sets of healthcare reforms occurred, and their situation has radically worsened since. The average doctor still only earns the same as most other college grads, despite much longer hours and greater risks. A junior doctor in a city hospital earns around USD 500 per month, rural doctors even less. It is not uncommon for a doctor to see more than 50 patients a day and sometimes up to a hundred. To date, doctors and hospitals have used kickbacks and high profit margins from selling specific medications to supplement their income, a practise which has become commonplace, and which the Central Government has seen as a simple solution to the problem of doctors’ pay and hospital’s profitability.

Unfortunately, having a doctor in the situation where he has to prescribe medicine simply so that he can pay the bills is awkward at best and not a typical recipe for quality care. It ensures higher costs for the patient and eventually creates the expectation that all treatment requires medicine and that any treatment can be treated with a medication.

These factors are creating an atmosphere filled with pent up rage, frustration and disappointment, with patients and doctors finding themselves in a very uncomfortable situation.

China is planning to continue increasing its healthcare spend significantly, and will be spending around USD 1 trillion a year by 2020. This will largely be taken up by insurance costs and with an aging population, the increasing availability of more expensive treatment and addition of more chronic diseases to the insured list, a trillion dollars will be spent surprisingly easily. It will be a total of about 7% of GDP and still less than half of the US healthcare expenditure – and the US has a quarter of the population. A trillion dollars sounds like a lot, but it is still on the conservative side.

We have already seen that public healthcare rarely improves simply because more money is thrown at it, and it appears that the authorities have seen this too. The developing situation in the pharmaceutical industry is a good example of this. Doctors and hospitals have come to rely on the income from sales of branded medicines, and a large chunk of the increased healthcare expenditure would most probably be absorbed by increased costs of prescription meds.
To counteract this, the Central Government have allowed a few provincial governments to trial a different approach. One such province that has risen to prominence is Anhui, where officials decided on some rather extreme measures, at least from the pharmaceutical industry’s point of view.

A legislative and healthcare framework being trialled in Anhui prohibits prescription providers from adding any markup to sales of any medicine on the Essential Drugs List (EDL), and centralises the process of bidding on and purchasing drugs. Hospital controlled pharmacies are out and EDL drugs will instead be distributed only from rural hospitals for a flat fee, while each drug will have exclusive distribution rights assigned to certain companies, decreasing competition and the ability of the pharmaceuticals to pay kickbacks to doctors in order to ensure high sales.

While other states have also developed models to try and bring pharmaceutical costs under control, the Ahnui model has become very popular and 18 out of 23 of China’s provinces have implemented measures based on the same model. The big pharmaceutical companies are understandably worried, as many of their most profitable drugs face the possibility of being added to an EDL, therefore stripping any profits from that particular drug. Another worry is that the Anhui model places a very large emphasis on direct price comparisons, and doesn’t test for quality very well. This has the potential of driving prices down so low that only below quality products can compete in the bidding process.
What has also tended to happen is that drugs on the EDL simply become unavailable, as doctors don’t trust the low cost drugs, hospitals cannot afford to stock items that they cannot make any profit on and pharmaceuticals either pull out of the bidding process or the bid winner ends up being unable to maintain the supply of the drug at the price they bid.

Keep in mind that the goal with all of this is to prevent overpricing and overprescribing, which to some degree it does (at least on a superficial level) however, it doesn’t really tackle the root of the problem and merely leaves doctors and hospitals in the position where they will have to find another way to supplement their income. To date, doctors employed at public hospitals have not been allowed to do any private practise, although many do secretly work in private hospitals or from home to generate additional income. Authorities have loosened their grip on this matter, and doctors have recently been permitted to work one day per week in a private capacity. This helps a little, however, the greater problem still remains. The dismal remuneration of doctors really does need to be addressed in order to draw new doctors to the profession. China needs thousands of doctors to be added to the current workforce to even come close to meeting current demand, one estimate suggested that there is a shortage of 200,000 pediatricians alone in the country. There is also a lot of ill will towards doctors in China, and it is not a career with anywhere near the same earning potential or prestige as in western countries. The dysfunction in the healthcare system has brought the public’s appreciation of and respect for doctors to an all time low. It has become so bad that an online poll by Chinese People’s Daily was removed after a large majority of respondents selected a happy emoticon to characterise their reactions to the recent murder of a doctor by a very unsatisfied, knife wielding patient.

Somehow, China needs to turn this situation around; the country desperately needs more doctors and with the powerfully negative public sentiment, low pay and huge workload, it is hard to envision many young Chinese people harbouring a desire to be a doctor one day, much less acting on that desire.

