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PEOPLE'S REPUBLIC OF CHINA

CONTENTSgeneral social-economic characteristics of residential life in CHINA (KWONG HENG SHENG) population statistics (belton winford) characteristic of the populations health in the cOuntry (LIM KHENG HAO & Kwong heng sheng) organization of the health service system in the country (charLENE CHAI & GERALDINE ANG)Model of a health service system The management of a health service system Organization of hospital care to urban populatioNOrganization of medical care to rural populationThe main principles of emergency care organization The system of protection of motherhood and childhood

ConclusionBibliography

(I) General social economic characteristics of residential life in a given country (region)

Government structure and Political regime

Administrative and Territorial subdivisions

Climatic and Geographic PecularitiesIn China, a vast land spanning many degrees of latitude with complicated terrain, climate varies radically. Five Temperature Zones:Cold-Temperate ZoneMid-Temperate ZoneWarm-Temperate ZoneSubtropical ZoneTropical ZonePlateau Climate Zone

Economy of ChinaChina'ssocialist market economyis theworld's second largest economy by nominal GDP, and theworld's largest economy by purchasing power parityaccording to the IMF.

Until 2015 China was the world'sfastest-growing major economy, withgrowth rates averaging 10%over 30 years.

Types of production in China: Agriculture and IndustryAGRICULTUREChina is the world's largest producer and consumer of agricultural products. China ranks first in worldwide farm output, primarily producingrice,wheat,potatoes,tomato,sorghum,peanuts,tea,millet, barley,cotton,oilseedandsoybeans.INDUSTRYIndustry and construction account for about 48% of China's GDP. Chinaranks secondworldwide in industrial output. Major industries include mining and ore processing;ironandsteel;aluminum;coal;machinery;armaments;textilesandapparel; petroleum;cement;chemical;fertilizers;food processing;automobilesand other transportation equipment including rail cars and locomotives, ships, and aircraft;consumer productsincludingfootwear,toys, andelectronics;telecommunications andinformation technology.

(II) POPULATION STATISTICS

POPULATION STATISTICSPopulation ;1,375,114,753Population rank ; 1Urban-rural ratioUrban 49.68%Rural 50.32%Population growth rate 0.57% (2000-2010)

Area (km2)PopulationDensityChina9,650,000 (100%)1,300,000,000 (100%)134.7 h/km25 provinces5,246,400 (54.45%)79,533,000 (6.12%)15.16 h/km2Inner Mongolia1,183,000 (12.28% )24,051,000Xinjiang1,660,000 (17.23%)20,952,000Tibet1,228,400 (12.75%)2,842,000Qinghai721,000 (7.48%)5,516,000Gansu454,000 (4.71%)26,172,000China proper4,403,605 (45.55%)1,221,000,000 (93.89%)277.27 h/km2Source: National Bureau of Statistics

Population density and distribution

Ethnic groupsThe People's Republic of China (PRC) officially recognizes 56 distinct ethnic groups, the largest of which are Han, who constitute 91.51% of the total population in 2010. Ethnic minorities constitute 8.49% or 113.8million of China's population in 2010. During the past decades ethnic minorities have experienced higher growth rates than the majority Han population, because they are not under the one-child policy. Their proportion of the population in China has grown from 6.1% in 1953, to 8.04% in 1990, 8.41% in 2000 and 8.49% in 2010.

Religions

Chinese traditional religions: including worship of gods and ancestors, Confucianism, Taoism, and aspects from Buddhism Buddhism Islam Ethnic minorities' indigenous religions Mongolian shamanism Dongbei folk religion and Manchu shamanismPresently, the Party formally and institutionally recognises five religions in China: Buddhism, Taoism, Islam, Protestantism, and Catholicism (though despite historic links, the Party enforces a separation of the Chinese Catholic Church from the Roman Catholic Church).

LanguagesThe official spoken standard in the People's Republic of China is Putonghua. Its pronunciation is based on the Beijing dialect of Mandarin, which was traditionally the formal version the Chinese language.Other languages include other varieties of Chinese: Mandarin dialects, as well as Wu (Shanghainese), Yue (Cantonese), Minbei (Fuzhou), Minnan (Hokkien or Taiwanese and Teochiu), Xiang, Gan and Hakka; there are also minority languages spoken in ChinaNon-Chinese languages spoken widely by ethnic minorities include Mongolian, Tibetan, Uyghur and other Turkic languages (in Xinjiang), Korean (in the northeast), and Vietnamese (in the southeast).In addition to Chinese, in the special administrative regions, English is an official language of Hong Kong and Portuguese is an official language of Macau.

