Comparing Healthcare Systems: China vs New Zealand

This research report compares the healthcare systems of China and New Zealand, focusing on service delivery, health workforce, health information systems, and access to essential medicines.

Running head: GLOBAL HEALTH SYSTEMS
Global Health Systems
Name of the Student
Name of the University
Author Note

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Introduction
In the year 2015, the leaders of the world frame a new report stating the worldwide
goals. This report was named Sustainable Development Goals (SDGs) and the aim of this
report is to reduce poverty prevailing in the world and planet while ensuring prosperity for all
(United Nations, 2015). Within these goals, the principal focus is healthcare. A proper
understanding of the healthcare systems of different countries and their mode of functioning
is imperative for improving the health equality globally (World Health Organisations [WHO],
2010). Thus, the purpose of this research report is to compare and the healthcare system of
two countries. The selected country of choice is China and New Zealand. According to the
World Bank Group (2019), China is an upper middle-income country while New Zealand is a
extremely poor low income country.
As per the recent statistics published by the World Health Organization (WHO)
(2016), the total population of China is 1,411,415,000. Gross national income per capita of
China as per the statistics published in 2013 is $11,850. Life expectancy as per the data of
2016 is 75/78. Probability of dying under the age of five (per 1000 births in the year 2017) is
9. Probability of dying between the age group of 15 and 60 years (per 1000 population in the
year 2016) is 93/67. Total expenditure over the health management as per the 2014 data is
$731 and this amounts to 5.5% of the GDP. In China, the central government has main
responsibility for maintaining the national health legislation policy and administration. It is
guided by the principle that every citizen of China is entitled to enjoy basic healthcare
services under the local government. The main healthcare authorities in China include the
National Health and Family Planning Commission and Local Health and Family Planning
Commission. Generally, the health insurance is funded publicly and is financed by the local
governments. During the year 2014, China has spent 5.6% (appox) of its GDP (gross
domestic product) in health care insurance management. Central and the local government
financed 30% and 38% of it is publicly funded health insurance. There are three main types
of publicly funded health insurance in China named urban employment-based basic medical
insurance, urban resident basic medical insurance and the new cooperative medical scheme
designed for the rural citizens of China (The Commonwealth Fund, 2019).
In contrast to China, the total population in New Zealand as highlighted by the WHO
(2016) report is 4,661,000. Gross national income per capita as per the data is 2012 is $2012.

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Average life expectancy at the time of birth as per the 2016 statistics is 80/84 (male/female).
Probability of people dying under the age of five (per 1000 births) in the year 2017 is 5. The
probability of people in New Zealand dying between the age group of 15 to 60 years is 81/51
(male/female) in the year 2016. Total expenditure on the health per capita in the year 2014 is
$4018. Total expenditure on health in GDP in the year of 2014 is 11%. As per the report
published by the Reserve Bank of New Zealand (2018), New Zealand’s private insurance
sector is comparatively small as per the international standards. The insurance funded by the
government of New Zealand is mainly government by the Insurance Council of New
Zealand. It was established in the year 1895 and is the representative body of the fire and
general insurance in New Zealand. Apart from government support, there is continued public
support in setting the policy agenda and service requirement for the determining the publicly
funded annual health budget.
The principal public health system of both the country is sub-divided in to arts like
paediatric care, maternity care, elderly care and palliative care, mental health care and general
care (Brintnell, 2015). Through comparing the WHO health system, building blocks of the
service delivery, the health parameter of the workforce, health information systems, essential
medicines, financing, governance and leadership between China and New Zealand will be
compared. After comparison, similarities will be highlighted along with discrepancies
prevailing between the healthcare systems along with the ongoing challenges present within
each building blocks.
Method
The research was conducted over duration of four week by the use of keywords based
search of the literary articles in the search engines like ProQuest, Google Scholar, Medline
Embase, Scopus and Griffith University library. The keywords used for the search of the
articles was mainly focused on the WHO Health Systems Building Blocks words like “health
workforce”, “health system” with the name of the country like “China” and “New Zealand”.
The research approach used was a descriptive type data analysis procedure for the studies. A
clear exclusion of the criteria was used. For example, studies that are published before 2002
were not included in this comparative study. The inclusion criteria include reliable
methodologies and peer reviewed articles.

