In China today there are almost no general practitioners. One of the current characteristics of the Chinese health system - however strongly inspired by the French model it seems - is the absence of a first-line health service. In fact, barely 6% of doctors are generalists, 94% are specialists (50/50 in France). The Chinese therefore do not have a family doctor and must go to the hospital to consult for whatever reason. But while monitoring the state of health is a major concern for the population, how is it ensured in the absence of a network of general practitioners? For the 50% of the population living in the countryside, the only solution is the dispensary where the nursing staff is poorly qualified: the service is provided by the famous "barefoot doctors", who are not doctors in the sense that we hear it, but people with very rudimentary training. In urban areas, the 400 million migrants - ie those who have left the countryside to work in big cities or their peripheral industrial zones - cannot use "barefoot doctors". The hospital is therefore their main access to healthcare solution, difficult to access for financial reasons.
Healthcare system in China
Oversea medical tourism
Conversely, the wealthiest do not hesitate to go abroad, including for a routine check-up. In 2016, more than 500,000 rich Chinese people traveled outside of China for their health, spending more than 10 billion euros, mainly on a health check-up and cosmetic surgery.
Chinese middle Class has a limited access to good treatment
There remains the middle class, estimated at more than 300 million people, whose annual income is between 60,000 RMB and 229,000 RMB (i.e. between 7,700 euros and 29,300 euros), which has purchasing power in strong growth and which is more and more sensitive to health issues, at least its health.
For the latter two categories, representing 21% of the Chinese population, in the absence of general practitioners, the solution consists in going to prevention and screening centers to ensure their medical follow-up.
The market is large and promising. Appeared 15 years ago, it is estimated at more than 200 billion RMB (26 billion euros) in 2016, which is very modest compared to the total health expenditure of the country (less than 2%), but with very significant growth: it should reach 300 billion RMB (38 billion euros) in 2020, i.e. a multiplication by 6 in value between 2014 and 2020 (source Frost and Sullivan) .A standard balance sheet, common to the three groups, provides most often dental, vision, hearing, blood pressure measurement, complete blood test, hepatitis B and C screening (China has the highest number of people infected with hepatitis C worldwide), syphilis and AIDS (frequently an AIDS patient in China loses his job), a urine and stool test, a chest X-ray but also tests for markers of lung and liver cancers and intestines; finally, the assessment includes a nutrition consultation.
general trends about health in China
Men also have a cardiovascular test, single women have a mammogram, and married women have a smear and pap smear in addition to the mammogram. The centers offer other optional exams, which some employers include for a category (most often managers) of their employees, rarely for all, or which the employees buy themselves: MRI of the head or even of the whole body, densitometry bone, thyroid ultrasound, colonoscopy… All the players offer very comparable content and prices. The market is financially stable, growing very fast, but not very different: the ingredients for a ruthless competitive war are there. Today, two categories of players compete for this market: public hospitals - which account for 85% of activity - and a few private chains.
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