What has China’s public healthcare system learned from the twin coronavirus outbreaks of Sars and Covid-19?

China’s public-sector expenditure on health care increased almost 14-fold between the Sars outbreak in 2003 and the end of 2018

System is too “hospital-centric,” fragmented and volume-driven, according to a joint report by the World Health Organisation and World Bank

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China’s public-sector expenditure on health care increased almost 14-fold between the Sars outbreak in 2003 and the end of 2018. Illustration: SCMP

Published: 1:00pm, 14 Mar 2020Updated: 9:31pm, 14 Mar 2020

When the first patients came through the emergency ward at Roberta Lipson’s United Family Hospital in the early spring of 2003 with feverish coughs and chest pains, doctors at Beijing’s biggest privately run hospital had little clue on how to deal with the mystery disease spreading through the Chinese capital.

Befuddled, doctors reached out to the Chinese authorities, as well as the US Centre for Disease Control (CDC) and the World Health Organisation (WHO) for help. Based on their advice, the hospital did its best to give patients comfort while the medical world looked for answers. Officialdom eventually named the disease the severe acute respiratory syndrome (Sars) to distinguish it from other types of respiratory tract infections.

“Many of us worked around the clock, upgrading our systems to keep up with the evolving situation and find ways to keep our patients safe,” said United Family Hospital’s chief executive officer Lipson in an interview with South China Morning Post. The disease, caused by a coronavirus, spread to 17 regions and countries, afflicting 8,098 people with a death toll of 774.

Seventeen years later in 2020, China is again the epicentre of a global coronavirus epidemic, with almost 60 per cent of the world’s 131,627 confirmed cases of Covid-19 at last count. As the slowing economy struggles to maintain the current growth level in health spending, how China proceeds with the next phase of the country’s health care reforms will command the world’s attention, especially for investors looking for opportunities in a market that is expected to grow to 16 trillion yuan (US$2.3 trillion) by 2030.

Roberta Lipson, co-founder and chief executive officer of the Beijing United Family’s Hospital, with a newborn baby at what was then called Chindex International on 14 April 1999. Photo: SCMP

“Sars was a wake-up call to the government and the public in terms of [having] a system for prevention, and in [raising] public health awareness,” said Lipson, adding that the result was a big improvement in public hospitals, and a lot more transparency in public health data. “In the case of Covid-19, the government has given us excellent guidance, informed us what to do from the very beginning.”

The outbreak of Covid-19 has been a show case of what China learned from Sars. After an initial period of denial, the government moved quickly to quarantine an estimated 50 million people to contain the pathogen’s spread. No expenses were spared to build care facilities, famously completing a 1,000-bed hospital in 10 days.

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What has China’s public healthcare system learned from the twin coronavirus outbreaks of Sars and Covid-19?

China’s public-sector expenditure on health care increased almost 14-fold between the Sars outbreak in 2003 and the end of 2018 System is too “hospital-centric,” fragmented and volume-driven, according to a joint report by the World Health Organisation and World Bank

China’s public-sector expenditure on health care increased almost 14-fold between the Sars outbreak in 2003 and the end of 2018

System is too “hospital-centric,” fragmented and volume-driven, according to a joint report by the World Health Organisation and World Bank