The private sector does present some potential solutions to this. Doctors in private hospitals are not as highly regarded by the government’s medical bureaucracy or the public at the moment, but those doctors who brave the current scorn from their peers in public service to work in private institutions receive much higher pay, better conditions and a much improved doctor-patient relationship. This is a trend that will continue to change, with private institutions gaining credibility with the government and general public through quality of service and level of care.

It should not be hard to outshine the average public hospital. Most public patients see a doctor for only 5 minutes after hours of waiting, and on this point alone the private sector should be able to show stark contrast. Having a doctor that has time to meet the patient, focus on their case, make a proper diagnoses and decide on an appropriate treatment, can go a long way towards increasing patient satisfaction. Add to this the fact that the doctor will not be overworked, exhausted, stressed out or waiting for an “incentive” in a red envelope, and it isn’t difficult to see how people will be prepared to pay for a better service if they can afford it, at least they will feel like they’re getting value for money.

The challenges of provisioning public healthcare are not to be sneezed at. China’s sustained period of unprecedented development has increased the demand for modern medicine among more than a billion people. Ten years ago less than 30% of Chinese people were entitled to some kind of healthcare insurance, today, that number has risen to at least 95%. This in itself is a major feat, but to actually bring the benefits out of the world of statistics and into the lives of almost a quarter of the world’s population is a lot more difficult.

China needs approximately 500,000 doctors as soon as they can be trained or hired. To start meeting the demand, not only does the desirability of being part of the medical profession need to be improved, but so too must the capacity to train these new doctors. Finding a way to improve the quality of life of the average doctor is also important, not only by increasing salaries, but also by improving the work-life balance, professional development opportunities and making it easier for doctors to increase their income through excellence – not just work-rate or levels of prescription.

Aside from the challenge of finding the human capital, there is also that of ensuring the availability of affordable drugs and technology, without alienating the large brands and ending up without any quality suppliers available. The big pharmaceutical companies have a reputation for putting profits high on their agenda, and will not be interested in doing business in China purely on humanitarian grounds, they will need a carrot to keep them in the game.

The increasing costs of a progressively older population also needs to be accounted for, and when looked at in the light of the current economic slowdown and the sheer scale of things in China, this becomes quite a large hurdle. China’s one child policy has produced a large “elderly overhang” with the imbalance reaching its peak in the next twenty years. With more than 2 generations of single child families, Chinese youth are heading for a future where each adult will have potentially 6 elderly family members to look after (4 grandparents, 2 parents). Even just in terms of taking care of the elderly, by 2020, spending USD 1 trillion at a national level would have to be split between 15% of the population who are over 65, that’s only USD 5000 each when split between 200 million people.

China is working to improve its healthcare, questions remain as to how the private sector will fit into the picture, and whether solutions offered by new technology to the urban rural divide will help turn the tide. Above all, the big question is just how China will pay for it all, and what the chances are of actually turning public opinion against the medical system around.

Following a tribute in the London 2012 Olympics that was broadcast to the world, the NHS is encouraging its member trusts to do the same and expand globally in a bid aimed at funding health services in the United Kingdom. The idea originated in the Labour Party and is now gaining speed to expand the National Health Service beyond the UK’s borders. However, will this idea affect the costs and quality of care for current residents of the UK?

The government is supporting a recommendation for large private hospitals, such as the Great Ormond Street, Royal Marsden, and Guy’s and St. Thomas’. Following the model set by Moorfields Eye Hospital in London which has set up shop in Dubai, the UK hopes to emulate the success which Moorfields’ Dubai branch has seen since its establishment overseas in 2007.

Governmental officials say that these large hospitals and entities should utilize their profits derived from their private practices and use them to develop healthcare assets overseas. After the overseas operations are established, profits from the entity should be rerouted back to the NHS to fund ongoing improvements to the UK healthcare system.

The NHS aims to make itself a global leader in providing healthcare by marketing itself as a recognizable name worldwide. By setting up hospitals overseas, it can market its services and create a demand for it.

“The NHS will be bringing together the Department of Health, the UK Trade, the National Commission Board, and form an organization that will help healthcare providers in [the UK] and develop those skills and sell them abroad for the benefit of the patients in [the UK],” says Health Minister Anne Milton, a Member of Parliament of Britain. Any kind of profits will have to be redirected back to the benefit of NHS patients, in a scheme which Ms. Milton says is a, “Win-win.”

The government is currently eyeing hospitals and institutions with great international reputations, allowing for an easier uptake of the program. Once the program becomes more successful, the government should open it up to smaller private healthcare providers.

