China Medical News


March: China to give more support to patients with rare diseases

China has launched a program aiming at helping patients with rare disease in diagnosis and treatment and offering financial support to those in need. "The cost of treatment and care throws a lot of families into poverty. But what is more desperate yet, is that people often simply don't know what took their loved one's life," said Wang Yiou, head of the Illness Challenge Foundation, who lives with brittle-bone disease. The program, which was launched Wednesday, will be sponsored by the Illness Challenge and China Social Assistance foundations. It will help with diagnosis and treatment of up to 100 diseases.

With its enormous population, disparate geography and socioeconomic inequalities, China faces considerable obstacles in improving care for patients. "Patients in remote areas like the northwest often suffer years of physical and mental torture and have to bear with misdiagnosis or delayed diagnosis before they know what's wrong," said Wang.

At present, Chinese patients with rare diseases have very few options in terms of treatment. "For most of them, there is no effective treatment and when there is, patients cannot afford it," said Wang.

China is still in the early stages of making policy on rare diseases. "Diagnosis and availability of drugs remain significant challenges," said Zhang Xue, a member of the committee for rare disease treatment and support with the National Health and Family Planning Commission.

Some progress in licensing drugs and increasing reimbursement has been made and the first national list of rare diseases will be published this year. According to the Medical Insurance Directory, China currently has 119 new drugs at various stages of licensing and registration, of which 49 are covered by national medical insurance. "The support program will bridge the gaps between individual patients, medical resources and insurance. We hope misdiagnosis and delayed diagnosis will become less frequent. Patients and their families deserve a good living and should know they are supported," said Wang.  (Source: Xinhua)

March: Chinese scientists develop DNA nanorobots to treat cancer

Chinese scientists said they have successfully created and tested the world's first autonomous DNA nanorobots to combat cancer tumors, paving the way for revolutionary cancer therapy.

Scientists from China's National Center for Nanoscience and Technology (NCNST) led the research and cooperated with scientists from Arizona State University in upgrading the design of the nanorobots. The scientific study was published in Nature Biotechnology in February.

A nanorobot refers to a designed system that can perform a specific task at nanoscale dimensions. According to researcher Ding Baoquan, the DNA-based nanorobot has a tube-shaped structure with a diameter of about 19 nanometers and a length of about 90 nanometers.

"The nanorobot is exceptionally small and impossible to see with naked eyes. It is about 5,000 times smaller than the tip of a needle," Ding said. It can travel through the bloodstream searching for tumors. Once it detects a tumor, it will release its load of thrombin directly into the tumor to cut off its blood supply and "starve" the tumor to death. As the DNA nanorobot is a natural biocompatible and biodegradable material, it is cleared out of the body after it has finished its task.

Nanotechnology has provided new opportunities for medical industry. The research was started five years ago, when NCNST researchers first looked at cutting off the tumor blood supply by using DNA-based nanocarriers. Ding said although the concept of nanorobots for medical use has previously been introduced and experiments conducted in test tubes, this is the first time that experiments have been completed on living organisms with sophisticated biological environments.

The research evaluated the nanorobots in mice with tumors. The DNA nanorobots were injected into mice, and the results showed significant tumor shrinkage and often, complete tumor regression, within days or weeks. According to scientist Zhao Yuliang, the research team also conducted extensive safety studies of the nanorobots in two different mammals, including the Bama miniature pig, which is physiologically and anatomically similar to humans.

"Unlike chemotherapy and radiation, the DNA nanorobots are able to treat tumors without harming surrounding healthy tissue. The nanorobots do not accumulate in the brain and thus, do not pose the risk of causing a stroke," Zhao said.

Nie Guangjun, also part of the research team, believes this is a milestone in cancer research, a field that has been striving for decades to develop effective therapies. "Our research shows that DNA-based nanocarriers have been shown to be an effective and safe cancer therapy," Nie said. "We are currently working with a biotech firm to do pre-clinical studies and hope to translate this revolutionary technology into a viable anti-tumor therapeutic," Nie added. (Source: Xinhua)

February: Health program helps 4 million patients pay bills

A national program to aid impoverished villagers affected by serious diseases has benefited more than 4.2 million people, according to data released on Feb 12th by a leading health authority. Over 4.9 million rural families left in dire straits due to crippling medical expenses had been lifted out of poverty as of October, 46% of the total number, data from the State Council Medical Reform Office show.

The program, launched in June 2016, targets villagers registered with local authorities as surviving on just $1 a day and provides preferential medical insurance policies and other relief measures.

On average, those eligible for the program paid only 19% of their medical bills last year, compared with 43% in 2016, Wang Hesheng, head of the office and vice-minister of the National Health and Family Planning Commission, said.

Of the 4.2 million patients who benefited, 420,000 were cured as a result of the assistance they received, according to Liu Kui, the commission's deputy director of finance. "The program is aimed at ensuring basic medical care for the impoverished rural population and ensuring the basic life needs of someone affected by a major disease," he said.

Serious diseases including stomach cancer, terminal kidney disease and child leukemia are covered by the program.

Losing the ability to work and high medical bills are among the leading causes of poverty in China. Nearly 20 million people were living below the poverty line due to illness in 2015, accounting for 44% of the registered impoverished population, according to the commission. Included in this figure were 7.3 million people with serious diseases.

Authorities say these patients now receive family doctor services and greater reimbursements on the cost of medicines. In some areas, hospitals offer treatments in advance of payment - counter to standard policy - to allow poor patients time to receive government subsidies toward the costs.

More measures to alleviate poverty through improved health services are expected in the next few years, such as additional medical insurance programs and improved training for doctors at grassroots clinics, Liu said. (Source: China Daily)

February: 97% of Chinese netizens use mobile Internet

An industry report says that 753 million Chinese netizens accessed the Internet using their mobile phones in 2017, accounting for 97.5% of China's online population, the Beijing News reports.

The number of Chinese netizens reached 772 million at the end of last year, up 5.6% year-on-year, according to a report on China's Internet development released Wednesday from the China Internet Network Information Center (CNNIC). As mobile phones become the most widely used device for accessing the Internet in China, fewer people use desktops, laptops, or tablet computers to get online, said the report.

The number of mobile payment users in China has been steadily increasing. Mobile payments are now used by 68.3% of the online population for purchases ranging from personal shopping, public transportation, and medical services, according to Wang Tao, an analyst with the CNNIC. (Source: China Plus)

January: Beijing saved 6.7 billion yuan on medical costs in 2017

The Beijing Municipal Commission of Health and Family Planning said on Jan. 28 that Beijing saved about 6.7 billion yuan (US$1.06 billion) on medical expenses since the separation of clinic from pharmacy in April 2017. As hierarchical medical care advances, the outpatient visits in large hospitals have decreased by over 10%, and 20% less patients are seeking appointments with experts. In the meantime, the outpatient visits have increased by 16% in community hospitals.

The recent report on the work of the municipal government highlighted the establishment of hierarchical medical system as this year’s primary task. Each district will build a compact medical treatment unit that strengthens primary medical care. Meanwhile, the reservation service will be improved to facilitate patients and crack down on scalpers. The Beijing Municipal government has also announced that, by 2020, it will provide at least three general medical practitioners and five rehabilitation nursing beds for every 10,000 residents, and help to raise the average life expectancy to 82.4 years old. By the end of 2017, a total of 251 community medical centers, or 75% of the total, had changed the payment method to paying after diagnosis and treatment, instead of paying upfront.

Since April 2017, more than 3,700 hospitals have eliminated the margins in sales on medication, according to the commission. The separation of clinic from pharmacy has propelled the establishment of hierarchical medical care, rendering 12% and 3% less outpatient/emergency visits to tertiary and secondary hospitals respectively, as well as 16% and 25% more visits to primary hospitals and community healthcare institutions respectively. The number of outpatient and emergency visits to medical experts has also decreased, making it easier for patients with real needs to make such appointments.

From Jan. 1, the city merged urban and rural medical insurance policies to become an integrated insurance policy for both urban and rural residents in Beijing. This expanded the number of medical institutions under insurance coverage to over 3,000. The hospital hierarchy is also helped by the new reimbursement system, which provides higher coverage for primary hospitals and below (55%) and lower coverage for secondary hospitals and above (50%). In addition, the new system standardized the insured categories of medication, medical service and medical facility for all the urban and rural residents, and expanded the types of medicine under coverage from 2,510 to more than 3,000. (Source:

January: China's gender imbalance reduces further in 2017

At the end of 2017, China had 32.66 million more males than females, down from 33.59 million at the end of 2016, according to the National Bureau of Statistics. The gender imbalance has continued to decline over the last five years, dropping by around 1.2 million annually, with the largest reduction seen in 2017, official data showed.

Chen Jian, deputy head with China Society of Economic Reform, attributed the improvement in China's gender balance to the introduction of the "second-child policy," which has helped reduce the number of selective abortions performed in regions where boys are preferred over girls.

About 17.23 million babies were born in 2017, of which 51% have an older sibling, according to the National Health and Family Planning Commission. However, the total number of births fell by about 630,000 compared with 2016 while percentage of the population aged over 60 rose from 16.7% in 2016 to 17.3% in 2017.

China should roll out more supportive policies to encourage couples to have children in order to help the country deal with the aging society issue, said James Liang, a professor with Beijing University.

The government could reduce taxes or offer subsidies for families to help cover the costs for raising multiple children, Liang suggested. (Source: Xinhua)

January: Another Chinese city admits 'fake' economic data

A northern industrial city in China said its 2017 fiscal revenue was significantly less than it had earlier estimated partly due to “fake” additions, making a revision just days after reports of similar incidents fueled scepticism over official data.

Baotou in China’s Inner Mongolia Autonomous Region revised its estimated fiscal revenue in 2017 lower by nearly 50% in an annual work report, a copy of which was published on the Baotou government’s website on Jan. 13. The Baotou city government said in the report that the revision was due to factors including “fake additions”. It did not say how the additions came about or who was responsible.

Days earlier, the governments of Inner Mongolia and Tianjin, a large port city in northern China, said their fiscal and economic numbers for 2016 had been overstated. “We have been trying to change our mindset and change the course of our development model,” the Baotou government said, while pledging to tame government borrowings in part by halting debt-burdened public projects. Baotou was forced to halt an ambitious subway construction project earlier last year as the central government questioned its ability to finance the debt.

Inner Mongolia cut its industrial output figure for 2016 by 40%, according to the official Xinhua news agency on Jan. 3. It also said fiscal revenue for that year ought to be 26% less than initially stated. It did not give details.

The 2016 gross domestic product of Tianjin’s Binhai New Area - an economic zone once touted to become China’s Manhattan - was actually about a third smaller than previously announced, according to a commentary in the official People’s Daily on Jan. 15.

The incidents of data fraud coincided with a campaign led by Beijing to crackdown on risky lending, aimed partly at curbing runaway local government debt. The People’s Daily said that while inflated data may look good on paper, it would lead to more stress in the less developed hinterland as it would cause the central government to reduce funding.

In January last year, the northeastern province of Liaoning said it had faked fiscal data from 2011 to 2014, becoming the first province to make such an admission. Chinese provinces and cities have long been suspected of cooking up numbers, with the focus on local government officials, whose performance are often assessed based on how well their respective economies have performed.

China’s top leaders signaled a shift in priority as the country strives to be more quality driven. In an agenda-setting Communist Party congress in October, President Xi Jinping said China has now entered a “new era” where the country will prize quality growth over quantity.

China is set to release its 2017 GDP data on Thursday. Premier Li Keqiang has signaled that GDP growth should be around 6.9%, accelerating from a 26-year low of 6.7% in 2016. (Source: Reuters)

January: 17.5% of patients in China use TCM

About 17.5% of all patients in China are treated with traditional Chinese medicine (TCM), the State Administration of Traditional Chinese Medicine said on Jan 15. As of September 2017, 20.4 million patients had been discharged from TCM hospitals, accounting for 15% of all discharged patients in the country, the administration said.