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Results
In describing and comparing the healthcare systems of China and New Zealand, six
WHO Health Systems Building Blocks were used for structuring the results.
Service Delivery
A strong healthcare system requires good service delivery approach (WHO, 2010).
Some dimensions that are used for the measurement of the service delivery include quality of
care, timeliness, accessibility (physical, social and financial), continuity of care, range of care
and proper availability of care (WHO, 2010). Under the Chinese healthcare perspective, it
can be said that China is reforming its path in healthcare finance as it is taking steps further
towards the Universal Health Coverage (UHC). Improvement in the finance equity is the
main policy goal of the healthcare system during progression towards the universal health
coverage. However, in spite of the initiatives taken by the government of China, the Chinese
healthcare financing system is not equitable in true grounds. Decreasing the proportion of the
indirect taxes might considerably help to improve the financing equity in the healthcare of
china. The flat-rate contribution might not be applicable for bringing equity in the public
health schemes of China and thus more attention must be given for the optimization benefit
packages during the China’s healthcare progression towards the UHC (Chen, Palmer & Si,
2017). As per the business review published by Dudek, Mitch, Chen, Tony and Zhang
(2004), the availbility and affordability of in Chinee healthcare system has declined mainly in
the rual areas as governemt has stopped providing free medical services since 1980s. From
the context of New Zealand, it can be said that medicines though available at a reasonable
rates but the overall accessibility of medicines to the people residing in the rural parts of New
Zealand is less. However, New Zealand goevrnment is at present taking active initiatives in
order to increase the accessibility of medicines to the poor people residing in New Zealand
like the aboriginals by providing medicines as subscidised rates(Babar, et al., 2012).
Moroever, accessibility of the hospitals in the rural or the remoate areas of the New Zealand
is less thus increasing health inquality and a gap in comprehensive service delivery in
healthcare. Though there are many public funded hospitals in New Zelands that offer
healthcare at a subsidisesed rate, the time travel towards the destination of hospital is long for
the people in the remote areas, the lack of proper transport further makes the overall
communication difficult for the population residing in the rural areas (Brabyn& Skelly,
2002). Thus in both the healthcare system there is a lack of comprehensive health care
access.

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Health Workforce
It is the second parameter for the measurement of the effectiveness of a healthcare
system (WHO, 2010). There is a direct relationship between the total number of
knowledgeable workforce resources present in the healthcare system and the presence of
motivated health workers. Both these factors help to increase the health outcomes of the
population (WHO, 2010). Under the context of the New Zealand (NZ) health care system,
Douglas et al. (2012) have highlighted that there is shortage of efficient and trained
workforce since 1980s. The administrators of the NZ healthcare system fail to take active
responsibiliti in recruiting trained yet efficienct work force. The poor financial condition of
the NZ is creating a barrier for the government to clear a standard salary for the healthcare
professionals and thus increasing the dearth of trained and efficient nurses, midwives,
paediatricins, utlra-sonographers, physiotherapists and other allied healthcare
professionals.Grigg and Tracy (2013) have stated that the NZ healthcare system is known for
a well-known maternity system and this have helped to reduce the number of the deaths
occurring at the time of delivery. This might be the reason behind reduced number of deaths
in NZ (5 deaths per 1000) with the age of 5 in comparison to that of China (9 deaths per
1000). The government of NZ is planning to increase funding in the maternity service surface
for the recruitment of trained midwives. China has visualised a sea change in the heathcare
sectors with the number of private hospirals are increasing (19 to 205) exponentially during
the tenure of 2001 to 2013. However, due to the better salary offered in the priavetly run
hospitals in China, there is a dearth in healthcare professionals in the public hospitals (Tang
et al., 2013). However, Chisense government is making active initiaves in order to increase
the number of the colleges for increasing the number of the doctors graduating per year. This
initiaves have helped to balance the crunch in the human resource and also helped to increase
the number of general practitioners in China (Hou et al., 2014). Thus from the above
discussions it can be concluded that the in NZ poor financial condition is causing dearth of
healthcar profesionals. Whereas in China the doctors are more inclined to the privately
funded hospitals in order to draw large salary. However, government of China is increasing
funding to increase the numbe rof graduating doctors and government of NZ in fnding for
trained midwives.
Heath Information Systems
As per the information stated in the WHO (2010), highlight that availability of the
health-related information to the doctors, nurses and the service user helps to increase the

