by Shenglan Tang
Traditional Chinese Medicine (TCM) has over 2000 years of history in China and is well known as one of pillars of Chinese culture. It is also an important part of health care delivery system throughout East Asia. Over the past six decades, the Government of China has been promoting TCM with a mixed result of success and failure. One interesting observation we have found is that TCM hospitals in China has been to a large extent westernized. This blog is to look at what are happening at the TCM hospitals and why, as well as what needs to be done.
Here’s a history lesson:
Prior to the founding of the People’s Republic of China, the development of TCM was not put in a high national political agenda, as many leading medical authorities questioned its lack of sound theories and scientific evidence. Since 1949, the Chinese government under the leadership of the Communist Party has emphasized the development of TCM as a top health policy priority. In the 1950s, the government made “integrating TCM and Western medicine” one of the three policy guidelines for health development. One of strategies for developing TCM in China was to establish TCM at different administrative levels, e.g. provincial, municipal and county. In the early 1950s there were only TCM hospitals in China. By 2008, there were over 2,600 TCM hospitals, of which half have been set up at the county level. In addition, the Chinese government has developed a number of quantitative indicators for TCM hospitals. For example, the county-level TCM hospitals are required to have a minimum of 70% health professionals whose primary training is in TCM.
So, what’s happened to the TCM hospitals over the past decades?
In 1993, an average county-level TCM hospital in China had about 15 TCM physicians and 10 Western medicine physicians, nearly meeting the target set up by the government. However, in 2008, the number of TCM physicians working in a typical county-level TCM hospital has hardly changed – 16-17, while the number of Western medicine physicians has increased from 10 to 30. In the meantime, the average revenues from TCM have declined significantly. Meanwhile, the average revenue from Western medicine has increased sharply. Such a result was supported by an empirical study undertaken by Shen and her colleagues1 from University of Nevada, USA.
Why are TCM hospitals in China providing more western medical services?
This result is not what the Chinese government intended to see. Why did this happen? It is true that more Chinese now prefer Western medicine which is generally more effective in dealing with most health problems, especially many acute ones. However, positive health outcomes are not the reason TCM hospitals in China have been Westernized. The key is the mechanism used to finance Chinese hospitals. Almost all Chinese hospitals receive a small proportion of its income from the government (the larger the hospital, the smaller proportion of the income from government grant). They instead rely heavily on revenues from service charges and profits from the sale of drugs. Selling Western medicine and providing high-tech diagnostic services, like CAT scans and MRIs, can earn bigger and quicker profits for all the Chinese hospitals including TCM ones. Over the past two decades, I visited many county-level TCM hospitals and talked with the hospital directors. They were very keen to recruit good surgeons and cardiologists in order to attract more patients. Developing TCM was a lesser priority because TCM is not as profitable and there’s less patient demand. One thing is clear, the policy of developing TCM has not been successful, at least at the county level of China. The Chinese government needs to rethink its strategy of TCM development. It is not wise to set up TCM hospitals in almost every county, while these hospitals are de facto asked to compete with county-level general Western medicine hospitals located in the same towns. Instead, TCM-related services should be strengthened within the existing county general hospital system. Policies need to support efforts to identify a range of specific TCM services that are most effective in dealing with certain diseases, especially some non-communicable diseases. In addition, a special set of human resource/career development policies for TCM physicians should be developed, considering its unique practices and learning. Otherwise, attracting bright young people to learn and practice TCM will be increasingly difficult. Without the effective production of TCM physicians with high skills and a hospital system that supports these services, preserving TCM as one of the national treasures of China will be in serious jeopardy. Reference (1) Shen J, et al. Trends of increase in western medical services in traditional medicine hospitals in China. BMC Health Services Research 2011.11:212