Age sex composition More young due to the implementation of one child policy.

-Infant mortality rateTotal: 15.2 deaths/1,000 live births (2013 est)Male: 15.16 deaths/1,000 live births (2013 est)Female: 15.25 deaths/1,000 live births (2013 est)Major causes of death per 100,000 population, based on 2004 urban population samples:malignant neoplasms (cancers): 119.7cerebrovascular disease: 88.4respiratory diseases: 78.1heart diseases: 74.1accidents, violence, and poisoning: 43.5

belton winford (bw) - (III) Characteristic of the population's health in China

Morbidity and InjuriesGeneral incidence and prevalence rate of the population

Specific Morbidity indicatorsSurveillance for communicable diseases is the main public health surveillance activity in China. Currently, the disease surveillance system in China has three major components:National Disease Reporting System (NDRS): The system covers the entire population (1.3 billion persons) living in all the provinces, prefectures, and counties that make up mainland China. Thirty-five communicable diseases are reportable under this system.Nationwide Disease Surveillance Points (DSPs): This surveillance system, comprising 145 reporting sites selected by stratified cluster random sampling, covers a 1% representative sample of China's population.Surveillance system for specific infectious diseases, occupational diseases, food poisoning, etc.

General Occupational Morbidiy and InjuriesMigrant workers account for a disproportionate burden of occupational injury morbidity and mortality in China. However, data are inconsistent and inadequate to detail injury incidence or to evaluate interventions. The following are suggestions to decrease injury incidence among migrants: strengthen the national system of occupational injury surveillance; focus surveillance and interventions on high-risk occupations employing migrants such as construction operations; improve occupational safety training and access to appropriate safety equipment; evaluate recent changes in occupational health and safety and evaluate outcome of multi-party interventions to reduce occupational injury among migrant workers.

Infectious Morbidity rate in China1999200320042008Percentage (%)95% confidence intervalQuarantinable diseasesPlague0.01000.00362257 to +41Cholera0.00810.000248*70 to 12Epidemic haemorrhagic fever0.02350.015912*20 to 3Vaccine-preventable diseasesPoliomyelitis0.0001b0.0001b00 to 0Measles0.01010.0058620 to +10Pertussis0.00810.000344*59 to 23Diphtheria0.00800.0080060 to +153Tetanus0.03230.017412*2 to 8

Gastrointestinal diseasesBacillary and amoebic dysentery0.01550.008710*18 to 1Typhoid fever/paratyphoid fever0.00860.002922*39 to 2Vector-borne diseasesEpidemic/endemic typhus0.00800.00015487 to +61Japanese encephalitis (scrub typhus)0.02540.0196614 to +3Visceral leishmaniasis (kala-azar)0.00750.0035569 to +20Malaria0.00870.00401426 to +1Dengue fever0.01000.005142*80 to +66

Zoonotic infectionsLeptospirosis0.01120.004020*32 to 6Brucellosis0.01000.00352464 to +63Anthrax0.00830.002531*100 to 1Rabies0.07530.215326*+14 to +37Bacterial infectionsMeningococcal meningitis0.00990.012632 to +8Scarlet fever0.00800.00342366 to +74Tuberculosis0.05800.224428*+14 to +43Sexually transmitted infectionsHIV infection0.02850.218544*30 to 58Gonorrhoea0.01000.000249*63 to 30Syphilis0.00830.0059419 to +15Viral hepatitisAll0.06970.08975*2 to 8Hepatitis A0.00590.002521*32 to 8Hepatitis B0.04730.06429*1 to 20Hepatitis C0.00270.007630*16 to 46Hepatitis E0.00190.003193 to +24

Chronic Disease rate in China

Facts :In china, chronic diseases are projected to account for 79% of all deathsTotal projected deaths in china, 2015 = 9,427, 000Total projected deaths due to chronic disease in China, 2015 = 7,471, 000WHO projects that over the next 10 years in Chinaover 80 million people will die from a chronic diseasedeaths from infectious disease, maternal and perinatal conditions, and nutritional deficiencies combined will increase by 2%deaths from chronic disease will increase by 19% - most markedly, deaths from diabetes will increase by 50%

Substance abuse disorderAlcohol abuseChinas rapidly growing middle class and pressurised workplace culture have created a nation of boozers, with the average Chinese drinker now consuming more alcohol than his or her British peer.Alcohol consumption per capita in China has risen from an average of 4.9 litres between 2003 and 2005 to 6.7 litres five years later, according to data from the World Health Organisation cited in a recent medical journal report.When non-drinkers are excluded, seeing as 56pc of Chinas population are teetotal, consumption per capita soars to an annual 15.1 litres of pure alcohol.