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quality of care and awareness in disease management. Proper regulation of the privacy and
confidentiality of the health information system is also the duty of the government (WHO,
2010). The health care system of NZ is having introduced new security system in NZ in order
to improve the stringency of the health information systems and proper access of the heath
information. The baseline Health Information System (HIS) in NZ is used to keep a track of
the medical records, information security and other information related privacy
(Janczewski&Shi, 2002). The government of China governs the health information system in
China. The government of China gives the required funding in order to manage the healthcare
information system. At present, the government of China is taking active initiative in order to
improve the mobile-based technology for the promotion of the health information system.
The digital psychiatric services are the main revolution made by China in the healthcare
information technology (Li et al., 2014). However, Guo et al. (2014)are of the opinion the
though the government of China is taking active initiatives in health information system, the
elderly population in Chin is experiencing problems in the extensive adoption of the health
information technology. In New Zealand however, there is a lack of comprehensive access of
the health information system and this is mainly due to the lack of proper funding. Tis is
further creating a gap in the clinical governance (Gauld, Horsburgh, Brown, 2011). Thus it
can be said that China being a technological giant is far ahead than NZ in the effective
implementation of the healthcare information system.
Access to Essential Medicines
This is another important parameter of the healthcare system as highlighted in the
guidelines of WHO. Equitable access of medicines helps in procurement of the early
interventions and effective recovery of the disease. However, in order to increase the access
of the medicines, the medicines must be made available easily at a cost effective rate (WHO,
2010). From the perspective of the healthcare system of China, Barber et al. (2013) studied
have helped in understanding how the social insurance reform in China helped to bring a
revolution in the medicine availability in different parts of the country. The aim of the social
reform is to improve the basic medication framework model in China in order to ensure easy
access of medicines at cost effective expenses (Barber et al., 2013). Patel and Toossi (2016)
stated that China mainly favors the use of the traditional medicine like use of Ayurveda as
opposed to NZ. However, the healthcare protection model in the area of easy availability of
the medication elderly care population of China is deprived. Proper education of the mass and
improvement in the network based medicine delivery will help to improve the equitable