What’s unclear at the moment is exactly where the doctors and medical practitioners will be sourced from. There are two possibilities: The NHS could source the staff from their own current employees – after all, they are the world’s fifth largest employer. Alternatively, the NHS could source the staff internationally, which could also be feasible because of the vast number of readily available professionals around the world. However, there are possible negative effects of both methods of sourcing which need to be taken into consideration.

First, if the NHS proceeds with sourcing from existing NHS staff, skilled workers in the UK may be less readily available. With workers being asked to work abroad, there could be a premium added to their salary, as well as other fringe benefits which compensate workers for their move. In addition, as these workers will be a direct foreign representation of the organization itself, there is a high chance that highly skilled workers will be recruited to move overseas first. More skilled workers may also be more adept at adapting to challenging situations, further making them a target for recruitment overseas. However, this will draw the UK’s more skilled healthcare workers away from the UK system, potentially lowering the standard of care in the country. This also represents a costlier decision because of the need to incentivize doctors to go abroad by adding benefits to their compensation packages.

What if the NHS decides to hire internationally? The goal of the NHS is to export the “brand names” of the NHS that have international and esteemed reputations. As such, it could be contradictory to start a new branch with staff who do not previous history with the NHS in essential, and especially management, roles. It would make most sense for the NHS to at least fill higher level roles with skilled medical practitioners from the NHS in order to preserve the level of service. Moreover, an international hire may not inspire as much confidence in local patients who are seeking high quality international care based on the NHS brand name. Why would they need to go to the potentially more expensive NHS which features a local hire if they can receive the same type of treatment at a potentially lower cost? Furthermore, hiring the best doctors available locally in the oversea hospital’s area might cause issues for the local healthcare system, especially if there is already an ongoing shortage of doctors in the region. If the NHS doesn’t hire in the target area but still recruits internationally, it may still represent a higher cost because of relocation packages and expatriate salaries that they may need to attract international hires.

Will the costs of healthcare increase because of the expansion? As mentioned earlier, highly skilled workers may be incentivized to take up positions in the new hospital developments overseas. As such the ability to properly provision healthcare for the nation may be reduced if the NHS does not replenish or properly account for the departure of some of its staff. Moreover, the NHS has been widely reported to be experiencing a significant shortage of workers, despite being the world’s 5^th largest employer. Shortages of nurses and doctors are, in some cases, extreme, as data from the Department of Health indicates that some family doctors may be responsible for as many as 9000 patients. A new development requiring skilled practice may hinder the system, preventing patients in the UK from having adequate access to much needed healthcare services.

The demand for medical practitioners is high in the UK. There is a general shortage for the medical field, vastly due to the amount of doctors leaving the UK for better packages worldwide. In a recent report by the Policy Research Programme in the Department of Health, UK doctors are being offered attractive benefits packages, better living standards, higher control of their work, and in places with better living conditions than the UK. This incentivizes many highly trained doctors to move abroad, resulting in a shortage of doctors able to provide important healthcare services. Some of the doctors surveyed also indicated that they were disillusioned by the NHS, stating that it was bureaucratic and limiting.

This expansion overseas will not affect the highly specialized private hospitals which have a well-recognized name brand – in fact it may be quite easy bring in profits as foreigners may be attracted to these brand names. However, whether smaller hospitals will be capable of following suit or willing to remains to be seen. Many hospitals in the UK are currently designed to be providing an essential service to the community and gearing them towards acting as for-profit multinational companies may cause them to lose focus on providing quality care within the UK. If managed poorly, the implementation of this program could cause shortages and cuts to existing services as hospitals direct their attentions and funds overseas. This could affect prices negatively for the patients they service locally in the UK. With the significant burden that many general practitioners already face – upwards of 3,000 patients per doctor, some even 9,000 – and in the middle of a large scale reorganization of the NHS, the main focus should be improving these services and ensuring that the new system provides the benefits its supposed to.

This leads to a discussion about the focus of the NHS – should this really be what they are redirecting resources towards? The NHS is asking for their hospitals and entities to redirect profits from private health practice to fund their international developments. While the NHS does provide quality services to UK citizens, waiting times for both scheduled treatment and A&E care are a serious problem due to a lack of beds and medical professionals.

Could this expansion affect healthcare costs and insurance premiums? There is a possibility this could happen if the private hospitals which are establishing hospitals overseas increase charges on private care in order to raise funds to start the overseas ventures. Similarly, if the overseas private hospital programs lead to increased brain-drain on UK doctors, it could drive up the costs of private care further. Both of these possibilities could have knock on effects on the private health insurance system in the UK, which is already trying to avoid large premium rises to avoid off putting customers.

Given the NHS budget freezes and cost savings put in place as part of QIPP (Quality, Innovation, Productivity and Prevention) policies in the UK, it is understandable that new sources of income are being investigated and considered. However, it is of the utmost importance that these efforts do not come at the expense of local capabilities, especially during the largest reorganization of the NHS system in years.