Drug Addict populationThere are over 900,000 registered drug addicts in China, but the Government recognizes that the actual number of users is far higher. Some unofficial estimates range as high as 12 million drug addicts. Of the registered drug addicts, 83.7 percent are male and 73.9 percent are under the age of 35. In 2001, intravenous heroin users accounted for 70.9 percent of the confirmed 22,000 human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) cases. Chinese officials are becoming increasingly concerned about the abuse of methamphetamine and other amphetamine-type stimulants.

SmokingMain article: Smoking in the People's Republic of ChinaSmoking related illnesses kill 1.2 million in the People's Republic of China; however, the state tobacco monopoly, the China National Tobacco Corporation, supplies 7 to 10% of government revenues, as of 2011, 600 billion yuan, about 100 billion US dollars.[35]

Injuries incidence rate in ChinaTransport accidents

YearNumber of accidentsNumber of deathsNumber of injuriesNumber of deaths per 10,000 vehicle 1)Number of deaths per 100,000 population1996287,68573,655174,44720.416.021997304,21773,861190,12817.505.971998346,12978,067222,72117.306.251999412,86083,529286,08015.456.822000616,97193,853418,72115.607.272001754,919105,930546,48515.468.512002773,137109,381562,07413.718.792003667,507104,372494,17410.818.082004517,889107,077480,8649.938.242005450,25498,738469,9117.577.60

Suicide rates in chinaThe most recent government data provides statistics more inline with external estimations. According a 2011 Centre for Disease Control and Prevention report, China's suicide rate is 22.23 people out of every 100,000. This rate places the country among the countries with the highest suicide per capita in the world. However, a 2014 study conducted by the Centre for Suicide Research and Prevention at the University of Hong Kong reported that China's suicide rate has dropped significantly, among the lowest levels in the world. An average annual rate of about 9.8 people out of every 100,000 committed suicide as of 2009 to 2011, a 58% drop, largely as a result of population migration from rural areas and urbanization of middle class

Homicide rate in ChinaHomicide rate in China is as low as Switzerland, a country known as one of the safest nations, reported Southern Metropolis Daily on Thursday.

"The homicide rate in China in 2014 is 0.7 per 100,000 residents, which is better than those in developed countries such as the United States, the United Kingdom or France," said Meng Jianzhu, head of the Commission for Political and Legal Affairs of the Communist Party of China Central Committee, during a national conference in Dalian, Liaoning province.

DisabilityOf the total number of disabled individuals, men account for 42.77million (51.55%) and women account for 40.19million (48.45%), making the gender ratio 106.42 disabled men for every 100 disabled women.

Furthermore, 20.71million (25.96%) individuals of the disabled community reside inurban areas, whereas 62.25million (75.04%) inrural areas.

According to theChina Disabled Persons' Federation, approximately 12.33million (14.86%) people havevisual disabilities, 20.04million (24.16%) have ahearing disability, 1.27million (1.53%) have aspeech disability, 24.12million (29.07%) have aphysical disability, 5.54million (6.68%) have anintellectual disability, 6.14million (7.40%) have amental disability, 13.52million (16.30%) have multiple disabilities.

Age-specific incidence rates of disability

Current government programs of the assistance and support of disabled personsThe Government of China has adopted and implemented a number of laws, policies standards and initiative pertaining to people with disabilities, including their right to productive and decent work. The main ones are: The China ConstitutionThe Law on the Protection of Disabled PersonsThe Rehabilitative Medical Education Plan (1992)The Regulations on the Education of Persons with Disabilities (1994)The Provisional Regulations of the Qualification System for Prosthetists and Orthotists (1997)The Rules on the Employment of Disabled Persons adopted in 2007The Employment Promotion Law (2007)The 12th Five Year National Programme on Disability (2011-2015)The Regulations on Construction of Accessible Environment (2012)The Mental Health Law (2012)

(IV) organization of the health service system in the country

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A. Model Of A Health Service System

State Sources Of Health Service Financing There are 3 major insurance programs which cover specific groups Rural residents under NCMS [new rural cooperative medical scheme]Urban employees under UR-BMI [urban employees basic medical insurance]Unemployed urban residents under UR-BMI [urban residents basic medical insurance]