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access of medication among the population of China (Gu et al., 2014). From the healthcare
perspective of the general practitioner, operating in NZ the accessibility of medicines is less
among the poor people or the people residing in the remote areas. However, the medicines
are available at a cost-effective range. Gleeson, Lopert and Reid (2013) have said that
increase in the affordability of the medicines in NZ is attributable to New Zealand’s
Pharmaceutical Management Agency (PHARMAC). PHARMAC has taken active initiative
in order to generate innovative procurement mechanisms of medicines along with careful
evaluation of value of money. However, through the Tans Pacific Partnership Agreement
(TPPA) with US is seeking to decrease the therapeutic pricing of the medicines and has
appealed processes for pharmaceutical companies to challenge formulary listing along with
decision of price making. The TPPA is creating a barrier in affordable access of medicines in
the disadvantaged population of NZ like Maori and Pacific peoples. Thus in both China and
in NZ, government is taking active initiative in order to increase the affordability of
medicines but distribution of the medicines across all the population.
Financing
Health financing is another dimension for effective healthcare system and it involves
collection and allocation of money for ensuring the health needs of the population (WHO,
2010). Ashton (2005) reported lasts modification in NZ healthcare framework. Three latest
modifications in the healthcare of NZ include development of effective funding system for
the NZ healthcare. The costing of the health care system in NZ is divided in an age explicit
manner (Blakely et al., 2014). The main funding for the healthcare system in NZ is done both
the NZ government and other NGOs as NZ is resides under poor socio-economic bracket.
The government funding of NZ health care is known as Whanau-Centred Health and Social
Care service Delivery (Boulton, Tamehana & Brannelly, 2013). In China, the health system
reform was launched in the year 2000 and has helped to improve the coverage of the health
insurance. Chinese government have reduced the premium at a subsidized rate for the people
from the poor socio-economic background. However, this rapid increase in the public funding
to subsidize the health insurance in China as a part of the reform strategy, failed to mitigate
the out-of-pocket payment for the healthcare during the last decade. Financial burden in the
rural healthcare of China have increased is gradually getting worse. Better financial
protection for the vulnerable Chinese population is important in order to improve the health
equity in China (Long et al., 2013). Chinese government has government has taken initiative
to fragment the social healthcare schemes in order to increase the equitable access to the

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health care along with financial protection for the people covered by different health
insurance schemes in China (Meng et al., 2015).
Leadership and Governance
Effective leadership and governance is defined as an integral part of healthcare system
(WHO, 2019). Effective leadership is important for resource allocation, channelizing proper
funding and healthcare framework making. Effective leadership governs the primary
healthcare system of China and its main motto is to reduce the rate of occurrence of disease
both communicable and non-communicable. The primary healthcare leaders of China do
proper channelization of funding (Li et al., 2017). The health care leaders of China also focus
on the health care reforms from the administrative point of view. This helps to increase the
affordability of the healthcare (Ramesh, Wu and He, 2014). The healthcare reforms in China
is generated and implemented at the state level and this helps in environment and
demographic specific implementation of the healthcare reforms. The central government
healthcare leaders approve the reforms designed by the state level leaders. The role of the
central government leaders is to perform policy awareness across the population (Milar et al.,
2016). In NZ the effective leadership of the central government helps in implementation of
new modes of governance. There is less propensity in NZZ than in other small nations or
locales towards the process of centralization (Barnett et al., 2009). The role of the local
government leders in the NZ healthcare is to conduct the service performance measurement
and then is submitted to the big metropolis council (Breitbarth et al., 2010). Thus in China the
duty of implementation of the healthcare service reform is distributed among the state of the
local level leaders unlike in NZ where central government leaders do the main work.
Discussion
The ongoing challenges for integrating six building blocks in public health services
are higher in NZ in comparison to China. While the system of the Chinese healthcare is well-
funded and is organized, the funding of the NZ is poor also lacks a proper health care
framework. The important drawbacks of NZ health care, the main leadership management is
done by the central government and state government leaders are asked to monitor the
change. This creates a gap in demographic specific implementation of the healthcare reforms
and this creating healthcare inequality. In China state government leaders monitor the
healthcare epidemiology and different state level policy helps in overcoming the barrier of
person or demographic specific implementation of the healthcare reforms. However, the