During his inaugural speech of the 6th FICCI HEAL (Federation of Indian Chambers of Commerce and Industry – Health Enterprise and Learning) 2012 annual international conference in Delhi this week, Indian President Pranab Mukherjee noted that there is a “high variance” in the quality of service available in public and private sector hospitals, and that the country’s healthcare system should be developed to meet medical requirements of all sections of the population.

“There is a high variance in the quality of service available. Some private hospitals provide world class facilities, so much so that people from third countries come here for treatment giving impetus to medical tourism. On the other hand is the lack of access to even basic medical care for many people, particularly the poor and disadvantaged.”

India’s healthcare system reflects the country’s massive rich poor divide very accurately. The public healthcare system is barely able to provide essential services to the urban population,  while there are many rural areas where no public health service is available at all.

The private healthcare sector has taken up some of the slack, and currently accounts for more than three quarters of total healthcare spending and a similar percentage of the country’s total hospital beds. While private hospitals provide a critical service, the majority of hospitals are based in large urban centres.

The rural population is generally also significantly poorer than the urban population, compounding the problem of availability of medical services with that of affordability. According to Future Generali India Insurance, only about 320 million, or 26% of the population, are covered by some type of health insurance and many pay for medical treatment out of the family’s savings.

Improving the affordability, availability and quality of healthcare available to India’s billion-plus population presents both a massive challenge and enormous opportunities. India’s government is actively pursuing Public Private Partnerships to try and tackle the problem, with the goal of leveraging the scale of the public system with the efficiency and quality of the private sector.

Some examples of these Public Private Partnerships working successfully already exist. The Urban Slum Healthcare Project in Andhra Pradesh is a partnership between State Commissionerate of Family Welfare and NGOs. Outsourcing of emergency transport services in 14 states  where state governments are in partnership with private providers has proven to be very successful, as has the partnership between GE Healthcare and public hospitals to set up diagnostic centres within the hospitals.

While some work is being done to alleviate the plight of the currently underfunded and short staffed public system, many hospitals are feeling the pinch and have not seen any government action for years.

For instance, the state run Gandhi Hospital in Hyderabad currently has an extreme shortage of anaesthetists, extending waiting times up to two months and preventing hundreds of operations from being performed.

The shortage is causing some departments to close down, despite long waiting lists, and while the hospital is still managing to handle all emergency cases, elective surgery has been all but suspended.

The hospital usually operates five days a week, but currently has no anaesthesiologist on duty for two of those five days. Even for patients already admitted, the waiting time for procedures has gone up from three days to two weeks.  According to Dr. Upender Goud, head of anaesthesia, an average of 40-53 surgeries per day are performed at Gandhi Hospital.

“The number of surgeries is not the criteria. What matters is the quality of work. Even a small mistake can cost the life of the patient. We are overburdened and hard-pressed,” says Dr. Goud.
Several representations by the anaesthesia department have been pending with the state government for nearly four years. For the time being, the officials said that they are planning to outsource a couple of specialists and are hoping that there will be some improvement to the situation within a month.

India spends only about 0.9% of its GDP on healthcare, and it will require a lot more investment than that to bring the 30 year old health system up to date. There is a shortage of more than 6000 doctors in primary care facilities across the country, while there is only 1 public hospital bed for every 2000 people. A leading government think tank recently produced a report proposing some changes to try and tackle this massive healthcare conundrum. The report suggests some radical changes in the current system. One of the major proposals is for the government to relinquish its role as the nation’s primary healthcare provider, leaving that role to private facilities, and focus on administration and management of the healthcare system  It envisions a situation where the government pays private healthcare providers fixed rates for providing medical services to the public. These proposals have not been well received by the Health Ministry, which prefers to try and bolster the public system and use private resources to fill in the gaps.

It hasn’t been suggested how much such proposals would cost to implement, but in a country with such a large part of the population living in poverty, one wonders where the money will come from. India not only needs to make some major investment in its healthcare infrastructure, but its road network is falling into disrepair, the railway system is ancient and the electricity grid needs massive investment as well. While the current government is promising to spend USD1 trillion on infrastructure upgrades by 2015, the healthcare problem is far greater than a mere lack of facilities, with issues that are not so easily solved.

The situation in private hospitals is far better, the problem is that very few can afford treatment in them. With almost a billion people having to pay for any healthcare costs out of their own meagerly filled pockets, it is absolutely certain that private healthcare will stay out of reach of the vast majority of Indians for the forseeable future given that only around 6% of the population is covered by private medical insurance.