System Of Medical Insurance The government, employers, and individuals pay for healthcare. In December 1998, a nationalmedical insurancescheme was launched by the State Council. By end of 2002, most of the county or above level cities had joined the scheme and covered a population of about 100 million. Social Insurance Fund Administration Centre, a department of the Ministry of Labor and Social Security, oversees this insurance system. Currently, this system only focuses on employees of enterprises at or above township level. Those in remote or less developed areas cannot enjoy the benefits of this scheme, which is considered a shortcoming of the social medical insurance scheme.The National Basic Medical Insurance Scheme ensures basic medical access by the public under the social security system. Individuals pay an annual insurance premium for their basic medical treatment entitlements. This scheme has replaced the previous government-funded labor insurance medical system.Foreign-invested enterprises are required to provide health insurance benefits, but are not required to participate in the basic plan. For example, for employees of foreign enterprises in Beijing hired through Foreign Enterprises Service Corp. (FESCO), foreign enterprises pay FESCO, and FESCO then buys insurance policies for these employees. The government also allows commercial health insurers to operate in China.

Private Medical Institutions. Paid Medical Services Forms.In 2000, a reform started to occur in the Chinese hospital system. Government owned hospitals are being restructured, some of them being sold to individual investors, and more and more private hospitals are founded.In 2004, Beijing Aikang Medical Investment Company bought a state-run-enterprise owned AAA hospital (the highest standard), and the acquisition was the first of this kind in China. The investment company plans to buy 10 hospitals in the next three to five years. InFuzhou, the capital city of Fujian province, four government-owned hospitals have been sold to private investors.

Other Financing Sources (Private, Profitable Insurance Organizations, Non-profitable Organizations, etc.)According to a news report, 44.8% of urban residents and 79.1% of rural residents have no medical insurance. Many of people are private payers. They either cannot afford to buy medical insurance, or do not understand the value of medical insurance.In contrast to rural residents, urban residents have much better situation. Many employers have bought for their employees group or supplementary medical insurance, and employers deduct from employees payrolls a small percentage of their monthly incomes.

Relations Between International Organizations and Health Service System In The CountryNational immunization program has been implemented. The national immunization program represents one of the most notable and influential undertakings of China's healthcare work. In the early 1960s, China eliminated smallpox through vaccine inoculation, a dozen years ahead before the World Health Organization (WHO) announced the eradication of the disease in 1980. China attained the goal of eliminating poliomyelitis in 2000. In 2002, the Chinese government decided to include hepatitis B vaccination for the newborn in the national immunization program, increasing the number of four vaccines against six infectious diseases to five vaccines against seven infectious diseases. In 2007, China decided to further expand the scope of the program, increasing the number of vaccines to 14 to prevent 15 infectious diseases and extending the scope of vaccination from children to including adults. Since the launch of the new round of medical reform, the scope of the national immunization program has kept expanding, and it has played a positive role in reducing the morbidity of infectious diseases and improving the health of the public. Already, the morbidity of most infectious diseases that can be prevented by vaccination has fallen to the lowest level in history.

Major infectious and endemic diseases have been brought under effective control. Patients of many major infectious diseases, such as AIDS, tuberculosis, snail fever, hydatid disease, leprosy and malaria, are provided medicines and treatment free of charge. In 2011, China's living HIV-infected persons and AIDS patients were estimated at 780,000, far below China's goal of controlling the HIV-infected population within 1.5 million. The morbidity of infectious tuberculosis has fallen to only 66 per 100,000 people, attaining the goal defined in the UN Millennium Development Goals ahead of time. All counties where epidemics of snail fever used to break out have attained the goal of bringing under control such epidemics, limiting the number of snail fever patients to 326,000. China took the lead in eradicating filariasis among the 83 countries where epidemics of filariasis hit. China keeps improving its capabilities of influenza control and prevention, taking monitoring at the major task. In 2010, the National Influenza Center of the Chinese Center for Disease Control and Prevention was officially nominated the fifth WHO Collaboration Center for Reference and Research on Influenza. China steadily promotes endemic disease prevention and treatment. It has eradicated the diseases caused by iodine deficiency at the national level, and brought under effective control of Kashin-Beck disease, Keshan disease and fluorine poisoning, notably reducing the incidence of these diseases

Financial Problems In Health Service System and Other DisadvantagesImplementing health reform first requires a thorough and comprehensive view of the current issues with the healthcare sector today. Identifying problems can set the blueprint for changes to be made in the future. There are three main challenges: The lack of access to affordable healthcare Inefficient use of healthcare resources A lack of high-quality patient care.

