Unwell, on a tight budget, and far from a medical practitioner you know. What would you do? For the first time, a research study based outside of China is exploring Chinese people’s attitudes towards their healthcare system.
When diagnosed with an illness, our thoughts tend to leap to the practicalities of recovering – arranging time off, picking up prescriptions and getting as comfortable as possible. An already unpleasant experience can be made far worse, however, if there are doubts over the quality of the medical advice available.
The commercialisation of China’s healthcare system over the last 25 to 30 years and simultaneous migration of workers from rural areas where they know their doctors, into urban environments that are more anonymous, have led some people to question the motivations of their medical professionals.
A matter of trust
Now, a project led by Professor Jane Duckett, Director of the University’s Scottish Centre for China Research, is bringing together experts from the Social & Public Health Sciences Unit at Glasgow, the University of Manchester and Peking University to conduct the first nationally representative study exploring the relationship between Chinese people’s attitudes to the healthcare system and how they use it.
“One of the issues in China has been a mistrust of doctors, because the system has become very commercialised, with doctors selling medicines and hospitals selling drugs and making money out of some services,” explains Professor Duckett. “There’s anecdotal research by anthropologists in China that says people will do all kinds of unexpected things if they don’t trust their doctor, such as self-diagnosing or even seeing a vet.”
Talking to patients
The increasing share of household incomes and GDP being consumed by healthcare services in China has led to many studies into the impact in terms of people’s ability to pay or to travel long distances to be treated. Professor Duckett is convinced, however, that trust is just as critical a factor in how people use these services.
Professor Duckett explains: “The trust issue is talked about by policymakers and academics in and outside of China as an issue but no one has actually asked people in a systematic way that can confirm the extent of the problem.”
The study will be based on a nationwide survey that asks Chinese people what they think of their healthcare system, how much they trust doctors and if that affects how they use services. Without quantifiable evidence that explains this relationship, it is impossible to say why it has developed and what can be done to address it.
There has never been a better time to act. New satellite technology that measures population density will allow the team to obtain a sample of the population previously unparalleled in terms of accuracy. Traditional surveys used registers of where people lived but these did not account for the people who would leave rural areas for work without officially registering in their new urban home.
“This new method of surveying allows us to include these migrants who would traditionally have been left out. And there are lot of them – approximately 250 million,” says Professor Duckett.
The team hopes to use the study to aid Chinese policymakers and government advisers in shaping the future of healthcare in China. They will also work with the World Health Organisation and the United Nations Development Programme to ensure their insights gathered on health behaviours are available to inform worldwide policy.
“A lot of what happens in China is very relevant because with a fifth of the world’s population, it’s going to have an increasing influence on us,” says Professor Duckett. “Any developments in its health system will have an impact on the landscape of health globally.”