Compounding the affordability problems of healthcare, the private insurance company, Future Generali India Insurance, sees medical costs in the country increasing at an average of around 15 per cent annually. Currently only about a third of all hospitalization costs in the country are covered by health insurance, meaning the inflation in medical expenses will progressively put quality healthcare further out of reach of a growing number of Indians.

The demand for health insurance coverage in India is very high. Getting more people covered by health insurance may help with removing the urban bias in the accessibility of health care, and may also improve the standard of medical services for all Indians. If the government does decide to step back from being a healthcare provider and chooses to use the private sector to fulfill that role, the demand for private healthcare will obviously increase. As we have seen in other countries who have similar systems, there will always be a market for premium medical services, away from the throngs of people, queues and budget constraints that feature so strongly in public healthcare.

The health insurance industry is expected to grow at a rate of 16-20 per cent per annum for the next five years. The potential for growth is high but for insurance companies it is still a loss making business. Basic loss ratios, which only take into account premiums to claims, have been above 100 per cent and combined ratios which are a measure of ultimate profitability are above 120 per cent. Some of the factors making it difficult for insurers to turn a profit are a high ratio of fraudulent claims and almost no regulation of private healthcare providers, meaning that private hospitals can charge whatever they like. Furthermore,  the Indian system of using third party administrators (TPA’s) to act as a kind of broker between insurers, hospitals and policyholders is prone to abuse and fraud. TPA’s are supposed to ensure that claims are dealt with smoothly, by helping the customer file a claim, working with the healthcare provider to settle bills directly, and referring clients to doctors who are able to deal directly with insurers. The reality is that currently, TPA’s are often delaying payments, offering to settle only partially, leaving policy holders with large unexpected bills, and some are even processing claims for fictional treatments at non-existent hospitals. There have been calls to regulate the role of TPA’s more strictly, but no new measures have been implemented to date.

In an effort to increase market exposure and improve efficiency and ultimately, profitability, insurers are developing strategic partnerships with banks. In one such recent move, Tamilnad Mercantile Bank Ltd, in partnership with United India Insurance Company Ltd, has launched a co-branded family healthcare product, to offer customised health insurance policy for the bank’s customers. “The cost of healthcare is going to increase rapidly in the coming years and insurance is a requirement to meet the cost of healthcare for each individual. This co-branded product will give our customers a fine risk coverage at a low premium,” said KB Nagendra Murthy, managing director and CEO of the bank.

Indian health officials have some big decisions to make. They could choose to simply try and improve the current system by investing in public healthcare infrastructure, increasing training facilities and using the private sector to simply fill in where it cannot provide care, such as in super specialized facilities or experimental treatments. Another option would be to step out of the healthcare provider role altogether, as outlined above, and simply pay private healthcare providers set amounts for treatment. This option is fraught with potential dangers of overpricing and overdiagnosis, as is the case in the USA, where providers are paid per treatment, and the more they do for a patient, the more they get paid.

The PPP model seems to be the most promising, and if done right can play into each sector’s strengths and existing infrastructure. Whichever route India decides to take to deal with its healthcare challenges, working out affordable solutions will definitely be a challenge. However, India has a reputation for innovation, creativity and adaptability in business, let’s hope they have politicians brave enough to implement the changes they need.

Teetering on the brink of economic collapse is Greece, the land of ancient mythological deities, and like the Gods before them hopes and beliefs in a timely turnabout for the Greek economy are dwindling hastily. At hand is the issue of the Eurozone: does Greece stay within and keep the Euro, or will it revert back to the obsolete drachma, the original Grecian currency which existed prior to 2001?

If the Eurozone were to retract it’s inclusion of Greece, there could be drastic effects which affect not only Greece, but the entire Eurozone as well. Specifically, the once-Eurozone-greats of Spain, Italy, and Portugal, who similarly share severely weakened economies, are significantly at risk should the Greek make an exit. It is ironic that the four major players pulling down the system are Portugal, Italy, Greece, and Spain – bearing the acronym of PIGS.

What are some of the possible issues at hand? How will the lifestyle and welfare of the residents be affected? And something more topical, with the state of Greece’s public funding slashed, what will happen to healthcare and health insurance?

Should the Greek system withdraw its participation in the Eurozone, there will be widespread effects across economies not just in the Eurozone, but around the world as well. In preparation for the withdrawal, the Greek banks will probably limit the amount that a person can withdraw from their bank accounts to prevent a bank run and a collapse of Greek banks. Greeks will need to endure the changeover of their currency from Euros to drachma as well as the subsequent devaluation of the drachma. The Euro will most likely be converted to the drachma at a pre-defined rate which will remain fixed for the duration of the changeover. As it stands, the exchange rate, which was revised in April of 2012, stood at 1:340.75. There is a glimmer of hope: many sophisticated investors and those with significant savings have already shifted their funds out of their Greek banks into foreign banks. What this means is that if Greece were to recover, the money is ready to come back in, without experiencing a dismal devaluation.