Currently, 67% of the town-level and community health centers have TCM units, totaling over 30,000. By September 2017, there were 45,800 TCM clinics across China. Wang Guoqiang, head of the administration, said TCM services are still unbalanced and relatively weak at the grassroots level. "The needs of the public for TCM cannot yet be met," Wang said. The administration plans to support medical institutions with specialties on TCM and build at least one public TCM hospital in each county. (Source: Xinhua)

January: Chinese researchers make breakthrough in lupus diagnosis

Chinese researchers have developed a new testing method for the diagnosis of lupus, which could improve the accuracy rate to over 90%. The new method uses DNA methylation detection to find lupus-specific information in genes, the first time researchers are able to elevate the diagnosis of lupus to the genetic level, according to Lu Qianjin, a professor with Central South University.

Lupus, technically known as systemic lupus erythematosus or SLE, is an autoimmune disorder that can damage joints, kidneys, hearts, lungs, brain and blood. It affects 1 million Chinese, and 40 to 70 of every 100,000 people worldwide.

"Early symptoms of lupus are often too general to be distinguishable, making accurate diagnosis difficult and depriving patients of timely treatment," Lu said. "The new method can accurately discriminate lupus from other dermatoses, with an accuracy rate of above 90%."

The breakthrough, made by Lu and his team after 20 years of research, was awarded at the National Science and Technology Award Conference in Beijing. The new testing method has been adopted by 23 hospitals in China, Lu said, adding that he had applied for patents for the technique both at home and abroad in hopes of benefiting more patients. (Source: Xinhua)


December: More young people suffering from colorectal cancer in China

Chinese doctors said incidence of colorectal cancer has been rising among young white-collar workers due to unhealthy lifestyles and eating habits.

Colorectal cancer usually occurs in people around 60 in developed countries, but in China, the average age to contract the disease is 45, said Professor Kong Dalu from Tianjin Cancer Hospital. "The number of white collars under 30 diagnosed with colon cancer has been rising steadily in recent years, accounting for 10 percent of all inpatients of the disease," he said.

The disturbing rise is in part due to their sedentary lifestyle and an unhealthy diet, said Kong. China has seen a rapid improvement in living standards in recent decades, which results in a diet rich in fat, calories and protein but low in fiber. Oncologists recommend that young adults engage in regular physical activity, and stick to a diet rich of whole grains, vegetables and fruit and low in red and processed meats to prevent the disease. (Source: Xinhua)

December: System of family doctors developing

China's top health authority is standing by its statement that more than 500 million people had been assigned family doctors as of the end of November, despite a barrage of questions raised by netizens. The National Health and Family Planning Commission said on Wednesday (Dec. 20th) that the figure was based on data reported by local governments since May. It reiterated that the number of people who accessed family doctor services met the target for the year.

According to a circular from the commission in May last year, more than 30% of China's population was supposed to be covered by family doctors by the end of this year.  On Sunday, the commission said residents in more than 95% of China's cities can now access family doctors, with the total number exceeding 500 million people, more than 35% of the population. However, the announcement was met with disbelief by some netizens, who said the number was too high, Science and Technology Daily reported.

While the commission said on Wednesday that the number of people covered by family doctors had met the target, it added that coverage varies by area, and quality of service in general needs improvement.

A system of family doctors has been promoted nationwide since May and is in its infancy. Many difficulties exist, including a lack of general practitioners and customized grassroots services, the commission said. It said it will focus on improving family doctor services next year, so that residents are more satisfied with the services they receive. Measures include more intense training of healthcare workers at the grassroots.

Currently, family doctors comprise physicians mainly working at grassroots medical institutions, such as community health centers and village health facilities. It is expected that family doctors who serve as health gatekeepers for residents will help solve health challenges such as the increasing number of patients with chronic diseases and soaring medical costs resulting from too many patients going to big hospitals while grassroots medical institutions are ignored, the commission said.

Wang Xin, a family doctor at the Zhongliang Community Health Service Center in Beijing's Shunyi district, said that of all 1,200 residents in the community, about half have signed up with him, the sole family practitioner in the center. "The biggest difficulty in promoting family doctors in Beijing is lack of enough qualified doctors," Wang said. "In some areas a family doctor may not even have a bachelor's degree and cannot provide medical services; they can only provide public health services or prescribe drugs, so local residents lack trust and still prefer to go to big hospitals for treatment."

The number of people covered by family doctor services reached 7.6 million as of May, accounting for 35% of permanent residents in Beijing, according to the city's health commission. Beijing residents can sign up with family doctors in their communities for free because of subsidies from the city government. (Source: China Daily)

December: New program launched to address poverty caused by illness

China launched a new program Friday to help address poverty caused by illness. The program, which will last until February, aims to use the slack farming season and the Spring Festival holiday when migrant workers return home, to figure out how many poor people have diseases and keep them updated with new policies, according to Xia Gengsheng from the State Council Leading Group Office of Poverty Alleviation and Development.

Xia said that more than 50% of impoverished residents in 10 Chinese provinces fell into poverty due to illnesses, at the end of 2016.

China aims to lift all people above the poverty line -- per capita annual income of 2,300 yuan (USD 348) -- in rural areas by 2020. Strong efforts have been made in helping the rural poor suffering from illnesses.

More than 4.2 million poor patients with serious or chronic diseases have been treated since last year. The family doctor system has expanded to include around 80% of those living under the poverty line.

Meanwhile, more than 900 top hospitals have dispatched doctors to over 1,000 hospitals in poor counties, and developed a network of distance health care. (Source: Xinhua)

December: Hospitals not responsible if families refuse to give consent

Hospitals will be exempted from responsibility if doctors perform emergency surgery before they are able to secure consent from patients’ relatives.

The ruling, issued by the Supreme People’s Court on Wednesday (13th), clarifies responsibilities of hospitals when they have to perform medical emergencies but do not have agreements from patients’ families.

Doctors often face this dilemma when they are not able to find patients' families or the relatives do not reach an agreement or refuse to sign before the hospital starts the procedure. But after the surgery, sometimes families disagree and demand the doctors to pay, an official with the national top court’s research office said in a statement.

Now doctors can perform emergency treatment after securing approval from the person in charge of the hospital, the court said. “The courts will support the doctors and the hospitals will not have to compensate under this ruling,” said the official, whose name was not disclosed.

“The move is to encourage doctors to save patients in emergency and consider rescue as the priority.” But if hospitals neglect or are late to take medical actions, they will be held responsible and would have to pay compensation , the ruling added.

The interpretation, which will come into effect on Thursday, can also help regulate hospitals as they handle emergencies, the official added. (Source: China Daily)

December: China's clinical illness insurance covers 1 billion people

China's critical illness insurance (大病医保) now covers more than one billion people, according to the National Health and Family Planning Commission.

Improving the system of critical illness insurance has been a major task for the health sector during the 13th Five Year Plan period (2016-2020). While expanding the coverage of the insurance to all urban and rural residents, health authorities also lowered the threshold for payment by insurers, raised the ratio of payment by insurers and expanded the scope of services covered by insurance.

Wang Hesheng, vice head of the commission, said that insurance for critical illnesses now covers more than 50% of patients' medical costs, and in some rural areas a basic medical insurance system for the impoverished covers 80 to 90% of medical fees. The commission said it would work to ensure families with low incomes, senior citizens, juveniles and those with severe disabilities or severe diseases will receive proper medical treatment. (Source: Xinhua)

December: China opens first mobile poisoning emergency center in Guizhou

China opened its first emergency mobile center for cases of poisoning in Guiyang, capital of southwestern China’s Guizhou province on Dec 6. The center is stationed at the Guizhou People's Hospital and is expected to increase the local capacity of dealing with emergent cases of poisoning.

The center in Guizhou will offer professional treatment, including on-the-spot surveys, tests, individual protection and medical security. Cases of poisoning emergencies in recent years from around the world will be analyzed to improve the training and exercise of health emergency staff.

During the 13th Five-Year Plan (2016-20), China will open 11 emergency mobile centers all around the country. (Source: National Health and Family Planning Commission)

December: Boom in HPV vaccinations shows Chinese women's growing health consciousness

Fan Lei, 32, cannot wait to get her first human papilloma virus (HPV) vaccine, after a fretful three-month wait. "I asked for leave immediately after the call from the community health service center," she said. The HPV vaccine Fan received in the city of Yinchuan in northwest China's Ningxia Hui Autonomous Region, was developed by U.S.- based Merck & Co, and approved by the China Food and Drug Administration to enter the market in May. The first batch reached Chinese consumers a month ago.

The introduction of the new vaccine came after a good response from Chinese women to GlaxoSmithKline's Cervarix, the first HPV vaccine licensed for use in China, earlier in the year. But Cervarix has an age cap of 25, while the Merck product is available for anyone from 20 to 45. "In fact, I intended to get the Cervarix vaccination, but was told I was too old," Fan told Xinhua.

The younger generation in China, especially middle-class women of Fan's age or younger, now have a much greater health consciousness. In just a month, the center Fan visited received more than 910 reservations for the new HPV vaccination, but only 280 vaccines were available, according to Gao Xiaoyan of the center.

The popularity of HPV vaccines in Yinchuan mirrors the strong demand nationwide. According to the report "Cancer Statistics in China 2015" published by CA: A Cancer Journal for Clinicians, more than 30,000 patients died of cervical cancers, and over 98,900 new cervical cancer cases were reported in China in 2015. In other words, three Chinese women were killed by cervical cancer every hour.

But cervical cancer, by far the most common HPV-related disease, can largely be prevented. According to the WHO, nearly all cases of cervical cancer, the fourth most frequent cancer in women, can be attributed to HPV. It can take 15 to 20 years for cervical cancer to develop in women with normal immune systems, and the symptoms tend to appear only after the cancer has reached an advanced stage, making it important to take precautions in advance.

The two HPV vaccines currently available on the market can protect against both HPV 16 and 18, which cause at least 70 percent of cervical cancers, according to the WHO. The vaccines may also offer cross-protection against other less common HPV types that cause cervical cancer. But for some time, HPV vaccines were not greenlit on the Chinese mainland due to safety concerns, and many had to travel to Hong Kong to get a shot.

A complete HPV vaccination requires three shots in six months, which meant patients had to travel to Hong Kong three times during this period, at high cost. "Some of my friends went to Hong Kong to get the vaccination, but it's too troublesome to go from Yinchuan. Now we have it at home, it's much easier," Fan said. Though one shot of the vaccine costs over 800 yuan (121 U.S. dollars), Fan and her friends believe it is worth the money. "It is pricey. But compared with the economic and mental burden of the disease, it is nothing," she said.

China is also developing its own HPV vaccine. Clinical testing of a second-generation HPV vaccine, led by the National Institute of Diagnostics and Vaccine Development in Infectious Diseases, was approved by the China Food and Drug Administration in late November. It is expected to enter the market in 2022.

"HPV vaccination can prevent most types of cervical cancer, but a regular health check is still necessary," said Zhou Liwei, vice chairman of the Center for Disease Prevention and Control in Ningxia. "Cervical cancer patients are getting younger. We should care more about our health through regular health checkups and proper vaccinations," Fan said. (Source: Xinhua)

December: Chinese-made ventricular assist device enters clinical testing

On Dec. 8th, several Chinese hospitals started a clinical test for a ventricular assist device (VAD), which is believed to be the first such test conducted on the Chinese mainland. A VAD is an electromechanical device for assisting cardiac circulation, which is used either to partially or completely replace the function of a failing heart. It is expected to benefit hundreds of thousands of Chinese patients with severe heart failure.

The VAD was developed by Chongqing Yongrenxin Medical Devices Co. Ltd., a Sino-Japanese joint venture. The device entered a period of clinical testing in Japan in 2005. In November, the Chongqing-based company officially obtained approval for the clinical test from the China Food and Drug Administration.

According to Hu Shengshou, president of Fuwai Hospital, heart failure caused more than 40% deaths due to diseases in China annually. Hu said that China has at least 600,000 patients with severe heart failure. However, due to a severe donor shortage, the country only conducts around 300 heart transplant surgeries each year.