Simply put, a significant portion of Chinas urban and rural population is without access to affordable healthcare. Rural areas are particularly hard hit, with 39 percent of the rural population unable to afford professional medical treatment.14 Furthermore, 30 percent of respondents in rural areas indicated that they have not been hospitalized despite having been told they need to be.15 This grim situation is largely attributed to the abolishment of farming communes and rural health clinics that were replaced with private medical practices in the 1980s without any alternatives established to date. The situation is not much better for urban residents, with 36 percent of the population also finding medical treatment prohibitively expensive.

The second key challenge is that current healthcare resources are often not allocated to and used effectively by the segments of the population that need them most. This imbalance is driven by inefficiencies in the supply and demand of healthcare services. A disproportionate amount of Chinas healthcare resources have traditionally been concentrated on larger hospitals, particularly those in urban areas. More than 80 percent of health expenditures are allocated to urban areas even though 70 percent of the total population resides in rural areas.23 This spending disparity is reflected in the number of hospital beds and healthcare personnel in rural and urban areas (see Figure 2) and is in line with the overall urban emphasis of Chinas social security system

Another factor contributing to the lack of high-quality patient care is the difficulty in monitoring the level of quality care within Chinas very complex healthcare system. Currently, there is a lack of integrated health policies that apply to all hospitals. The provision and regulation of health service delivery is largely decentralized and managed by a multitude of different stakeholders, including the Ministry of Health, provincial and city governments, military, and even large state enterprises that continue to operate their own hospitals. This decentralization not only creates great variation in terms of quality of care across the healthcare system, it also makes it difficult to consistently monitor the level of care.

B. The Management Of A Health Service System

Structure Of The Health Ministry Of the Republic Of China theMinistry of Health of the People's Republic of China(MOH) was anexecutive agencyof the state which plays the role of providing information, raising health awareness and education, ensuring the accessibility of health services, and monitoring the quality of health services provided to citizens and visitors in themainlandof thePeople's Republic of China. In the reforms of 2013 the ministry has been dissolved and its functions integrated into the new agency called theNational Health and Family Planning Commission. As part of theNational Health and Family Planning Commissionit is now headed by Ms.Li Bin.

The organization structure of Chinese health Care system

State Department Government of Provincial, Municipal, Autonomous RegionProv Dept of Health Local Dept.of Health Chinese Academy of Medical ScienceChinese Academy of Preventive Medicine Medical Colleges and UniversitiesDrug and Bioengineering Product Research Institute The Ministry of Health General and Specialized hospitalEpidemic Prevention StationMaternity and Children Health Care Hospital (Clinic)Drug Inspection StationRegional Administrative OfficeGeneral and Specialized hospitalEpidemic Prevention StationMaternity and Children Health Care Hospital (Clinic)Drug Inspection Station

Government of Municipal, County, DistrictTownship hospital (clinic), District hospitalOutpatient clinicMunicipal (District) hospital, County hospital, Epidemic Prevention Station, Endemic Disease Prevention StationMaternity and Children Health Care Hospital (Clinic), Secondary Health School

Township government, Subdistrict OfficeVillagers committee, Neighborhood residents committeeVillage health station, Red Cross health stationDistrict department of Health

Three tiered prevention and health care system

Number And Types Of Medical Institutions Of Outpatient and Inpatient Care, The Main Ways And Tasks Of Their Work

Hospitals inChinaare organized according to a 3-tier system that recognizes a hospital's ability to provide medical care, medical education, and conduct medical research. Based on this, hospitals are designated asPrimary,SecondaryorTertiaryinstitutions.

A primary hospital is typically a township hospital that contains less than 100 beds. They are tasked with providingpreventive care, minimal health care and rehabilitation services. Secondary hospitals tend to be affiliated with a medium size city, county or district and contain more than 100 beds, but less than 500. They are responsible for providing comprehensive health services, as well as medical education and conducting research on a regional basis. Tertiary hospitals round up the list as comprehensive or general hospitals at the city, provincial or national level with a bed capacity exceeding 500. They are responsible for providing specialist health services, perform a bigger role with regard tomedicaleducation and scientific research and they serve as medical hubs providing care to multiple regions.Further, based on the level of service provision, size, medical technology, medical equipment, and management and medical quality, these 3 grades are further subdivided into 3 subsidiary levels: A, B and C ([ji], [y], [bng]. This results in a total of 9 levels. In addition, one special level - 3AAA ()- is reserved for the most specialized hospitals.