Once Greece exits, there will be defaults on their debt, which still hold their face values in Euro dollars. Even with 95 billion euros of the debts face value wiped, it still represents almost 265 billion euros. But what kind of implications will that have on the other countries whose economies are also at risk? Spain, Portugal and Italy’s liquidity is affected significantly due to investor fears of economic collapse and worries about debt repayment. Since all three countries require debt financing and liquidity for day-to-day activities, the loss of foreign investments can cause serious liquidity issues. The financial health of these countries could be in considerable trouble, especially since Italy and Portugal carry a considerable amount of debt – with inabilities to pay off the interest payments on loans and bonds, both countries could default. Currently, both countries owe more than their annual GDP.

If it turns out that Greece needs to roll in the new currency, the drachma, the currency that most likely will replace the Greek Euro, will take time to officially come into place. Experts predict that it will take four months until the currency is printed and entered back into circulation. Until then, monies held in bank accounts will likely be changed immediately, while the physical Euro, or at least those denoted by a Y which is the Greek country code, will still be accepted with those.

After the drachma is returned to the Greeks, what will likely happen is inflation, or worse, hyperinflation – you may have seen those old photos of people carrying a wheel barrel of cash just to buy a loaf of bread, or starting a fire with the local currency. If hyperinflation takes place, and this may become a reality for the Greeks should the drachma drastically devalue after its introduction, a basket of goods does not. The relative value of a drachma compared to that basket of goods will widen, resulting in the price of goods soaring.

Moreover, as the drachma is worth less and less, imports become exponentially more expensive. This is not good news for Greece as it is a net import state – Greece imports more than it exports, including food. Conversely, exports will receive a great benefit from the devaluation as one of Greece’s biggest export, tourism, will surely rise due to inexpensive holidays and cheap money.

Inflation, or hyperinflation, will cause Greece to be highly unaffordable for many of those struggling amidst the grip of unemployment; stability in the region will be hard to attain until the government gets back on its feet and is able to borrow again. Residents of Greece may leave the country in a bid to reduce the effect of the devaluation, but measures may be put in place to restrict some of these movements, including provisions on bank account withdrawals.

Compounding the damage is the cut in public spending and governmental policies which affect the business community. Specifically, a lowered minimum wage will have negative effects on residents’ ability to afford goods, making daily necessities difficult to attain. Greece’s two-tiered wage cut, was disproportionately hard on the younger generation, with the minimum wage for those under 25 cut 32 percent, instead of 22 percent. The effects of this and other cuts are being felt more acutely as goods become more expensive. As there are proponents of a spending method to get out of a recession, it seems like this is almost an impossible option for Greece at the moment whose debt outpaces its GDP by over 170%.

Businesses may begin to fail – their ability to borrow money and to keep a sufficient flow of business will be seriously affected by the devaluation of drachma. Furthermore, as citizens concerns start to turn towards more essential goods, such as accommodation, food, and other necessities, relative luxury goods and services become less important in their lives. Businesses suffer due to the lack of demand for their goods and may be forced to close doors.

And what about the necessities of healthcare and the ability to receive healthcare? Already, hospitals all over Greece are feeling a financial asphyxiation which is being transferred to the patients. Supplies are low and resources are lower. As public benefits decline, people increasingly turn to the public hospitals to receive treatment where the waits are long but the prices are lower. Significant changes have been made to treatment policies, allowing only for serious cases to be treated in a timely manner, or at all. There have been numerous reports of supplies being stolen, especially syringes and gloves.

Citizens’ ability to receive healthcare will be negatively impacted and will continue to worsen as the burden on health services is driven by the declining health of citizens. Wait times will be compounded as hospitals are flooded with demand for healthcare and an increasing lack of personnel and resources to service them. Doctors and nurses may flee to private hospitals or other countries in the wake of cuts to benefits, increases to workload and the potential of frozen salaries.

The medical system is already beginning to collapse. Big Pharmaceutical companies are refusing to provide medication because of the inability of hospitals and clinics to pay. In some cases, doctors and nurses are providing healthcare and treatment with no pay and can endure such a lifestyle for only so long.