VAD is known globally as one of the most effective measures to treat patients with severe heart failure. Domestically-made devices are not yet ready to be put into commercial use, while foreign-made devices are often unaffordable. The device will be put into use in 2018 after the clinical test concludes. (Source: Xinhua)

December: China’s elderly population to account for 40% of Asia’s total by 2050

China’s elderly population is estimated to hit 480 million by 2050, accounting for two-fifths of the total figure in Asia, said Zhu Yaoyin, vice-president of China National Committee on Aging on Dec 6.

China is currently the only country in the world with an elderly population of over 200 million, and that percentage is expected to increase by 24% from 2000 to 2050, twice that of the estimated world average, Zhu said.

In addition, Zhu noted, China has turned into an aging society as a developing economy, which constitutes a serious issue. As a result, the country is faced with a huge task, especially with ongoing urbanization and a low-birth rate trend.

Zhu promised that the country will further enhance the social security system and basic public services for senior citizens, and find solutions to tackle major difficulties. Meanwhile, the country will take measures based on comprehensive evaluations to improve the elderly care system, such as community-based and smart care services. (Source: People’s Daily Online)

December: Tuberculosis Diagnosis and Care in China: A Lesson for All

A new study provides data on the “know-do” and “policy-practice” gaps found in tuberculosis diagnosis and care across three levels of China’s health system.

Tuberculosis Diagnosis in China

In China, tuberculosis remains a high health burden and the rate of accurate tuberculosis diagnosis is low. There may be several factors influencing the low rate of diagnosis, particularly in rural areas. So far, health care research has focused on those already diagnosed, but research into those who are undiagnosed in rural areas remains scarce. Healthcare providers and policymakers need to understand the reasons for the low rate of diagnosis in urban areas in order to implement effective policies to eliminate TB.

In a recent study published in PLOS Medicine, researchers from the University of North Carolina trained and sent standardized “test” patients to present with classical TB symptoms for 274 healthcare providers at village clinics, township health centers, and county hospitals in China.

The results showed that the county hospitals managed the patients’ visits correctly 90% of the time, compared to only 38% in township health centers and 28% in village clinics.  While antibiotics were prescribed in 61% of the consultations, incorrect antibiotic use was high at all levels of care.  Only 28% of village doctors and 18% of township providers correctly referred the case onward.


The “Know-Do” Gap

Although patients presenting with symptoms typical of TB were generally not properly managed, the deficits were not due to a lack of provider knowledge.  These same doctors managed according to TB recommendations 81% of the time when these same symptoms were described in clinical vignettes.  In other words, the providers seemed to know the medical guidelines for TB management but, in practice, do not follow them.  This “know-do” gap can be seen in hospitals worldwide.

The “Policy-Practice” Gap

Although sputum testing is recommended for tuberculosis diagnosis, this study found that when the healthcare providers ordered tests, they were most likely to order chest X-rays. Despite the availability of sputum testing, their focus was to establish what might be wrong with these individuals who were unwell rather than on diagnosing TB.

Despite incorrect testing practices, their actions may not be indicative of poor medical care.  Primary healthcare providers may see several patients each week whose symptoms could be associated with TB, but could also be caused by a chest infection.  They may not want to worry patients unnecessarily or add to patient and/or clinic costs.  In understaffed centers, healthcare providers may practice under the assumption that individuals with persistent conditions such as TB will return to be seen again.

This study highlights that the elimination of tuberculosis should not rely upon the development of better tests or pills.  The disconnect between medical guidelines and medical practice, particularly in poorly resourced and rural areas, will require interventions targeting integrated healthcare training in real-world situations so that they feel empowered to properly diagnose and refer tuberculosis patients. (Written by Debra A. Kellen, PhD; Source: Medical News Bulletin)

November: Shanghai Pharma buys Cardinal Health China business

China's leading drug maker and distributor, Shanghai Pharmaceuticals Holding Co. Ltd., said Wednesday it will take over Cardinal Health Inc's China business. Shanghai Pharma's subsidiary Century Global and Cardinal Health's subsidiary Cardinal Health Cayman Islands Ltd. signed a contract Wednesday to buy the Cardinal Health Co., Ltd. for 557 million U.S.-dollar acquisition. Century Global thus holds Cardinal Health China business through the acquisition.

U.S. pharmaceutical distribution giant Cardinal Health Inc's China business is the eighth largest drug distributor in the country, with a network covering 322 Chinese cities. The acquisition will enable Shanghai Pharma to enter the market in Tianjin and Chongqing municipalities and Guizhou Province, expanding its distribution network to 24 provincial-level areas, and the company will become one of the biggest imported drugs agents in China, said Liu Dawei, board secretary of Shanghai Pharma. (Source: Xinhua)

November: China's TCM industry grows 20%

The traditional Chinese medicine (TCM) industry in China grew by 20% in the past year, according to the State Administration of Traditional Chinese Medicine (SATCM). The sector earned more than 860 billion yuan (about US$130 billion) last year, one third of the country's total medical industrial output, said Wang Guoqiang, head of the SATCM.

The Law on Traditional Chinese Medicine went into effect on July 1,to regulate and support the development of the industry. With a history of more than 2,000 years, TCM has unique theories and practices in herbal medicine, acupuncture, massage and dietetics. There are 482,000 TCM practitioners in China now. (Source: Xinhua)

October: China records increase in medical resources in 5 years

Li Bin, minister of the National Health and Family Planning Commission held a news conference on the sidelines of the 19th National Congress of the Communist Party of China on October 22nd, and said that the availability of medical resources in China has increased in the past five years, with people at grassroots having better access to healthcare facilities.

Li mentioned that by the end of last year, the number of medical institutions in China reached 980,000, and the number of health workers exceeded 11 million. She added that the number of registered physicians per 1,000 people in China reached 2.3 last year, compared with 1.8 five years ago, the number of registered nurses per 1,000 people in China reached 2.5 last year, compared with 1.5 five years ago, and the number of hospital beds for every 1,000 people reached 5.4 last year, compared with 3.6 five years ago.

Of all 7.9 billion diagnostic and treatment services provided by hospitals and clinics in China last year, more than 55% were provided by institutions at grassroots. And to help medical institutions at grassroots improve abilities, more than 6,800 public hospitals have established partnership with such institutions through internet to provide guidance and training, Li said.

To control medical expenditure, all public hospitals, the primary provider of healthcare services in China, banned price markup for the drugs they sold to patients at the end of September, a practice carried out for decades by many public hospitals as a major source of income, Li said. Besides drugs, fees for medical services and checkups and tests, such as CT scanning, were also reduced as part of the ongoing healthcare reform. For example, in Beijing, which abolished drug price markup in all the city's public hospitals in April, patients saved 4.4 billion yuan ($665 million) in medical expenditure between April and September, Li said. (Source: China Daily)

October: Better test developed in China to detect liver cancer

Scientists in China have identified DNA markers specific to liver cancer, which is expected to greatly improve accuracy in diagnosis of one of the most common cancers in China.

Using the new technology, doctors can provide a diagnosis and prognosis to patients with liver cancer through simple blood tests. That could decrease the chances of a misdiagnosis by more than half, according to Xu Ruihua, director of the Sun Yat-sen University Cancer Center in Guangzhou, Guangdong province, who has led the research.

After five years of research, involving over 100 researchers from different institutes, the scientists identified methylation in DNA circulating in the blood that is related to liver cancer. Methylation, like genetic mutation, is an abnormal genetic change that can cause cancer, Xu said.

Using samples of circulatory system DNA from a large group of 1,098 liver cancer patients and 835 healthy people for comparison, they constructed a diagnostic prediction model that showed high diagnostic specificity and sensitivity, Xu said in the study, which was published in Nature Materials, a science journal, on Oct 9.

Liver cancer is one of the most common cancers in China. The number of new cases reached 466,000 in 2015, and the cancer caused 422,000 deaths that year, according to the center, accounting for more than half of the world’s liver cancer cases and deaths. (Source: China Daily)

September: Spread of resistant bacteria reduced

Health authorities have been emphasizing the control of bacterial drug resistance and the rational use of antibiotics, and efforts made in the past 10 years have yielded noticeable results, said Xiao Yonghong, a member of the National Health and Family Planning Commission’s expert committee for rational use of drugs and a professor at Zhejiang University’s First Affiliated Hospital.

Last year, antibiotics dispensed at medical institutions across China accounted for 11.2% of the total value of all drugs sold at those institutions, compared with 19.7% in 2010, he said. According to Xiao, in 2010, more than 67% of inpatients in China used antibiotics, and nearly 20% of outpatients used antibiotics. By the end of last year, the percentages decreased to 37.5% and 8.7%, respectively. The quantity and frequency of antibiotics used on patients also saw a decrease of about 41% from 2010 to 2016.

With the reduced use of antibiotics, the proportion of cases of major multidrug-resistant bacteria at medical institutions in China have been controlled, according to Xiao. “Gaps still remain between China and countries that have taken the lead in the control of bacterial drug resistance, but China is close to the US and major countries in Europe in certain aspects,” Xiao said. For example, the proportion of cases of methicillin-resistant Staphylococcus aureus, a type of multidrug resistant bacteria prevalent in many countries, was lowered from about 52% in 2011 in China to about 30% last year. In comparison, the proportion of cases in the United States is 44% and in India, 48%, Xiao said. (Source: China Daily)

August: CV disease mortality rate is the highest amongst all deaths

China Circulation Magazine published the "China Cardiovascular disease Report 2016", which showed that the mortality rate of cardiovascular disease was the highest amongst total deaths in China, even higher than cancer. The mortality rates of cardiovascular disease are 45.0% in rural areas and 42.6% in urban areas. Overall, the prevalence rate and mortality of cardiovascular disease in China are still in the rising stage, and with the obvious prevalence of CV risk factors in China, CV disease is expected to continue growing rapidly in the next 10 years.

According to the report, the number of cardiovascular disease patients was estimated to be 290 million, including 13 million with stroke, 11 million with coronary heart disease, 4.5 million with heart failure, 5 million with pulmonary heart disease, 2.5 million with rheumatic heart disease, 2 million with congenital heart disease and 270 million with hypertension.

The report said that in 2015, the mortality rate of cardiovascular disease was 298.42 /100,000 in rural areas (144.79 / 100,000 for heart disease and 153.63 / 100,000 for cerebrovascular disease) and 264.84 /100,000 in urban areas (136.61/ 100,000 for heart disease and 128.23 / 100,000 for cerebrovascular disease).

Cerebrovascular disease:

The mortality rate of cerebrovascular disease exceeds that of heart disease, and according to the national census data, there were 853,600 urban residents and 1,034,900 rural residents who died from cerebrovascular disease in 2015.

According to the Statistics Yearbook of National Health and Family Planning Commission (NHFPC), the mortality rate of cerebral hemorrhage was higher than that of cerebral infarction in 2015, with 52.09/100,000 vs. 41.82/100,000 in urban area and 72.26/100,000 vs. 46.99/100,000 in rural areas.

Coronary heart disease:

According to NHFPC's Statistics Yearbook, the mortality rate of coronary heart disease was around 110/100,000 in 2015, with slightly higher rates in rural areas. This mortality rate was slightly higher than the rates in 2014 (110.5/100,000 in urban and 105.37/100,000 in rural).

According to this commission's PCI network data, there were total of 56,753 interventional therapies conducted for the treatment of coronary heart disease in 2015. This calculates to around 427/1,000,000 people in China who were treated with PCI. The average number of stents remained at around 1.5/person.

The annual volume of coronary artery bypass grafting (CABG) is around 40,000 cases, and is increasing at a rate of around 10% each year. Around 60% of China's pure CABG is carried out without cardiopulmonary bypass, whereas in Western countries, this is around 20%.