System Of Disease Surveillance In China

Surveillanceforcommunicable diseasesis the mainpublic healthsurveillance activity inChina. Currently, thedisease surveillancesystem in China has three major components:

National Disease Reporting System(NDRS): The system covers the entire population (1.3 billion persons) living in all the provinces, prefectures, and counties that make up mainland China. Thirty-five communicable diseases are reportable under this system.Nationwide Disease Surveillance Points(DSPs): This surveillance system, comprising 145 reporting sites selected bystratifiedclusterrandom sampling, covers a 1% representative sample of China's population.Surveillance system for specificinfectious diseases,occupational diseases,food poisoning, etc.

There are 35 notifiable infectious diseases, which are divided into Classes A, B, and C. The functions of the surveillance include explaining the natural history of infectious diseases, describing the distribution of case occurrence, triggering disease-control effort, monitoring epidemic of infectious diseases duringnatural disasters, predicting and controlling epidemics and providing the base of policy adjustment.Data collected through the disease surveillance network serve as the basis for formulating health policies and devising strategies for preventing disease. A computerized reporting system for notifiable diseases has been established that links China's 30 provinces, autonomous regions, and municipalities. Mechanisms for providing timely feedback to units that report data and for systematically assessing the quality of those data are important attributes of this system.

Sources Of Disease Surveillance Data For All Medical Institutions Of Outpatient And Inpatient Care Morbidity and Mortality Monthly Reports (MMMR)Each month, all provinces transmitcountry-level summaries of the numbers of cases and deaths associated with 35 notifiable communicable diseases to the Academy of Preventive Medicine. Reports are sent on the 13th to 15th day of each month via the NACTN. At the central node of NACTN, the Academy's Center ofComputer Scienceand Health Statisticscompiles and analyzes the data, provides feedback to the provinces, and creates national summaries within one week. Copies of the MMMR are distributed regularly to health authorities at various levels.

Morbidity and Mortality Annual Report (MMAR)Each January, all provinces providesupplementaryreports to revise and update the monthly reports submitted during the previous year.Age- andoccupation-specific reports of mortality and morbidity are also submitted at this time. In April, after the surveillance data have been reviewed at the national meeting on epidemic diseases, the MMAR and other analytical reports are distributed.

System Of Disease Eradication In China (State and International Programmes)Chinas surveillance system has been strengthened in the post-SARS era. Both the U.S. centres of disease control and prevention and the who Bejing office have been working closely with the Chinese ministry of health and Chinese centres of disease control to strengthen and computerize routine disease reporting for many infectious diseases in accordance with chinas strengthened law and regulations on infectious disease reporting. By mid-2005, all 2800 counties in china had direct connection to the minister of agriculture monitoring system for avian influenza and 93% of higher level hospitals or 43% of township hospitals now have direct connections to the Chinese centres for disease control reporting system. Rural doctors are now required to report by telephone to township health centres all cases of suspicious pneumonia or serious flu.

Medical Education In China There are 94 educational institutions in china which include medical universities, colleges, institutes and schools. The Chinese medical education system follows theBritishsystem, but it compressed from six years to five years to shorten the educational cycle. To become a medical doctor, a person usually needs to study for five years at a medical school. After graduation, young doctor needs to complete 3-6 years residency training, some need extended training for subspecialty. Internal medicine usually takes 3-4 years residency training, but surgical specialties may takes 5-8 years to complete the training.Upon graduation, the graduate must work as a resident physician for few years to be eligible to take a National Medical Licensing Examination (NMLE) for physician certification. This examination is conducted by the National Medical Examination Centre (NMEC). Without approval of registration by the Ministry of Health one can not practice medicine in China as a physician or assistant physician.

There are general hospitals and specialty hospitals. A medical graduate rotates through several departments and then assigned to a specialty department according to his or her strengths and the hospitals needs.a Specialty physician usually are attendants who are specialized in a certain specialty during the training process in a specialty hospital or in a subspecialty at a general hospital. Some medical experts have called for a standardized training and testing system for specialty physicians in accordance to American system. The classification of specialties at a Chinese hospital is similar to that at a U.S. hospital.

Medical StaffNursesare normally well trained before being eligible for working with a hospital, but support workers are a problem. Some hospitals hire skill-less underground labors and after giving them some simple training use them as hospital support workers. These workers, mostly originating from rural areas, are poorly paid by those hospitals.To secure the quality of hospital services, Beijing recently has passed a regulation on training and hiring qualified hospital support workers. In Tianjin, Chinas third largest city, about 1,000 unemployed people have been trained by local authority and passed hospital support work test. These people returned to work as certified support staff of a number of big hospitals.