Medical insurance will be equally negatively impacted in the near future. As businesses feel the increasing effects of the slowdown, so will local health insurers as business functions are hampered by inabilities to borrow and inflation makes existing or collected premiums insufficient for providing coverage. Moreover, premiums collected before the collapse may be converted to the drachma from the Euro and may not be enough to cover the cost of providing healthcare once devaluation sets in. Premiums will probably need to rise in order to keep pace and many may cancel their plans and opt for basic health coverage through the government because they cannot afford to keep up with the increasing premiums. This is under the assumption that the Greek government will continue to provide subsidized health coverage – under austerity measures, subsidized health coverage could very well be one of the earlier things that a government will cut. This will likely result in the collapse of many local health insurers, leaving those previously insured with them without coverage.

As for international health insurance in Greece, premiums for new plans should increase. Since premiums are calculated based on a community rating, the risk profile for those in Greece is increasing alongside the cost of providing healthcare in Greece. Those who do not have health insurance should consider purchasing an international health insurance plan prior to any change in currency that may take place. The plan will be good for the year before the devaluation takes effect, resulting in confirmed coverage for the higher costs of healthcare. It will be a money saving route for the long run. As for existing international health insurance premiums, they too will probably increase in the coming years because it will be costlier to provide healthcare in the country given the lack of supplies or credit to purchase them, as well as the possible need for more people to travel abroad to seek treatment. Furthermore, the health of the residents may continue to decline, resulting in a riskier health profile to the insurance companies, especially since big pharmaceutical companies are wary of providing more supplies on credit.

This makes acquiring an international health insurance policy in Greece much more attractive now rather than later. Before the conditions are unfavorable for you to acquire insurance, acquiring now is a safe way to hedge your bets against both financial and healthcare problems in the future.

There is salvation in sight: with the devaluation of the drachma, many exports become significantly more inexpensive across the world. This makes Greeks exports attractive, helping the country get on its way to recover. However, if the country does not exit the Euro, recovery could be long and arduous.

With Greece controlling its own currency and fiscal policies, it can make provisions and decisions which can bring it out of its slump faster. For example, if Greece wanted to increase its exports, it could further devalue its currency by printing more of it. In addition, Greece has free reign to set its own interest rates, which could facilitate lending and financing throughout the region.

Argentina and Latvia are similar examples of the two options which Greece is faced with: stay with the old currency or move on to their own. Argentina was pegged to the US dollar and Latvia is part of the Eurozone. When faced with their financial meltdowns, Argentina opted to discard the pegging and Latvia decided to stay with the Euro.

What happened was Argentina’s peso devalued significantly and unemployment soared, as did inflation. But quickly after, Argentina crawled out of their depression and reached their peak output levels in just a few years. In contrast, Latvia struggled significantly while under the Euro and GDP growth plunged to the deep negatives. Living conditions continued to decrease and is projected to start recovering in the coming years.

The rise of the middle class in East Asia is proving to be a boon for private healthcare providers. Kuala Lumpur based IHH illustrates this nicely. In their recent IPO, which was 132 times oversubscribed, IHH raised more than USD 2 billion and the shares climbed by more than 10% in the first few days of trading. The value of the company stands at around USD 8 billion. IHH is now the second largest hospital group on the planet, and the largest outside the USA.

Owned by Khazanah Nasional Bhd, a state owned investment arm, IHH tells a story of unprecedented growth. Khazanah started their move into the healthcare sector in 2005, when they bought a 13.2% stake in India’s largest private hospital group, Apollo Hospitals Enterprise. A string of acquisitions and investments in the following years have enabled IHH to build itself into the powerhouse that it is today, able to ride the wave of opportunity created by the growing economies of East Asia.

According to Frost & Sullivan, the market for healthcare in Asia Pacific region will grow by 8 % until at least 2015, and IHH already has plans to add another 3300 new beds and 17 hospital developments in China, Singapore, Malaysia and India, as well as expansion plans Turkey, Egypt and Lybia by the end of 2016.

The success of IHH has been largely due to their ability to fill the gap created by lagging national healthcare infrastructure and rising demand for quality medical services in countries like Indonesia and Malaysia. The strategic positioning of their Singapore based hospitals, all within a relatively short 3-4 hour flight from Malaysia, Indonesia, Vietnam, Myanmar and Bangladesh, has created a healthcare hub which IHH has been well positioned to exploit.

IHH is now applying their winning formula to expansion in other developing regions of the world. It recently bought a 60 percent stake in the owner of Turkey’s largest hospital group, Acibadem Saglik Hizmetleri & Ticaret AS, which it bought for $826 million. Turkey is conveniently situated within easy reach of Central and Eastern Europe, the Middle East and Africa, much like Singapore is to East Asia. IHH hopes to develop their Turkish operation into another global  healthcare hub, alongside Singapore and Malaysia.