According to the NHFPC's online registration system, there were approximately 65,697 cases of pacemaker implantation in 2015, which increased by 9.98% since 2014. And there was no significant change in pacemaker indications compared with 2014: Sick Sinus syndrome accounted for 51.1% and atrioventricular block accounted for 39.8%. Dual chamber pacemaker accounted for nearly 69%.

Implantable cardioverter defibrillator (ICD) also showed an increasing trend with an 18.3% increase from 2014, and there were 2,759 cases of ICD implantations in 2015. Single chamber ICD accounted for 67.1% with the rest being dual chamber. 58% of ICD implantations were for secondary prevention.

Cardiac resynchronization therapy (CRT) also showed an increasing trend with an 8.4% increase from 2014, with 2,986 implants in 2015. CRT-D accounted for 57% and CRT-P accounted for 45%.

There were also 1111,000 cases of catheter ablation in 2015, with an annual growth rate of around 13.5%~17.5% since 2010. (Sources: Xinhua and

July: 36 more drugs added to the National Reimbursable Drugs List

The Ministry of Human Resources and Social Security in a statement on Wednesday July 19th said it had agreed to add 36 drugs to the National Reimbursable Drugs List (NRDL) in return for an average 44% price cut against last year's retail prices.

The ministry updated the NRDL after an eight year hiatus in February, when it said it was still negotiating around 45 expensive medicines with high clinical value. On Wednesday, it said the agreed price cuts were as much as 70% - reflecting drug-makers' desire to get their products onto state insurance schemes, which helps boost sales volumes.

"After the negotiations, the majority of the imported medicines will be cheaper than in surrounding international markets, greatly reducing the financial burden on Chinese patients from healthcare costs," the ministry said.

The additions to the list include a number of major cancer drugs such as Roche Holding AG's Herceptin, Avastin and MabThera, Celgene Corp's Revlimid, Johnson & Johnson's Zytiga and Novartis AG's Afinitor. Also included are AstraZeneca PLC's heart treatment Brilinta and Novo Nordisk A/S' diabetes injection Victoza.

The ministry said of the 36 drugs added, 31 were "Western" treatments - including 15 for cancer - and five were traditional Chinese medicines (TCM). (Source: Reuters)

July: Chinese life expectancy up to 76 years old

The National Bureau of Statistics revealed in the latest statistics on July 25 that the life expectancy of Chinese people has increased to 76.34 years old in 2015, an extra 18 months longer than in 2010. This makes the average Chinese person's life 4.74 years longer than the world average.

Chinese women's life expectancy reached 79.43 years old, 2.06 years older than in 2010, while men die earlier at 73.64 years old. This is a 1.26-year improvement from 2010, showing women's life expectancy is growing faster than men's, in line with the global trend.

The National Bureau of Statistics said Chinese life expectancy exceeded that of upper middle-income countries, reflecting China's remarkable gains in medical care and living standards.

The figures also show that the ratio of Chinese men to women has narrowed from 117.7 in 2012 to 113.5 in 2015. The bureau said the ratio was normalizing, which will promote a long-term balanced population development.

According to the white paper released by the Beijing municipal government and Beijing Municipal Commission of Health and Family Planning, which reported on public health and Beijing residents' health conditions in 2016, the life expectancy of residents with household registration in Beijing reached 82.03 years last year. (Source: China Daily)

June: Guideline issued to ease shortages of medicine

A guideline to improve the supply to prevent shortages was issued on Wednesday (June 28th) by nine government agencies, including the National Health and Family Planning Commission, the National Development and Reform Commission, and the Ministry of Human Resources and Social Security.

China has about 3,000 drugs approved for common clinical use, with 130 of them occasionally in short supply, according to Zeng Yixin, deputy head of the National Health and Family Planning Commission. "That's mainly due to the market gap between supply and demand," Zeng said.

Under the new guideline, an online drug consumption monitoring network will be set up to determine which drugs might run out and issue timely warnings about emerging needs so that the authorities can intervene. The guideline calls for the creation of a cross-province coordinating system to alleviate regional shortages of certain drugs.

For drugs in short supply nationally, emergency imports will be arranged, and if that doesn't work, "the authorities will assign selected drug companies to produce more", Zeng said. (Source: China Daily)

May: The "two invoice system" in pharma distribution

At the beginning of this year, China’s National Health and Family Planning Commission, along with seven other ministries, issued a new policy designed to streamline pharmaceutical distribution channels.

Previous distribution chains were typically comprised of manufacturers who sold to multiple distributors, which then goes through multiple tiers of distributors before reaching the hospitals, thus the price becoming high with margins at each tier.

This new policy, originally introduced in December 2016, is called ‘two invoice system’ where, during the distribution process from drug manufacturer to the hospital, only two invoices can be issued. The manufacturer issues a first invoice to the distributor, while the distributor issues a second invoice to the hospital or medical service provider. This aims to reduce the cost of pharmaceuticals (by eliminating the margin of multiple tiers of distributors) and to prevent possible corruption.

The system is currently being piloted in a number of provinces, and is expected to be fully implemented nationwide by the end of 2018. (Source: China Briefing / China Business Review)

May: The move to scrap drug price markups has shown early signs of success in Beijing

As part of the general healthcare reform, measures were introduced in April 8 aimed at ending the markup on drugs prescribed at public hospitals and modifying the prices for registration, consultation and treatments.

After one month of implementing these measures, Fang Laiying, head of the Beijing Health and Family Planning Commission, said the latest measures worked well to provide better and more rational treatment at more affordable prices. He said that the average drug cost for each outpatient visit during the past month has decreased by 9.6% in tier 3 hospitals and by 14.8% in tier 2 hospitals. For inpatient care, the average drug cost has decreased by 17.7% in tier 3 hospitals and by 24.0% in tier 2 hospitals, with the entire hospitalization fee decreasing by 4.1% and 14.1% respectively (note: drug cost has reduced but the consultation fee has increased).

Under a hierarchical medical system, he said, patients with minor diseases visit community clinics. Only the seriously ill go to large hospitals for specialist care. But with no price difference, patients tend to swarm into already crowded large hospitals, even those suffering from a common cold, experts said. Meanwhile, community clinics are underused, resulting in a waste of medical resources.

After modifying the prices for registration, consultation and treatment in the latest reform, more residents, particularly those suffering chronic diseases, began to visit community clinics, Fang said.

Total outpatient visits in community clinics increased by 3.4% during the past month over March, according to official data, while outpatient visits dropped by 15.1% in tier 3 hospitals and 7.2% in tier 2 hospitals.

Under the new reform, all 3,600 medical institutions in the city are required to purchase drugs directly from pharmaceutical manufacturers through an open public bidding platform to further reduce prices, he added. That has helped the capital save 420 million yuan ($60.8 million) in the past month, according to the latest figures available. (Source: China Daily and MENET)

May: CFDA to put orphan drug approvals in the fast lane

China's FDA is offering to grant conditional OKs for orphan meds already approved abroad, even without in-China trial data. The new orphan drug move is one in a series of new proposals posted online May 11. China’s FDA is once again planning major changes to its clinical trial and drug approval policies, further aligning them with its Western counterparts. A key feature is the new “conditional marketing authorization” for orphan meds.

The CFDA is offering to grant conditional approval for meds that treat life-threatening conditions where significant unmet medical needs exist, if early- or mid-stage data can predict the drugs’ clinical benefits. This policy resembles the EMA's “conditional marketing authorization” and the U.S. FDA’s “breakthrough therapy” program.

The CFDA first listed the policy as part of its expedited review program rolled out last February, but the agency goes further this time by expanding it to cover orphan meds already approved in foreign countries, even those without any trial data from China. As in the U.S. and Europe, drug-makers would be required to conduct confirmatory trials or follow-up studies as agreed with regulators.

This is not entirely new territory for the CFDA. The agency conditionally approved Actelion’s Zavesca (miglustat) for Niemann-Pick disease type C in 2013, based entirely on trial data obtained in Western countries. The Zavesca data had been generated for a European approval application, and the Chinese review included post-marketing data as well. The CFDA asked for a follow-up trial on at least 15 patients in China to confirm its efficacy and safety. After that, the med gained official approval last year.

But this is the first time CFDA has put the rare disease policy in writing. If implemented, it stands to increase new drug applications from orphan drug-makers intent on gaining increased access to a pharma market that, despite economic woes, remains one of the world's fastest-growing.

Other proposed policy shifts include allowing foreign study data for Chinese NDAs, changing the clinical trial regulatory management system from certification to registration, and converting clinical trial approval to a 60-working-day response window. (Source: FiercePharma)

April: Increasing patients with mental illnesses

According to the deputy chief for disease control and prevention at the National Health and Family Planning Commission National Health and Family Planning Commission, the number of registered patients with serious mental disorders in China reached 5.4 million last year, with three-quarters suffering schizophrenia. Previous figures released by the commission showed the number of such registered patients was 4.3 million by the end of 2014.

The World Health Organization estimates that more than 54 million people in China suffer from depression. A professor of psychiatry at Beijing University Sixth Hospital said that "This means only a small portion of people with mental diseases are actually diagnosed and treated". He added "In many other countries, patients with mental disorders first seek treatment at community health centers or their family doctors, but in China, most patients go to big comprehensive hospitals first, as other institutes may lack qualified psychiatrists" and suggested the lack of facilities and talent at community-level medical institutions are major obstacles to prevention and treatment of mental illnesses in China. (Source: China Daily)

April: Study shows that doctors avoid best diabetes therapy

According to a new study, nearly 67% of people with diabetes in China have difficulty keeping their blood glucose within safe levels because of widespread "clinical inertia" - a reluctance to prescribe combination drug therapies that have proved effective in other countries. Backed by pharmaceutical giant MSD, the study tracked more than 5,000 patients and 237 clinical research centers for almost a year. It is thought to be the largest study ever conducted in China on the treatment of Type 2 diabetes. The findings were published in the first issue of Science China Life Sciences, an academic journal of the Chinese Academy of Sciences and the National Natural Science Foundation of China.

Research and clinical practice overseas has shown that a combination of the drugs metformin and sitagliptin is effective and safe. Other drugs may also be added for a triple effect. But clinical inertia in China has undermined effective treatment, according to Wang Jianping, a director of diabetes care research at the Third Affiliated Hospital of Sun Yat-Sen University in Guangzhou, who led the study.

Many Chinese physicians do not prescribe combination therapies in a timely manner, which leads to patients having excessively high blood glucose levels over a long period, he said. Poor control over time can lead to health problems such as heart disease, as well as damage to the eyes, kidneys or nerves.

Doctors "are reluctant to prescribe combination therapies, largely due to a lack of clinical evidence and treatment consensus" in China, Wang said.

Mu Yiming, a senior diabetes specialist who was part of the study team, said the findings could help bridge the knowledge gap and help develop clinical evidence in China supporting combination drug treatments. In addition, he said, "We're working closely to integrate the findings into the latest version of the national treatment guideline, which is due very soon".

Xing Xiaoyan, head of endocrinology at China-Japan Friendship Hospital, also stressed the importance of patient education. "It's hard to change behavior, and some patients tend to reject combination drug therapy, citing potential adverse reactions," Xing said. She said the cost of drugs was a concern for many patients, but the government is helping. "We've seen the government cover more diabetes treatments under public health insurance," she said.

According to the National Health and Family Planning Commission, China has about 113 million adults with Type 2 diabetes, roughly 25% of the global total. Experts estimate that more than 493 million Chinese are pre-diabetic, which means their blood glucose levels are too high but not high enough for a diabetes diagnosis. (Source: China Daily)

March: 900,000 new cases of TB a year

According to the National Health and Family Planning Commission, although there is a downward trend of tuberculosis (TB) cases in recent years, China reports roughly 900,000 new cases annually, keeping it among the 30 countries with the highest incidence of the infectious disease. Latest statistics from the commission's disease prevention and control bureau showed that by the end of 2016, the TB incidence rate stood at 61 per 100,000 people in China, down 14% since 2011.