One needs to study at anursing schoolfor around three years before being eligible to work as a nurse. Most nursing schools enroll middle school graduates (Grade 9) and senior high school graduates (Grade 12), and they run four-year and three-year programs respectively.A bachelors degree in nursing has been available since late 1980s and early 1990s in China. Many medical schools including the School of Medicine ofBeijing Universityoffer five-year programs in nursing.

Organization of Hospital Care to Urban PopulationKinds of Hospital Medical Aid in China

Organization of the Health Service System in China

Health care in urban areas is provided by paramedical personnel assigned to neighbourhood health stations - 1st tier.The patients who require more professional care are sent to a district hospital - 2nd tier.The most serious cases are handled by the municipal hospitals - 3rd tier. Organization of Hospital Care to Urban Population

Indices of Provision of Population with Hospital beds (per 10,000 persons) & Frequency of HospitalizationThis is the availability of number of beds to 10,000 population.In China, this index is 22 per 10,000 population.Number of inpatient beds (in millions):

Total admissions to hospitals (in millions):

The bed occupancy rate in 2014 was 83.2%2012201320144.164.584.96

201020112012100010501200

Average Duration of Patient Stay in Hospital It is 1 measure of the efficiency with which hospital resources are used.To calculate: total no. of days stayed by all patients in acute-care inpatient institution during a year / no. of admissions or dischargesAverage Duration of Patient Stay in Hospital in China in 2014, by region (in days)Shanghai: 11.2Beijing: 11Jilin: 9.8Yunnan: 9 Guangdong: 8.8Fujian: 8.7Others: 243.5 TTotal: 302 days

Hospital LethalityDeath rate in the urban(1997)Indicators of hospital activityCerebrovascular disease22.28Malignant tumor21.66Heart disease16.37Respiratory disease15.28Trauma and toxicosis6.52Digestive disease3.22Metabolic,immunity disease2.51Urinary disease1.51Mental disease1.12Neuropathy0.84Total91.31

199020002011Life Expectancy69.572.175Total Fertility Rate2.51.51.7Infant Mortality Rate42.230.212.9Child Mortality Rate (under 5)54.036.914.9Maternal Mortality Ratio88.057.526.5

Types of Medical Institution for Outpatiend and Inpatient CareIn rural areas, the first tier was made up of doctors working in village medical centers. They provide preventive and primary care services. The township health centers categorise the 2nd level. It functions as out-patient clinics and serve approximately 10,000 - 30,000 patients each. Staff consist of mainly assistant doctors. The lower 2 tiers provide most of the countrys medical care. Only the most seriously ill patients are referred to the county hospitals - the 3rd tier. Organization of Medical Care to Rural Population

Main Indices of Provision with Medical Services and Medical Institutions ActivityPrevention: immunization, prenatal care, family planning and sanitation, which was carried out by government trained individuals (paraprofessionals)New Rural Cooperative Medical Care System (NRCMCS) Established in 2003, to make health care more affordable in rural areasAims to reform private and public sectors of healthFunded by individual contributions and government subsidies for the poorStudies show a participation of more than 80%Disadvantages and Principal ProblemsLacks adequate funding Lacks medical staffLacks medical equipmentOnly inpatient costs are covered, outpatient costs are not

Types of Medical Institution Rendering Emergency CareChina has set up a response system for public health emergencies featuring unified leadership, reasonable distribution, quick response, efficient operation and powerful logistics. It can be divided into 3 sectors: Prehospital Care, Hospital Emergency Department (ED), and Hospital Intensive Care Units.The emergency management system is divided into 4 levels: national, provincial, city, and county.There are now 27 health emergency teams to respond to infectious disease control, medical rescue, poisoning treatment, and nuclear and radiation accident handling. The Main Principles of Emergency Care Organization

Indices of Provision of Population with Emergency Doctors, Medical Assistants & Staff NurseThe patients are triaged according to their chief complaints upon arrival and then evaluated by on-call specialists. Currently there are 300 emergency centres throughout the country. There are at least 4 emergency medical systems (EMS) models. They include: private ambulance service, stand-alone emergency centres, stand-alone 120 centres, hospital-based ambulance services, & combinations of those mentionedPre-hospital units include: a driver, a transporter (basic care giver), a nurse, a doctorIndices of Emergency Care Activity The patient volume in urban emergency department is approximately 150,000 - 200,000 per year6.7% call the ambulance 3.7% was treated for poisoning14.9% was treated for CVD1.7% was treated for cardiac diseases44.3% was treated for trauma

Disadvantages & Principal Problems1. Pre-hospital aid development is unbalanced, with great disparities in the nation.2. There are no national standards for pre-hospital care management, and certain current policies are counter-productive.3. Multiple emergency response systems co-exist, and they are often in unhealthy and disordering competition.4. There is a lack of systematic planning of emergency systems.5. There is a lack of information exchange and sharing.