The growth of private healthcare, especially in the developing world, is certainly a good thing, providing top medical services to those who can afford it, and easing some of the burden on national healthcare systems by providing an alternative source of treatment and the associated networks of training and development facilities. IHH owns a private medical university and a nursing training centre in Malaysia. Private healthcare is also the incubator for new healthcare technologies and techniques, as public sector healthcare often doesn’t have the budget or the staff to invest in much other than proven technologies and treatments.

There is a downside to this success story though. The draw of shiny new hospitals, new technology, a better working environment and higher salaries is proving to be too much for many healthcare professionals to resist, and is causing a slow but steady exodus from the public health systems all over the world, from the poorest and most underdeveloped, to the wealthiest and most advanced, basically without exception. Patients in private healthcare enjoy the luxury of not having to wait for treatment, of being treated by doctors who are well paid, have had enough sleep and who have enough time in their day to carefully consider a patient’s diagnosis and treatment.

The state of public health services is not quite so utopian. Even in somewhere as developed as Hong Kong, the public Health Authority struggles to find staff, and is left with no choice but to require the staff it does have to work unsustainably long hours for pay which is well below the equivalent in the private sector. This situation is not only making it difficult to convince new personnel to work in the public sector, but also creates an environment that is prone to mistakes and accidents.

President of the Hong Kong Doctors Union Henry Yeung Chiu-fat said many young doctors nowadays want easier jobs. Their preference for less stressful fields has exacerbated staffing problems. For example, becoming an ophthalmologist (eye doctor) is much more competitive with less-demanding on-call work than internal medicine or emergency room jobs.

Public hospitals In Malaysia, Thailand, China, India, UAE, South Africa, Australia, and even Europe have all been struggling with this issue, with some areas being so short of staff that they are having to close departments when a particular specialist is away for any reason.

While some of the problem can be alleviated by increased salaries and reform of health departments to be able to offer more flexibility to staff, there is another factor brought on by the rise in private medical services which could make the brain drain even worse.

The option for overseas treatment offered by a growing number of private medical insurance companies, as well as the relatively cheaper cost of treatment in developing countries, has created a massive growth in medical tourism. This lucrative market requires staff who are not only medically qualified, but who are also multi-lingual and culturally sensitive. This is a relatively unique demand of the private sector, since public sector hospitals treat a relatively small percentage of foreign language speakers.

This begs the question: If the unprecedented growth in international private health services continues, which it probably will (IHH alone are building 17 new hospitals), and the private sector continues to draw in much of the top talent in the medical industry, how will the public health services maintain a high standard of care, with fewer experienced personnel and many young doctors looking elsewhere for employment?

The crisis is very real, and there needs to be some serious thinking done on the part of the public health systems, especially those of developing countries. Stop gap measures will only work for so long, as human doctors and nurses will get tired and frustrated which can lead to them making potentially serious mistakes or quitting.

In China the problem is just as real, although slightly different. The private sector is still very small in comparison to public health system, instead, the problem China faces has to do with the urban – rural divide. China has recently spent more than USD 100 billion to try and bridge this gap, providing health insurance cover to 98% of rural Chinese, and ensuring access to improved primary healthcare facilities in a massive investment in rural infrastructure. While a large proportion of the rural population now have access to modern medical facilities, and are now more able to afford it, the State has still not been able to convince doctors and nursing staff to choose to work in more rural locations. Any career minded doctor in China would choose to work in one of the top tier city hospitals, where their case load will give them more interesting work with increased opportunity for career advancement, and where there are more opportunities for generating secondary income with some private practise on the side. In Shanghai alone 9 new hospitals are being built, which will all need to be staffed. A position in the rural areas is definitely not on the average Chinese doctor’s wish list, and the State faces some serious challenges in encouraging doctors to fill rural postings.

Unless creative solutions can be put in place, it seems that staffing issues in the public sector only going to increase around the world. With so many nations now facing economic turmoil, a significant increase in public health spending is not going to be easily managed. While investing more money into public health spending and salaries may alleviate the problem, other factors are involved in many cases.

What is certain is that all this bodes very well for the private healthcare industry. Being able to obtain first class medical care is going to become more dependent on whether patients are covered by private health insurance, and the public systems could decide, as the NHS in the UK and the Health Services Executive in Ireland have, to use the private sector to take some of the burden of healthcare off of public sector facilities. Add to all these factors the ageing world population, and it looks like the ideal environment for further growth in the private healthcare industry.

The largest challenge facing private healthcare providers may end up being that of finding and keeping their staff. Inevitable rises in salaries due to industry competition, are sure to be a major factor in the profitability and affordability of private healthcare. However, medical care will still be a necessity for everyone, and with a growing middle class in many developing parts of the world, an increasing number of people will be willing and able to pay for quality care.

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