The commission said that bacterial infection was not evenly distributed across the country, and rural areas in the western regions recorded the highest TB prevalence. The Xinjiang Uygur autonomous region reported the highest TB prevalence, at 184.5 people out of 100,000 in 2015, and the Tibet autonomous region and Guizhou province followed.

The commission has taken number of steps in the past several years to alleviate the TB burden in these areas, including increasing investment for health projects, improving training for local medical staff and encouraging local governments to issue favorable policies for TB patients, such as increasing medical insurance reimbursement for the disease. The commission said that health authorities will continue to support areas with higher reported cases of TB, and it also plans to intensify research in the prevention and control of TB in the next few years, with a focus on vaccines and new therapies for TB including chemotherapies and immunotherapies.

According to a national plan on the control and prevention of TB released by the State Council in February, the Incidence of tuberculosis in China is expected to be reduced to below 58 for every 100,000 people by 2020. According to the document, services for preventing and treating tuberculosis should be further improved by 2020 and those who have the disease should be diagnosed early and given access to regular treatment.

Former president of the Chinese Anti-tuberculosis Association said that there are few new drugs for TB, and those commonly used have lost their effect in many patients due to drug resistance. The WHO estimated that in 2015, China had 57,000 cases of multidrug resistant TB. (Source: China Daily)

March: Reduced drug costs for Beijing

Beijing Municipal Commission of Health and Family Planning announced on March 22nd that all medical institutions involved in the reform will abolish price markups, usually at a rate of 15%, on the drugs they sell to patients. The reform covers more than 3,600 medical institutions in Beijing, including all public hospitals, as well as some private medical institutions. In addition, all medical institutions will purchase drugs from pharmaceutical manufacturers through open and competitive public bidding, so drug prices will be further reduced. With these measures, the price of drugs sold at these hospitals is expected to be reduced by about 20%.

Abolishing drug price markups, which has been a key source of income for public hospitals, has been a major, but thorny, task of China's ongoing healthcare reform that is aimed at a universal coverage of basic healthcare services. The practice has been adopted by most public hospitals in China since the 1950s to make up for a deficiency in healthcare funding from the government, authorities said. They've mentioned that drug price markups result in serious problems such as "encouraging medical institutions to use more drugs and more expensive drugs, which results in a rapid rise of medical costs and increased burdens for both the government's medical insurance fund and patients".

Beijing started to pilot abolishing drug price markups in five public hospitals in 2012, and the income from drug sales accounted for about 33% of the total income for those hospitals last year, compared with 43% in 2012, according to the commission. To make up for revenue losses in drug sales, hospitals involved in the reform will increase the prices of some of the services they provide, such as surgery and nursing as well as traditional Chinese techniques such as acupuncture. Meanwhile, fees for checkups that involve the use of expensive machinery will be reduced.

According to the Beijing Municipal Commission of Development and Reform, overall, it is estimated that the cost of treatment per outpatient will be reduced by about 5%, while there will be an increase in price of 2.5% for inpatient treatment.

All public hospitals in China will abolish price markups by the end of this year, the National Health and Family Planning Commission, China's top health authority, said earlier this month. (Source: China Daily)

March: CFDA to ease pain for foreign pharmaceutical firms

There is a huge market potential for drugs and more foreign pharmaceutical companies should tap the sector, Bi Jingquan, chief of China Food and Drug Administration (CFDA), said on March 5th

Bi said there are several reasons behind the shortage of new drugs in China, including the availability of the medicines in other countries. Some of the other causes are: Strict drug inspection and approval policies, shortage in drug inspection and approval personnel at the CFDA, and concerns from some foreign pharmaceutical companies over intellectual property protection in China, which make them reluctant to sell new drugs in the country, he said.

The authorities will take measures such as streamlining approval procedures for drugs, intensify protection of intellectual property rights, and increase the staff for drug approval so that more new medicines are available in the market, he added.

The total number of staff for drug approval in China rose to 600 by the end of last year, while the number for the United States was 5,000, Bi said. The number of drugs that await approval fell to 8,000 by the end of last year, due to measures taken to accelerate approval, he said. (Source: China Daily)

February: China updates national drug list

China has updated its list of medicines covered by national medical insurance, adding some new drugs with a focus on pediatrics and major illnesses such as cancer, hepatitis, and renal and cardiovascular diseases.

China has a national medical insurance program, and the National Reimbursement Drug List (NRDL) names all the drugs covered by the insurance program, some in full (type A drugs) and others partially (type B). Patients must pay the full price out of pocket for those drugs outside the list, which means a huge financial burden, especially when new but more effective drugs are not covered.

The update, the first since late 2009, saw the list grow by 15% to 2,535, among which 1,297 are Western-style meds, an 11% increase. The additions include some blockbuster meds like tenofovir, an antiviral drug to treat hepatitis B and HIV, and marketed by GSK as Viread, cancer drug gefitinib, sold under the brand name Iressa by AstraZeneca, and China’s own non-small cell lung cancer med icotinib (Conmana).

The drug prices of these three products were largely reduced last year as part of a negotiation with the ministry, and for example, GSK cut Viread’s price in China by two-thirds last year, a move that obviously helped it earn a place in the updated drug list. In an interview by Reuters, a GSK spokesman said. "We have already seen a major increase in the uptake of our Hep B medicine (Viread) since reducing its price by 67% last year and inclusion in the NDRL will drive further access around the country."

Provincial-level governments are now requested to make their own lists by the end of July of this year. They can tweak a bit of the national list’s type B drugs based on local medical needs, meaning they can add or delete a few and detail their own coverage rates for each drug. (Source: FiercePharma and Reuters)

February: Chinese generic lung cancer drug hits market

A new generic gefitinib drug (Chinese commercial name Yiruike) produced by China's Qilu Pharmaceutical will hit the market on February 19th. Its release ends an almost decade-long monopoly by Iressa, developed by AstraZeneca and introduced to China in 2005.

Yiruike was approved for marketing by China's State Food and Drug Administration after Iressa's patent protection expired in April 2016, and is indicated as a first-line therapy for patients with non-small cell lung cancer (NSCLC) who have the EGFR-TK mutation.

Qilu's general manager Li Yan said "Yiruike, at less than 2,000 Yuan a pack, is a fraction of the price of the previously available drug, meaning more people in need can be helped". Although the Chinese health authorities cut Iressa's monthly cost from 15,000 Yuan to 7,000 Yuan in 2016, the cost of Yiruike will be more affordable. (Source: Xinhua)

February: Lung cancer kills more people than any other cancer in China

China registered over 3.6 million new cases of malignant tumors and 2.2 million deaths from cancer in 2013, said the vice director of the national tumor register center, on February 18th, quoting the findings of a report released by the national cancer center. The report noted that 270.59 in every 100,000 people develop cancer in China. The report also revealed that there are around 733,000 new cases of lung cancer in China each year, with about 591,000 people dying from it annually making it the deadliest cancer in China. (Source: Xinhua)

January: Second-child policy increases births by 7.9%

According to the National Health and Family Planning Commission (NHFPC), the number of births in China was 17.86 million last year, which is an increase of 7.9% (or 1.31 million) compared to 2015, and the highest annual number since 2000. The portion of the births to couples who already had at least one child rose to at least 45% last year, and a director of the NHFPC said "Some regions, mostly large cities in eastern areas, began recording second children as comprising more than half of local newborns". Expert estimations suggest the number of new births each year will stand between 17 to 20 million in China by 2020.
A professor of population studies at Nankai University said "The long-term effect of the universal second-child policy is very helpful to China's sustainable development," and that "By 2050, the policy is expected to bring about an extra 30 million working-age people and reduce the nation's aging rate by 2%". (Source: China Daily)

Separate data by China's National Bureau of Statistics (NBS) counted a slightly higher figure of 18.46 million births in 2016. The discrepancy was blamed on different statistical methods - the NBS numbers were based on a sampling survey, while the NHFPC's were based on hospital birth certificate data - but officials said both confirmed a significant upwards trend. (Source: BBC)


December: Chinese HCV drug expected for commercial use

On December 27th, China's first oral antiviral drug, danoprevir (ASC08), for treating hepatitis C virus (HCV) is going through the final approval procedure with the CFDA for general use, said Wu Jinzi, the chief of the development team at Ascletis Pharmaceuticals. The drug requires a 12 week course of treatment, and clinical trials have shown that it can cure 90% of HCV patients.

China has more than 8.5 million people with HCV. HCV can develop into liver fibrosis, cirrhosis and even liver cancer. An HCV drug sold by American drug maker Gilead costs USD 84,000 for a course of therapy, or around USD 1,000 per day, which is far beyond the means of almost all sufferers. Wu said the price of danoprevir has not yet been set, but it will be much cheaper than the American drug. (Source: Xinhua)

November: New guideline ends markup on drugs

To further the medical reform in China, the State Council released a guideline saying that all public hospitals will have to stop marking up the price of the drugs they sell. This is a controversial practice that has been adopted by such hospitals for years, to make up for a government funding deficiency, according to the guideline. Public hospitals generally sell drugs for prices that are up to 15% higher than what they pay for them. Some experts say this gives them incentives to buy more expensive drugs, and causes doctors to prescribe more expensive drugs.

With an expected decline in drug sales, the local government will allow public hospitals to adjust service fees. Checkup and test fees will be reduced, while services that require professional skills, such as diagnosis and surgery, will increase, the guideline said. However, the total cost to individuals will not increase, it added.

In contrast to soaring drug prices, some service fees collected by public hospitals are very low. For example, the price of a diagnosis offered by a doctor with a senior title is no more than 14 yuan ($2.10) in many public hospitals in Beijing, a rate that has not changed for many years.

The local government will make detailed policies to compensate public hospitals for the loss of drug sales revenue, and local governments are encouraged to increase remuneration for medical staff as an incentive, said the chief for medical reform at the National Health and Family Planning Commission.

"A major difficulty in the medical reform is to break up the strong interest groups that have formed in the medical sector over a long period, such as in drug purchases and distribution," said a medical reform researcher at Renmin University of China. (Source: China Daily)

November: Merck opens China pharmaceutical plant

Merck has opened a plant in Nantong, China's eastern Jiangsu Province, to produce pharmaceuticals on the country's Essential Drug List. Merck has invested 170 million euros (188 million USD) in this pharmaceutical plant, which had been under construction since 2013.

"By dedicating the largest manufacturing plant outside Europe to the production of pharmaceuticals to address widespread health care needs in China, Merck is connected to China more than ever," said Mark Horn, managing director of Merck's biopharma business.

The Nantong plant will reach an annual output of up to 10 billion dosages of pharmaceuticals for the treatment of diabetes, cardiovascular disease and thyroid disorders by 2021. The first batch of its pharmaceutical products will enter the market in the second half of 2017. (Source: Xinhua)

October: China to top the world in obese youth by 2025

The World Obesity Federation has predicted that Chinese youth will top the world in obesity by 2025. The report shows how the obesity rate in China has been growing, and that if the trend continues, obese children and teenagers aged between 5 and 18 in Chinese mainland will reach 48.5 million by 2025, a number that surpasses the total population of Spain. Obese youth is estimated to reach 7.3 million in India, and 16.7 million in the US. In 2013, China ranked 8th in the world's top 20 countries with the fastest growing youth obesity rate. The top three are Vietnam, Azerbaijan and Serbia. The report cautions against the rate of obesity in children in rural China.

Alongside the rising obesity rate among Chinese youth, millions of them are estimated to suffer from diseases such as fatty liver, diabetes, high blood pressure and low glucose tolerance.
The State Council released guidelines in 2011 responding to the increase of obese children in China. The guideline for the development of Chinese youth, set between 2011 and 2020, aimed to prevent more children from becoming obese. The guideline urges local authorities in China to strengthen the training of medical staff around children's health and promote the knowledge of balanced eating and drinking habits among their parents. (Source: South China Morning Post)

October: Rural China threatened by lung cancer

During the InterAcademy Partnership for Health 2016 Conference, held during October 4-5th in Beijing, the deputy head of the National Health and Family Planning Commission said that by 2020, senior citizens aged 60 or above will make up 17% of the population (approx. 240 million).