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maternity care of NZ is much refined that China thus helping to reduce the number of death
at the time of time. The NZ government provides considerable funding in maternity and
pediatric care. In China, private funding of the healthcare is large, leading to a major shift of
the healthcare professional from public funded healthcare to privately funded healthcare. In
order to cope up with this China is trying to increase the funding of the healthcare education
in order to increase the healthcare graduates per year. Poor funding of NZ is creating a barrier
in order to increase the number of fresh graduate per year (Yip & Mahal, 2008; Ashton,
2005). In the domain of information and health technology, China is fare ahead of NZ.
Altharthi (2012) stated that in tele-health implementation, China is much superior to NZ. The
aboriginals like Maori residing in NZ and their poor healthcare awareness is creating a gap in
effective implementation of tele-health as a part of the healthcare information technology.
However, both the China and NZ scores in the domain of equitable service delivery and the
main victims of this inequitable service delivery are the people in residing in the remote or
rural areas. However, both the government is supply medicines at subsidized rates (Chalmers,
Ashton & Tenbensel, 2017). Nevertheless, the healthcare system of China tends to cover all
six building blocks of WHO in to their healthcare system and proper funding channelization
is the main reason behind their success.
Conclusion
Thus from the above comparative analysis, it can be stated that there are certain
similarities and discrepancies between the China and NZ healthcare system. The population
of China is much higher than the NZ. However, adequate funding given by the government of
China helps to implement an advanced quality healthcare. NZ though having less population
than China, the poor socio economic background is the reason behind high inequality.
However, in comparison to China (5%), NZ spends more GDP in health care (11%). In the
service, delivery grounds both the country lags behind for promoting comprehensive
healthcare access. In health workforce, management China is ahead of NZ because every year
it has higher number of doctors graduating along with standard funding in the private run
hospitals. NZ lack proper funding and thus limiting the access of the allied healthcare
professionals in the hospitals and decreasing the quality of care. In health information,
technology China is superior to NZ being a healthcare giant. Essential medicines both the
country try to provide medicine at an affordable rate but fails in equal distribution. In

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leadership and governance, China scores more than NZ as it has proper hierarchy of
leadership management in healthcare.
This paper has however, sudden limitations. The papers are selected from 2002 in
order to increase overall search results. However, taking research articles from 2002 have
limited the access of the latest information of healthcare system of China and NZ. Moreover,
due to restriction of the word count, the author failed to make extensive comparison between
the different sub-parts of six building blocks. Both the countries need to work in proper
implementation of health care and distribution of the healthcare resources in order to improve
the healthcare service delivery and to reduce the health inequality.

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Reflection
The summary of the literature and the research report, helped me in increasing by
knowledge base in the area of public health. While doing the report on public health I went
through the WHO six domains that critically define public health. This helped me to
understand how health care is related to financing, service delivery, human resource,
information health technology, medicines and effective leadership management. The biggest
barrier experienced by me while doing both the tasks was poor internet connectivity in the
remote areas. During the night, when I was planning to conduct some rigorous research or to
want a lecture video, I encountered poor internet connectivity. This poor internet connection
disrupted my work planning, increased my time for conducting the research and also
hampered by level of concentration. Writing the discussion and the conclusion portion was
the second challenging task for me. At first I was unable to differentiate the content
requirement of the discussion and conclusion. I went through few samples files of my seniors
and this helped me to understand the narrative the required content under the discussion and
in the conclusion portion of the report. Search public health data was very time consuming,
ach time I need to validate the data with the governmental site of both the countries in order
to strengthen the evidence of my research.
Within the task, writing separately for six different building blocks and arranging
proper evidences against each of the building block was difficult and all of them are
interconnected. For example, service means equitable access at subsidized rate. However,
lack of proper financial resources and funding of the country lack equitable access of
resources. This finance resource again coincides with the funding milestones of the WHO
public health parameter. I also understood that there is no single answer to create or run an
effective healthcare system as the demography of each country is different from another.
Proper management of the confounding variable of each country as per the demographic
requirement will help to improve the quality of the healthcare system.
Assessment task 2a was helpful for me to understand the process of conduction of
search of the literary articles from the electronic database. I used keywords along with filter
in the year in order to refine the research. This was a group task. In the second task, this an
individualized task where we are asked to write review. Working in groups helped to increase
my overall knowledge based, effective communication skills and management of conflict.

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While working individually, I learnt how to complete the work on time, within the deadline
by setting proper plan before hand. The overall experience of conduction of the both the tasks
were very fulfilling. I enjoyed doing both the tasks. It helped me to improve my writing
skills. It also helped me to understand the different demographics of different countries like
China and NZ and how their healthcare system is designed.

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GLOBAL HEALTH SYSTEMS