System of Protection of Motherhood & ChildhoodLegislation about the protection of motherhood and childhood in the countryChina has worked out a series of laws concerning children's survival, protection and development. With the Constitution of the People's Republic of China as the core, some of these provisions includeThe Marriage LawThe Education LawThe Law on the Protection of Women's Rights and InterestsThe Law on Health Protection of Mothers and Infants

These laws include comprehensive and systematic provisions on children's right to life, survival and development, as well as basic health and health care. Provisions also address children's family environment and substitutional care, education, free time and cultural activities and the special protection of disabled children. It is specified that criminal acts, such as maltreating, abandoning and deliberately killing children, as well as stealing, abducting and trafficking, kidnaping, selling and buying in children, should be severely punished.

Organization of Medical Care to Women out of Pregnancy, System of Family PlanningIntensive healthcare services for pregnant and lying-in women are available, and a complete array of services for pregnant and lying-in women has been developed, covering prenatal examination, prenatal defect screening and diagnosis, screening and management of high-risk pregnant and lying-in women, hospitalized delivery, infant healthcare and postnatal home visits.

The network of family planning services in China consists of agencies at province, city, county and town levels

The Chinese Family Planning Policy guidelines include: controlling rapid population growth and reducing birth defects; later marriages, later births and fewer babies; and encouraging couples to have only one child.

the total fertility rate decreased from 5.43 to 1.6, and the natural population growth rate decreased from 23.33 per thousand to 5 per thousand between 1971 and 2012.

Systems of Prenatal Protection of Fetus, Health Protection of Newborn, Health Protection of Preschool and School-Age Children The state offers healthcare services for infants, young children and pre-school children, and exercises health management of children under seven years of age and comprehensive management of children under three years of age.In 2011, 84.6% of children under 3 years and 85.8% of children under 7 years received comprehensive health management and medical management services. Cases of malnutrition keep declining.The state strives to control birth defects and improve the quality of newborn babies, and has conducted disease screenings for newborns, early development programs for children under 3 years old, rehabilitation training for children with growth deviation, early-stage intervention for high-risk children, early-stage intervention in cases of food allergy, assistance with sleep problems, early-stage help in case of damage to children's health caused by environmental pollution, and adolescence healthcare.

The Basic Medical Institutions Giving the Obstetric-and-Gynecological Care to Women (System of their Organization, a Range of Services, Ways and Indicators of their Activity) All government hospitals in China follow practical guidelines from the Ministry of Health, and hospital leaders are responsible for implementation. For institutional deliveries doctors make decisions for childbirth interventions. Midwives assist during birth, but the doctor always takes medical decisionsOver 60% of women deliver in health facilities.

The Basic Types of Paediatric Medical Institutions (Main Tasks and Ways of Work in Children's Polyclinic and Hospital, the Main Indicators of their Activity)The Capital Institute of Pediatrics (CIP) was founded in 1958. It was the first research institution in China, specializing in child health care and basic research, prevention and treatment of childhood disordersTasks: medical services for children and higher education for college students.

Conclusion

Conclusion With the quickened pace of the country's industrialization and urbanization, as well as its increasingly aging population, the Chinese people are facing the dual health threats of infectious and chronic diseases, and the public needs better medical and health services. In the meantime, problems still exist regarding China's health resources, especially the shortage of high-quality resources and the unbalanced distribution of those resources. China has arduous tasks ahead for reforming and developing its medical and health services.

The Chinese government has announced that it will establish a sound basic medical and health system covering both urban and rural residents by 2020, so as to ensure that everyone enjoys access to basic medical and health services. For this goal, China will continue to reform and develop its medical and health services, and better maintain, ensure and enhance the health of its people. China will also continue its active role in international health affairs and work together with different parties to make greater effort to improve the health of mankind.

Bibliographyhttp://www.china.org.cn/e-white/children/c-2.htmhttp://www.china-embassy.org/eng/zt/bps/t1001641.htm

174.8372.3877.37

2010

Sheet12010life expectancy(age)74.83male life expectancy72.38female life expectancy77.37