The senior health official noted that the situation with chronic disease is severe, with more than 260 million chronically ill patients in the country, and that these illnesses are to blame for over 86% of deaths in China. The official also said that the per capita annual spending on health was estimated at around 472 U.S. dollars in 2015. (Source: Xinhua)

August: China tightens regulation on medical-related TV programs and online ads

China's top broadcast watchdog announced on August 26th that it will tighten regulation over health and medical related TV programs and advertising. The State Administration of Press, Publication, Radio, Film and Television (SARFT) recently issued a circular stating that such programs could only be produced by TV station personnel. Such programs will also be required to be reviewed and recorded. Programs made by private companies will not be allowed on air, the circular said. SARFT also banned advertisements during such programs. Experts on medical or health programs must have relevant qualifications issued by health authorities. The circular also imposed limits on the length and form of medical advertisements. Each advertisement should not exceed one minute, with advertisements disguised as TV programs strictly prohibited, it said.

Also, China will intensify efforts to regulate online commercials following public ire over deceptive online advertising. According to the vice head of the State Administration for Industry and Commerce (SAIC), a temporary regulation will take effect on Sept. 1, requiring publishers to clearly mark all online commercials as advertisements to warn netizens.
A college student died in April after he followed allegedly deceptive information promoted by search engine Baidu and signed up for medical treatment at a Beijing hospital. The upcoming regulation makes it clear that paid promotion of information on search engines is classed as advertising.
According to the SAIC, a department tasked with monitoring online commercials will also be established. From September 2015 to August 2016, the SAIC and other market regulators discovered around 3,200 cases of unlawful online advertising. (Source: Xinhua)

August: Beijing crackdown on hospital scalpers

Beijing will launch a crackdown on scalpers that camp out at the city's hospitals to book and resell appointments, authorities said Tuesday (August 16th). In a meeting on hospital offences and crimes, Beijing Police ordered hospitals to increase security and install surveillance cameras. The police will respond to any complaints made by these medical institutions and handle any emergencies related to scalpers, said the deputy head of Beijing's Public Security Bureau.
Scalpers in hospitals snap up registration numbers, making booking appointments very difficult for the public. In late January, a video shot at a Beijing hospital went viral in China. In the video, a woman raged about the fact that appointments for specialists had been booked by scalpers, who were selling them for 4,500 yuan (688 U.S. dollars), 15 times higher than the original fee. In Chinese hospitals, patients often pay a fee to schedule medical appointments and are issued a number ticket upon booking.
Triggered by the video, hospitals in Beijing have taken measures, including a real-name system for appointments, but a number of scalpers have continued regardless. (Source: Xinhua)

August: Internet users in China surpass 50%

According to the official report released by the China Internet Network Information Center (CNNIC) on August 3rd, China has 710 million Internet users as of June, accounting for 51.7% of its total population, exceeding the global average by 3.1%.
China gained about 21.3 million new web users in the first half of 2016, an increase of 1.3 percent compared with figures from the end of 2015, the report said. The report noted that 191 million people, almost 27% total Internet users were from rural areas, marking a huge gap of 35.6% in the Internet penetration rate between urban and rural areas. (Source: Xinhua)

June: Beijing smoking ban could be extended nationwide

Beijing's smoking ban, which came into effect on June 1 last year and made it illegal to smoke indoors in public places, has curbed smoking in the capital and won widespread public support, according to a survey published on May 27 by the Chinese Association of Tobacco Control.
The Beijing ban, the strictest in the country's history, prohibits smoking indoors at public places and at outdoor venues, such as schools and children's hospitals.

The survey at 450 public places in the Chinese capital found that the situation has improved markedly since the ban came into force. The biggest improvements were seen in bars and restaurants, while hospitals were recognized as the best enforcers of the ban, the survey said. Smoking was reported in only 14% of the bars visited, compared with 90% before the ban came into effect. A researcher at the Chinese Association of Tobacco Control, said the benefits have been recognized by the public, including many smokers.

The results of the survey will provide vital information for lawmakers, as the country mulls extending the ban to implement China's first-ever nationwide anti-smoking legislation. The proposed law was drafted by the National Health and Family Planning Commission, which solicited opinions from several government departments, said a spokesman for the commission.

However, insiders said the draft offers too much leeway because it would allow smoking areas to be established in public places, such as restaurants, bars and coffee or tea shops. A deputy director of the Beijing Tobacco Control Association, said: "That's like setting aside a peeing area in a swimming pool."

A spokesman for the National Health and Family Planning Commission said smoking areas in public places cannot protect people from the effects of second-hand smoke, and also added that "they make enforcement of the anti-smoking regulations even harder and more complicated." Nationwide, many obstacles remain to the full implementation of smoking bans, the spokesman said, citing poor public awareness of the health risks posed by both active and passive smoking, and a lack of respect for rules.
Moreover, China's tobacco industry is a State monopoly and the government relies heavily on the revenues generated, which means vested interests may attempt to block or delay measures to control tobacco use, he added. (Source: National Health and Family Planning Commission)

May: China to cut prices of some expensive patent drugs

High prices of imported and patent drugs are a great burden for Chinese patients and the country as a whole. The National Health and Family Planning Commission said that some pharmaceutical manufacturers have agreed to lower some drugs' prices on condition of bulk purchase. GlaxoSmithKline (GSK) will reduce the price of tenofovir disoproxil, a treatment for hepatitis B, from 1500 yuan (229 USD) to 490 yuan per month. Icotinib, an anti-cancer drug made by China's Betta Pharmaceuticals, will be dropped from 12,000 yuan to 5,500 yuan for a month's supply. AstraZeneca will lower the monthly cost for the anti-cancer gefitinib from 15,000 yuan to 7,000 yuan. (Source: Xinhua)

May: Hospitals cut back on antibiotic use

A recent global review by the UK's Lord Jim O'Neill on anti-microbial resistance, estimates that by 2050 antibiotic resistance could result in 1 million premature deaths annually in China. "China could suffer an enormous loss of GDP because of that," said O'Neill, who headed the expert review team. According to the report, China uses around half the world's antibiotics, of which 48 percent are consumed by people and the rest are used in the agricultural sector. Weak regulation on the use of antibiotics in agriculture also further encourages overuse, it said.

A director of the Institute for Disease Prevention and Control of the People's Liberation Army, said excessive antibiotic residue might be passed on to humans through meat consumption, increasing the possibility of antibiotic resistance in people. He added that this could "contaminate" other parts of the world due to increasing international travel and exchange. O'Neill said: "It's a serious global challenge and thus needs a global solution."

According to a member of the Rational Drug Use Committee of the National Health and Family Planning Commission, "The Chinese government recognized the challenges and implemented measures starting in 2012 to tackle that". The measures include stricter control over public access to antibiotics, overhauling their overuse by hospitals, and monitoring of antibiotic resistance. "Antibiotic use dropped by 40% by the end of last year," he said, citing the national surveillance network of drug use linking large hospitals nationwide. (Source: National Health and Family Planning Commission)

May: 60% of career women say "no" to second child

This is the first Mother's Day following the relaxation of the four-decade family planning policy in January to allow all couples to have a second child. According to a report released by Chinese job recruitment site,, which questioned 14,290 career women on their work and life choices, nearly 60% of working mothers in China don't want to have a second child. The study also found that 20% of women who have not given birth do not want a child.

For their reasons of not wanting a child, more than 56% mentioned "cost", with the second most common reason being the amount of time, energy and attention involved. Other reasons included career risks, the pain of childbirth and little faith in their marriages. A senior consultant at Zhaopin, said "most career women think it is impossible to live solely on their husbands' paychecks" and also "they fear that if they stop working, they will become isolated from a dynamic society and lose their career prospects".

A senior expert on human resources at Chinese job-finding platform, said, "Taking the economic situation into consideration, it is not realistic to require companies to provide absolute equality when choosing their employees. Chinese women shoulder more family responsibility. It is not just about maternity leave — a female employee might only get back to work three to five years after having her first child. If a job requires frequent business trips, extra work and more attention to work instead of to the family, a capable male candidate would be more suitable," and added "it is not about gender choice — I would say this is a market choice." (Source: China Daily)

April: China tightens regulation and management of vaccines

Premier Li Keqiang signed a decree on April 23 which has banned drug wholesalers from selling vaccines following a scandal in which millions of dollars' worth of improperly stored or expired vaccines has been sold to patients nationwide. With this decision, a vaccine tracking system will be set up in which virtually all vaccine circulation will occur under official arrangements, and enterprises and users will need to record information about the circulation and use of vaccines so that even the smallest vaccine package can be pinpointed anywhere in its entire life cycle.
Also, this decision will improve management of cold-chain storage and transportation, prohibiting vaccines from leaving the cold-chain system and requiring regular temperature monitoring. In addition, institutions and hospitals must request storage temperature records upon receiving vaccines, and needs to keep clear records of their purchases and received inventory.
The decision also heightened accountability. Fines for serious violators, such as those improperly storing and transporting vaccines, will be increased. Government officials will be required to resign from their jobs if they fail to perform their supervision duties well. (Source: Xinhua)

February: Infectious diseases killed 16,744 Chinese in 2015

According to the National Health and Family Planning Commission, there were more than 6.4 million cases of infectious diseases reported on the Chinese mainland in 2015, with a total of 16,744 deaths as a result of an infectious disease.
About half of the infectious diseases were categorized as Class B infections by China's Law on the Prevention and Treatment of Infectious Diseases, and HIV/AIDS, tuberculosis, rabies, hepatitis, and human infection of H7N9 avian influenza, accounted for 98.55% of deaths in this category (16,584 deaths). Class C infection occupied most of the remaining half of the infections, with foot and mouth disease, infectious diarrhea, and influenza accounting for 97.5% of deaths in this category (160 deaths).
Cholera was the only Class A infection, with 13 cases and no deaths were reported. (Source: Xinhua)

January: Two-child policy introduced, but lack of pediatricians

According to China's public health statistical yearbook in 2015, the number of pediatricians in China dropped from 105,000 to around 100,000 within five years. On average, there are only 43 doctors per 100,000 children. This situation is worse in some smaller cities, such as Weinan, located about 70km away from Xi'an, which is a capital city of Northwest China's Shaanxi province, in which they only have 17 doctors per 100,000 children.

The shortage of pediatricians has made it difficult for parents. In one of the best hospitals in Xi'an, the waiting area for the pediatric department and surrounding corridor was swarming with hundreds of parents and sick children, with cries ringing out continuously. This department receives more than 500 patients daily, and one doctor said "In the mornings I receive more than 100 outpatients," which means that the doctor can only spend only a few minutes with each patient.

A director of the pediatric department at Xi'an Central Hospital believes that low salary, high pressure and high risk are the main causes behind people's reluctance to become pediatricians. A doctor at this hospital mentions "My working time a day is, on average, more than 10 hours", a nurse mentions that "We always find ourselves facing anxious parents yelling at us", and another nurses mentioning "Pediatricians earn 30% less than other departments, because the department earns less income". In China, medicines and examinations are the primary source of income for medical departments and children are prescribed less medicine than adults. The dosage for 10 to 15 children equals that of roughly one adult.

