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Recently, the authoritative medical journal The Lancet published the 2016 Global Medical Accessibility and Quality (HAQ) rankings. China has leapt to the 48th place in 2016 from the 60th place in the world in 2015, ranking 12th place. It is one of the countries with the most advanced countries in the medium SDI (sociodemographic index).

This ranking is based on a comparison of the HAQ indices of 195 countries and regions around the world. The research team developed the HAQ index based on the mortality rates of 32 non-terminally-diseased diseases and the medical service progress of these diseases.

The study pointed out that in 2016, the country with the highest ranking of the HAQ index was Iceland with 97.1 points, while the lowest country was the Central African Republic with only 18.6 points. In general, countries with a high HAQ index have higher per capita health spending and health system investment.

In the top 20 of the global medical quality rankings, with the exception of Australia, Japan, Canada, and New Zealand, the remaining 16 countries are European countries, and the United States ranks 29th. From 1990 to 2016, China’s index rose from 42.6 to 77.9 points, an increase of 35.3 points, and the quality of medical care improved significantly. At the same time, the report also pointed out that the differences between China’s regions are relatively large. According to the assessment conducted by the provinces, the highest was Beijing, with 91.5 points, while Tibet only scored 48 points.

2016 World HAQ Index Map

In the past 26 years, China’s medical quality has improved significantly

In the assessment of the HAQ index, China made significant progress from 42.6 points in 1990 to 53.3 points in 2000 to 77.9 points in 2016. It has made significant progress in the global context, especially since 2000. In 1990, China ranked only 110. After 25 years, China has progressed to the 60th place in 2015 and the rate of progress ranks third in the world. By 2016, it has jumped 12 places a year, making it one of the most advanced countries in the middle SDI countries.

On June 8, 2018, the National Health and Hygiene Committee held a regular press conference to introduce the situation of China’s medical quality improvement and management. According to Guo Yanhong, deputy director of the Medical and Health Administration of the National Health and Human Services Commission, the constant rise in China’s HAQ index reflects China’s achievements in improving medical technology capabilities and medical quality levels. It has been widely recognized internationally. On the one hand, the supply of medical resources in China has continued to increase. On the other hand, the quality of some specialists, key diseases, and surgical procedures has also steadily increased.

Take cardiovascular disease as an example. According to Zheng Zhe, deputy director of the National Center for Cardiovascular Diseases, China’s cardiovascular disease incidence and increase rate are on the rise. It is currently estimated that the number of cardiovascular patients in China will reach 290 million, and cardiovascular surgery is the treatment crown. Since the reform and opening up, the number of hospitals capable of undergoing cardiovascular surgery in China has risen from 484 to 723 in 2016. The number has doubled. “This has improved the accessibility of medical care, and the quality of diagnosis and treatment has also been improved,” Zheng Zhe said. “Now, many people say that whether or not to perform an operation is not to go abroad. Actually, it is not necessary. It can also be very good in China. The treatment.” For example, in cardiac transplantation, 442 heart transplants were completed in 2017, and the survival rate was 10% to 15% higher than the international average.

In the field of cancer treatment, the 5 year survival rate of malignant tumors has risen from 30.9% to 40.5% years ago, according to the director of the National Cancer Center and the director of the National Cancer Center, academician of the Chinese Academy of Sciences.
The more significant improvements were: uterine body cancer, from 55.1% to 72.8%; thyroid cancer, from 67.5% to 84.3%; cervical cancer, from 45.4% to 59.8%; bone tumors, from 17.1% to 26.5%; cancer of the esophagus, from 20.9% to 30.3%. The five year survival rate of some tumors is higher than that of developed countries such as the United States, such as esophageal cancer, compared with 20% in the United States.

In some professional fields, even if there is a slight gap between the quality of the international advanced level, it is also very close. Taking anesthesia as an example, the current anaesthesia-related mortality rate is 12ppm, and the level of developed countries is 10%. The overall level of anaesthesia in China can be said to have approached the level of developed countries.
If you look at a single hospital, there are some hospitals in China that are better than the international advanced level, while the average level of the developing countries is one hundred and forty-one per million.
However, Guo Yanhong stressed: Even if we reach a level close to the international level of anesthesia-related mortality of 10 parts per million, it will not be possible to reach zero percent, which means that medical treatment is risky and individuals have different We need to let our people know that medical treatment is not a panacea, and it is virtually impossible to achieve 100%, even if it has reached the international advanced level.

HAQ index maps of several major countries and regions

How to solve the problem of regional differences?

Although the overall level of medical care in China has progressed greatly, regional differences among provinces are still evident. In the evaluation of the HAQ index for all provinces in China, the eastern provinces score higher than the western provinces. In all provinces in China, the highest HAQ index was Beijing with 91.5 points. The lowest HAQ index was Tibet with 48 points, a difference of 43.5.

HAQ index maps of various provinces and cities in China

“Although we have achieved certain results, we should recognize that there are still problems with the imbalance and inadequacy of current medical technology capabilities and quality in China,” said Guo Yanhong.

“Our country has a vast territory and the economic development is not balanced. Therefore, the level of cancer diagnosis and treatment in our country is not exactly the same. In particular, the level of diagnosis and treatment in various medical institutions is uneven, such as grass-roots units and the western region, and its level may be similar to that of developed regions. There is a certain gap,” said HeJie.

Then, how to improve the level of oncology in the basic units and in the western region? HeJie put forward his own ideas.
First of all, it is necessary to strengthen the functions of the national tumor quality control center, including the supervision and guidance of medical institutions. Strengthen the rational application of anti-tumor drugs, through the national tumor big data platform for tumor control and treatment of various regions of quality control and supervision.
Second, through the various medical consortiums or alliances of oncology specialists to improve the medical level of medical institutions. On the one hand, experts from upper-level medical institutions are assigned to provide services or guidance to primary medical institutions. Specialists in medical institutions can also go to higher-level medical institutions to conduct specialized training so that the medical institutions can be homogenized and the level of primary care can be further improved.
Finally, by strengthening telemedicine, medical institutions can be further promoted, especially in remote areas or in the western region. These areas are relatively remote and it is difficult to send people to higher-level medical institutions for training. In this case, it can be done remotely. Consultation, remote booking, remote training, etc., to further improve the level of basic medical care.

In addition to cancer diagnosis and treatment, cardiovascular disease and other types of diseases can also enhance the level of diagnosis and treatment in underdeveloped areas and enhance medical accessibility by strengthening quality control throughout the country, more training and remote diagnosis and treatment.

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