A decrease of pediatric graduates has also fueled the shortage, because in 1998, the Ministry of Education abolished pediatric departments in universities. A political adviser mentioned that, in Southwest China's Guangxi Zhuang autonomous region, there were only five universities with pediatric departments, as most stopped accepting pediatric majors. He added "Without timely measures, the situation will become worse". (Source: Xinhua)

January: Traditional Chinese Medicine (TCM) on the rise

At the 2016 national TCM meeting held in January, the director of the State Administration of TCM mentioned that the number of TCM hospitals in China has increased by 500 in the past five years, which is an increase of 15.5%. In addition, the numbers of TCM outpatient departments and clinics increased by 531 and 5,890, respectively. This director said that in 2014, there were 530 million visits to TCM hospitals, accounting for 17.9% of total hospital visits across the country, and that the TCM industry became a 730 billion RMB (110.8 million USD) industry in 2014, representing one third of the total industrial output of China's medical industry. (Source: Xinhua)


October: China to abandon its decades-long one-child policy

China's one child policy was introduced in the late 1970s to control the surging population by limiting most urban couples to one child and most rural couples to two children, if the first born child was a girl. The policy was later relaxed to allow parents to have a second child if they were both the only children. It was further relaxed in 2013, after the Third Plenary Session of the 18th Communist Party of China (CPC) Central Committee, allowing couples to have a second child if one of them was an only child.
The implementation of the one-child policy has resulted in an estimated reduction of approximately 400 million people in China, which successfully contained the problem of over-population. However, it has also been blamed for generating a number of social problems, especially the decrease in labor force and the aging population.
On October 29th, after the Fifth Plenary Session of the 18th CPC Central Committee, the CPC announced that China will be abandoning its decades-long one child policy, and that all couples can now have two children. This change of policy is intended to balance the population and address the challenge of an aging population.
After this announcement, Li Bin, the head of the National Health and Family Planning Commission, said that the two-child policy will optimize the demographic structure, increase labor supply, ease pressure from the ageing population, and help improve the health of the economy. Li added that the Commission will increase services in maternal and child health as well as build more kindergartens. (Source: Xinhua)

September: China’s cancer prevention and treatment three-year action plan (2015-2017)

On September 16th, NHFPC (National Health and Family Planning Commission of PRC), NDRC (National Development and Reform Commission) and 14 other departments jointly issued China’s cancer prevention and treatment three-year action plan (2015-2017).

Over the past 20 years, the incidence of cancer in China has increased year by year, and according to the national cancer registration results of 2013, the incidence of cancer in China was 235/100,000 with mortality of 144/100,000.

This plan has some specific goals including; increase the 5-year survival rate of major cancers, increase the public knowledge relating to cancer to 60%, increase early diagnosis rate to 50%, reduce the adult smoking rate by 3%, further standardize and increase the tumor registration to 30% of the population, and to formulate a national cancer map. (Source: NHFPC)

September: Heart disease patients in China are getting younger

According to a paper published by the National Center for Cardiovascular Diseases, one in five Chinese are in "poor cardiovascular shape", and one person dies from heart disease every ten seconds in China. Statistics showed that the number of Chinese aged between 35 and 44 with coronary heart diseases has increased 30% over the last three years, and the death rate of the same age group has risen 111% over the past 15 years. (Source: Xinhua)

August: Beijing's first private mental health clinic opens

Beijing's first private mental health clinic opened on August 2nd. The clinic is located in downtown Beijing, and is the first private mental health medical institution approved by the health authorities. The clinic is also China's first mental health clinic to combine online and in-person services. Fifteen mental health experts from major Beijing hospitals will offer medical services at the clinic as part of a move to encourage doctors to serve patients in multiple hospitals and clinics. China had 4.3 million severely mentally ill patients on official record at the end of 2014. To address a lack of mental health professionals, the 2015-2020 plan for mental health work encourages health institutes to set up psychology clinics and strengthen staff training, raising the projected number of doctors specializing in mental disorders to 40,000 by 2020. (Source: Xinhua)

July: Hepatitis B incidence drops

On July 28th, which is this year's World Hepatitis Day, a health official from the National Health and Family Planning Commission said that, according to data collected by the Chinese Center for Disease Control and Prevention, there are approximately 90 million people infected with the hepatitis B virus. However, the reported incidence of the disease has been decreasing in recent years. According to the 2014 statistics, the prevalence of hepatitis B infection in Chinese children aged 1~4 and 5~14, have both decreased by more than 60% from 2006, to 0.32% and 0.94% respectively.
The health official noted that the China's vaccination-based strategy to control the virus has helped significantly, and it has helped the country reach the goals set by the WHO to reduce HBV prevalence in children to less than 1% by 2017. The case load of hepatitis A in China also hit a record low in 2014.
However, the morbidity of hepatitis E has risen in the recent years, and the health official mentioned that China still has a long way to go in its battle against the disease. (Source: Xinhua)

July: Medical device adverse events rise 18.6%

China Food and Drug Administration (CFDA) announced on July 20th that there were 41,018 cases of medical device adverse events reported in 2014, which is 18.6% higher than the previous year. Of these medical device adverse events, 98 cases were fatal, and the rest left serious injuries on the patients. Of all medical device adverse events, 72% were performed by professional medical staffs. Most commonly reported medical device adverse event was related to medical polymer materials, followed by injection and puncture apparatus, and medical sanitary materials. (Source: Xinhua)

June: Chronic diseases on the rise

According to the "2015 report on Chinese nutrition and chronic disease" which was released by the National Health and Family Planning Commission (NHFPC), the prevalence of hypertension among Chinese adults was 25.5%, and diabetes was 9.7%. These numbers were higher compared to the results of 2002 when the first issue of this report was published.

This report also mentioned that the incidence rate of cancer was 235 out of 100,000 people in 2013 with lung cancer being the most frequently occurring cancer in men, and breast cancer among women. The incidence rate of cancer was also at an all-time high.

According to the report, in 2012, 533 out of every 100,000 Chinese residents died from chronic disease, accounting for 86.6% of all deaths, with cardio vascular diseases, cerebrovascular diseases, cancer and chronic respiratory diseases as being the top causes.

The report mentioned that "Body movement for the average Chinese is at a low level" with only 18.7% of the population between 20 and 69 years old regularly exercise (at least three times a week, 30 minutes per time). (Source: Xinhua)

March: 1/3 of China's population suffer from insomnia

A report published by several professional institutions, including the Chinese Sleep Research Society and the Chinese Medical Doctor Association says that around 38 percent of Chinese people are suffering from some form of sleep disorders. This is much higher than the global average of 27 percent announced by the World Health Organization. Dr. Zeng Rong a chief physician at the Shanxi Provincial People's Hospital said "With a faster pace of work and life, the age of people suffering from insomnia is dropping as well. Many adolescents, even pupils, come and say they have insomnia" and added that about two thirds of her patients with insomnia suffer from depression and anxiety. (Source: Xinhua)

February: China's population tops 1.36 billion and 1 million more babies are expected to be born every year

The National Bureau of Statistics reported that the Chinese population reached 1.3678 billion at the end of 2014. According to the Bureau, 7.1 million people were added to the national population in the past year. This data takes into account the total number born, 16.87 million, and offsets it with those who passed away, 9.77 million.
The number of babies born in China last year increased by 470,000 compared to 2013, and according to the National Health and Family Planning Commission, this is due to a series of moves to relax the family planning restrictions. Since late 2013, 29 of the 31 provincial regions on the mainland have enacted policies that allow couples to have a second baby if either partner is a single child. Little over 1 million such couples have registered with the authorities to have a second child by the end of last year, and the baby boom could last for 5-8 years, the commission said. (Source: China Daily)


December: China records 497,000 people with HIV/AIDS

National Health and Family Planning Commission revealed that, according to latest official figures, the number of people living with HIV/AIDS in China had exceeded 497,000 by end of October, with 154,000 deaths. The official said that infections among young students, the middle aged and the elderly have been particularly noticeable. (Source: Xinhua)

November: TCMs expected to play a bigger role in China's medical reform

According to the China Academy of Chinese Medical Sciences, the Traditional Chinese medicine (TCM) industry has developed rapidly during the last 10 years, and in 2013, the total value of TCM out-put exceeded 560 billion RMB (91.4 billion USD), one third of the total value of China's medicine industry. During the first TCM Science Conference which was held on Nov. 23rd, an official from the State Administration of Traditional Chinese Medicine said "TCM and western medicine complement each other, which is an important trait of China's health service system" and "as TCM has advantage in prevention and health care and is relatively cheaper than western medicine, TCM will help to solve difficulties for common people to get medical treatment" and thus suggested that TCM will play a bigger role in the future medical reform. (Source: Xinhua)

May: Increase of strokes in China

On May 19th, a vice director of a special committee on stroke treatment under the National Health and Family Planning Commission reported that 1.88% of China's population suffered a stroke in 2011, up from 0.27 percent in 1986. The study also revealed that more cases were reported in rural areas than in urban regions, and that the higher one's education level is, the lower the risk of suffering a stroke. While the study found that older people are more likely to suffer a stroke, it also noted that China's stroke patients are getting younger. (Source: Xinhua)

May: China to scrap price caps on low-cost medicine

On May 8th, China's economic planning body, National Development and Reform Commission (NDRC) announced that they will scrap caps on retail prices for low-cost medicine. Price caps of 280 Western medicines and 250 Chinese patent drugs, previously priced low by the government to relieve patients' medical burden, will be lifted, allowing producers to set prices according to their production costs, said the NDRC.
This move towards free-market pricing comes after strict price controls leading to drug quality problems and shortages in the country. For example, many pharmaceutical companies registered to sell the thyroid medication Tapazole have halted production in recent years after pricing restrictions squeezed out profits, experts say, creating a shortage. Also in 2012, some drug-capsule manufacturers were found to be using industrial gelatin to cut production costs. The industrial gelatin contained the chemical chromium, which can be carcinogenic with frequent exposure, according to the U.S. Centers for Disease Control and Prevention.
However, according to experts, the pricing reversal may not necessarily alleviate pricing pressure for these drugs. According to Justin Wang, a partner at L.E.K. consulting, "To get drugs into hospitals, companies must compete in a tendering process at the provincial level, and it's still unclear how the provinces will react to this new national list". (Source: The Wall Street Journal)

May: Mortality rate of children under five has dropped by 2/3 since 1990

According to a report released by the world's leading independent charity, Save the Children, the mortality rate for children under five in China has dropped by more than two-thirds since 1990, and the maternal mortality has been cut by 70 percent. The country director for Save the Children in China said, "China has been consistently rising on the index, with dramatic cuts in maternal and child mortality" and "[this is] the result of strong political will and willingness to invest in healthcare for children, which is a tremendous achievement given the size of the country and population". (Source: Xinhua)

April: China's surging cancer crisis

A week-long campaign, The Cancer Prevention Week, was held in Beijing from April 15 to 21 to boost public awareness of cancer prevention and control. According to a report released by the municipal commission of Health and Family Planning, cancer has been the top cause of death for people in Beijing for seven consecutive years between 2007 and 2013.
The National Cancer Registration Center estimated that about 3.5 million new cases of cancer are diagnosed annually, and 2.5 million die from the disease, and "although Chinese people's livelihood has improved, cancer incidence and mortality have also been on the rise," said the deputy director of the center. A professor of tumor studies with the Chinese Academy of Medical Sciences said "The cancer crisis will continue to rise with a growing and aging population in China. It is an uphill battle for the country and closely related to everyone". (Source: Xinhua)


December: 70,000 new HIV infections in 9 months

On World AIDS Day (Dec. 1st), health officials from the National Health and Family Planning Commission reported that there were a total of 70,000 new cases of HIV infections in the first nine months of the year, bringing the total number of people living with HIV/AIDS in China to 434,000. On the same day, a health authority from Shanghai mentioned that "the number of new HIV/AIDS cases has dropped from 18.2% in 2008 to this year’s 10.7%” and that "the disease has a low prevalence in the city.”. On the other hand, health officials from Guangdong Province mentioned that there were 7,030 new HIV cases in the province in the first 10 months, including 2,534 AIDS patients, which is a rise of 2.2% from the previous year. They also added that the number of young people in Guangzhou (between the age of 15~24) infected by the HIV virus is rising by 20% a year. (Source: Xinhua)

November: Incidence rate of diabetes increasing fast in rural areas of China, and the prevalence of diabetes at an "alert level"

At a seminar held in Beijing on Nov. 15th, a senior medical official with the Chinese Center for Disease Control and Prevention said that the incidence rate of diabetes among adults in China's rural areas has increased from 1.8% in 2002 to 8.4% in 2010, while the rates for 2011 and 2012 were not available. The official added that the incidence rate in the countryside increased faster than in cities, though the overall incidence rate was still lower than that of cities, and that the rural population has become a priority in diabetes control and prevention. (Source: Xinhua)

The increasing number of diabetes patients in China was also reported on an article in the September 4th issue of JAMA (The Journal of the American Medical Association). The article was about a study conducted by Dr. Yu Xu, of the Shanghai Jiao-Tong University School of Medicine, and colleagues of the 2010 China Non-communicable Disease Surveillance Group to investigate the prevalence of diabetes and glycemic control in the Chinese adult population. The study was conducted with a nationally representative sample of 98,658 Chinese adults in 2010, with the definition of diabetes and pre-diabetes based on the 2010 American Diabetes Association criteria; whereas, a HbA1c level of <7.0% was considered adequate glycemic control. This study showed that the overall prevalence of diabetes was estimated to be 11.6% in the Chinese adult population, and also, the estimated prevalence of pre-diabetes was 50.1%. In addition, the authors also found that the proportion of patients with diabetes who were aware of their condition was 30.1%. Also, only 25.8% of overall patients with diabetes were treated for this condition, and only 39.7% of those treated had adequate glycemic control. The author wrote, “These data suggest that diabetes may have reached an alert level in the Chinese general population, with the potential for a major epidemic of diabetes-related complications, including cardiovascular disease, stroke, and chronic kidney disease in China in the near future without an effective national intervention".

November: China has the highest number of diabetics in the world

According to the latest statistics from the IDF (International Diabetes Federation), in 2013 the total number of diabetes patients worldwide was 382 million. The country with the most diabetics overall was China with 98.4 million, which is roughly 1/4 of the global diabetic population. This number is expected to rise to 142.7 million in 2035. (Source: IDF)

October: Increasing senior population

China celebrated its first national Seniors' Day on Sunday. The Chinese government has made the ninth day of the ninth lunar month, the Double-Ninth Festival, a day to honor senior citizens since 1989, but this year's Seniors' Day is the first time the holiday has been observed since it was written into the revised law on protection of the rights and interests of the elderly.
China's population above age 60 reached 194 million at the end of last year, and China is the only country in the world with a senior population of more than 100 million.
According to a psychologist of Shenyang Mental Health Center, about 5% of the senior population has depression, about 5% seniors suffer from anxiety and about 44% of the elderly have insomnia. This psychologist added that the psychological disease was caused superficially by illness and pain but more deeply it was caused by lack of care from family and society.
In an announcement made by the State Council last month, the number of this age group is expected to reach 243 million by year 2020. (Source: Xinhua)

October: Approximately 25% of Chinese adults suffer from hypertension

On October 8th, which was China's National Hypertension Day, an official from the Chinese Center for Disease Control and Prevention mentioned that there are a total of 266 million people in China that suffer from hypertension. The official also mentioned that among those aged 15 and above, approximately 24% suffer from this condition and even for adolescents, approximately 15% have elevated blood pressure levels above the norm. According to this official, within these 266 million sufferers, only about 25% are receiving treatment for their hypertension, and 40% are not even aware that they have this condition. The official concluded that the increased incidence of hypertension has been caused by changes in lifestyle and diet, and preventing the condition requires not only medication but also people's awareness. (Source: Xinhua)

September: Increasing Obese Children

According to the Chinese Center for Disease Control and Prevention, the number of obese people under the age of 18 has reached 120 million in 2013, and the number is on the rise. (Source: China Daily)

August: Rising Number of Cardiovascular Patients

According to a report by the National Center for Cardiovascular China, an average of 9,590 people die from cardiovascular diseases each day (which is one person dying from CV diseases every 10 seconds). The report said that China has 290 million patients with cardiovascular diseases, which is an increase of about 60 million compared 2010. (Source: Xinhua)

August: Increase in Obesity Rates

According to a national survey of more than 43,000 adults, a little over 11% of people aged 20~39 in China are obese*. This was an increase of 2% since the last survey conducted in 2010. The average weight gain of this age group was approximately 2kg, which was higher than the other two age groups of 40~59 and 60 years old or higher. The survey also showed that this group (age of 20~39) was the least active exercisers, with 51% of them not exercising on a regular basis. The results also indicated that waist circumferences and hiplines have increased in all age groups, especially among young males and middle-aged females in urban areas. A different survey (The General Administration of Sport survey of 10 provinces, autonomous regions and municipalities) also found that 34.4% of Chinese between 20 and 69 are overweight. (Source: Xinhua)

*Please note that "obese" in China is defined as BMI 28 or above, and not 30 or above as defined by the WHO)

May: New Mental Health Law

China’s first national Mental Health Law came into effect on May 1, 2013. The Law explicitly states that patients with mental disorders (with the exception of those with severe mental illness or have the potential to harm themselves or others) shall receive inpatient treatment purely on a voluntary basis. The law also requires medical institutions to respect the patient's request to be discharged. The law has attracted a great deal of attention since a draft of the law was first submitted for discussion, as reports of people being wrongly institutionalized have increased. (Source: Xinhua)

April: More than 180,000 Medical device Adverse Events in 2012

On April 3rd, China Food and Drug Administration (CFDA) released the Annual Report of 2012 Medical Device Adverse Events for the public, and according to this report, China's National Center for Adverse Drug Reaction (ADR) Monitoring has received more than 180,000 suspicious medical devices adverse event reports in the year 2012.

The top five most reported non-active medical devices were; disposable infusion devices, intrauterine devices, disposable sterile syringes, contact lens and indwelling needles; and these accounted for 38.62% of all reported adverse events.

When reviewing the reports based on where the reports came from, 71.24% were submitted by the healthcare facilities that were using the devices, 21.58% from distributors, 2.49% from manufacturers, and 4.69% from other institutions and individuals.

In terms of where the adverse event happened, 69.26% was in the hospital, 16.17% was at homes, and the rest were others, such as research centers.

In terms of who was operating the device when the adverse event occurred, 72.11% were by medical professionals, 2.34% by non-medical professionals and 12.2% were by patients, and the rest is unknown.

Among the adverse events, 12.95% resulted in serious injury and 0.06% leading to death.
(Source: CFDA news)

March: New China Food and Drug Administration starts

Newly formed China Food and Drug Administration (CFDA) started operation on Friday (March 22nd) as a ministerial-level agency to improve food and drug safety. Previously, there were 4 different groups of regulators supervising the food and drug safety - State Council's Food Safety Office, the State Food and Drug Administration, General Administration of Quality Supervision, Inspection and Quarantine (AQSIQ), and the State Administration for Industry and Commerce (SAIC) – with some overlapping of supervision from different departments and "blind spots". As a result, Chinese consumers have encountered a series of food safety scandals in recent years, including recycled cooking oil, melamine-tainted milk, clenbuterol in pork, and such. These 4 departments are now merged into one as the new regulator (CFDA), and they will be responsible for supervising the entire process of food's production, circulation and consumption, which is expected to make the supervision more effective, professional and transparent. (Source: Xinhua)

March: Updated Essential Drug List

On March 16th, The Ministry of Health announced an updated version of the China's National Essential Drug List (which is catalog of drugs that is covered by all insurance plans in China). The updated list includes 520 drugs (317 Western drugs and 203 TCMs) which is an increase of around 200 drugs compared to the previous list issued in 2009 which included 307 drugs (205 Western / 102 TCMs). Noticeable increase came from anti-tumor drugs, in which 26 drugs were added to the list. Also, quite a few drugs for gynecological and pediatric treatments were also added to the list. (Source: MENET)

January: Among the healthcare-related policies announced in 2012, the following 10 are considered to have impact on the Chinese healthcare industry according to 21st Century Pharmacy Online
The 12th Five-Year Plan:
The State Council officially issued the "12th, Five-Year Plan for National Drug Safety" on February 13, 2012. This plan aims to improve the quality of medicines by standardizing and better regulating the manufacturing and distribution of all medicines. It will also strictly punish those who have produced and/or sold counterfeit and other illegal medicines. Also with this plan, all pharmacies will need to have a licensed pharmacist present during business hours by 2015.
Elimination of drug markups - Pilot reform programs in public hospitals:
Separating medical care and drug sales was one of the key topics during the NPC (National People's Congress) & CPPCC (Chinese People's Political Consultative Conference) Annual Sessions in March, 2012. One of the policies announced as a part of the hospital reform program was the elimination of drug markups (up to 15%) that the hospitals could charge for their drug sales, and a pilot program which eliminated this drug markup was implemented in public hospitals in Shenzhen and Beijing.
Strict regulations on antibiotic use:
On May 8th, the Ministry of Health announced a regulation for the clinical application of antibiotics, which took effect from August 1st. The key 3 elements of this regulations are; categorization of antibiotics to "non-restricted", "restricted", and "for special use", limitations on the number of types of antibiotics a medical institution can purchase, and the implementation of a system to manage and supervise the use of antibiotics including legal responsibilities (e.g. punishments for misuse).
Further cut on drug prices:
On October 8th, the National Development and Reform Commission (NDRC) announced a new round of retail price cuts for 95 drugs and more than 200 formulations for oncology drugs, immune system drugs and blood products. The retail price reduction averaged 17%. This price cut is in line with the previous price adjustment that the NDRC made in March, mainly for digestive drugs, which also cut the prices by 17% on average.
Expansion of the National Essential Drugs List:
The previously issued China's National Essential Drug List in 2009 (a catalog of drugs that is covered by all insurance plans) included 307 drugs (205 Western drugs and 102 TCMs). The Ministry of Health announced that they plan to increase this list to around 700.
Blacklist system for unsafe drugs:
On August 15th, the State Food and Drug Administration (SFDA) released a regulation that will go into effect from October, which will blacklist manufacturers of unsafe medication. With this regulation, the information of those found responsible for seriously violating drug safety regulations and medical equipment regulations will be blacklisted and posted on government websites for public supervision. Offenders may also be faced with a 10 year suspension of their operations.
Five standards for the pharmaceutical circulation industry:
On December 1st, the Ministry of Commerce officially announced five standards for the drug distribution industry, which are; "Assessment indicators for logistic service capability of wholesale enterprises" "Service standards of retail pharmacies" "operational guidelines for pharmaceutical circulation enterprises" "qualification standards for professional managers in the industry" and "position setting standards (such as president, store managers, quality control managers etc.) for pharmaceutical circulation enterprises".
Six OTC ephedrine-containing medications switched to prescription medication:
Following the earlier policy in September that required pharmacies to check and register IDs for people purchasing ephedrine-containing OTC medications, the SFDA announced on December 6th, that they have restricted the sale of six OTC medications that contain over 30mg of ephedrine. These medications will now only be available as a prescription drug.


December: Significant adjustments in essential medicine policy, scaled and intensive management are the leading directions for the pharmaceutical industry

"Top 20 sales enterprises should take more than 80% of the market share on the national essential drug list." This was formally written and signed by three government departments*. If this statement was actually implemented, "Designated Production" would lead essential drug industries to a large-scale intensive development.
Additionally, it is also stated that "Sales Revenue of Top 100 pharmaceutical companies should account for more than 50% (currently 40%) share of the entire industry in the next 5 years." There will be more M&A opportunities in the industry because of the 10% increase helped by the government.

*3 departments: Ministry of Industry and Information Technology, Ministry of Health, State Food and Drug Administration.

October: Restriction on OTC advertisement

It has been reported that the SFDA(State Food and Drug Administration) will revise the "Medicine Advertisement Examination Rule" on Sep. 25th to restrict or ban OTC drug advertising in the mass media. On Sep. 27th, the chairman of China's OTC drug association, Mr. Bai HuiLiang, confirmed that: on Sep.28th, the SFDA and other departments will organize a professional meeting to discuss this issue; whether OTC advertising will be limited or not is still under discussion.
According to China's OTC drug association, the market size of OTC medicine in 2011 increased to approximately 140 billion RMB, at least 5% of which was turned to advertising expenses.
If OTC advertisement is forbidden, it is expected that both the pharmaceutical and advertisement industries will receive a blow.

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