Comparing Healthcare Systems: China vs New Zealand
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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.
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Running head:GLOBAL HEALTH SYSTEMS Global Health Systems Name of the Student Name of the University Author Note
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GLOBAL HEALTH SYSTEMS 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 uppermiddle-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.
GLOBAL HEALTH SYSTEMS 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 theReserve 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.
GLOBAL HEALTH SYSTEMS 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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GLOBAL HEALTH SYSTEMS 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
GLOBAL HEALTH SYSTEMS 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
GLOBAL HEALTH SYSTEMS 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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GLOBAL HEALTH SYSTEMS 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
GLOBAL HEALTH SYSTEMS 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
GLOBAL HEALTH SYSTEMS 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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GLOBAL HEALTH SYSTEMS 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.
GLOBAL HEALTH SYSTEMS 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.
GLOBAL HEALTH SYSTEMS References Altharthi, M. S. (2012). Telehealth practice in eight countries: New Zealand, Australia, the USA, Canada, UK, Malaysia, China and India: a thesis presented in partial fulfillment of the requirements of degree of Master in Information Science atMassey University, Albany campus, Auckland, New Zealand(Doctoral dissertation, Massey University). Ashton, T. (2005). Recent developments in the funding and organisation of the New Zealand health system.Australia and New Zealand Health Policy, 2. doi: org/10.1186/1743- 8462-2-9 Babar, Grover, Piyush, Butler, Rachael, Bye,…. & Janie. (2012). A qualitative evaluation of general practitioners' perceptions regarding access to medicines in New Zealand. British Medical Journal, 2(2). Retrieved from https://search-proquest- com.libraryproxy.griffith.edu.au/docview/1783579451?https://search.proquest.com/ central&pq-origsite=summon Barber, S.L., Huang,B., Santoso,B., Laing,R., Paris,V. & Wu,C. (2013). The reform of the essential medicines system in China: a comprehensive approach to universal coverage.Journal of Global Health, 3(1). doi: 10.7189/jogh.03.010303 Barnett, P., Tenbensel, T., Cumming, J., Clayden, C…& Burnette, M. (2009). Implementing new modes of governance in the New Zealand health system: An empirical study. Health Policy,93(2), 118-127. Retrieved from https://www-clinicalkey-com- au.libraryproxy.griffith.edu.au/#!/content/1-s2.0-S0168851009001602 Blakely, T., Atkinson, J., Kvizhinadze, G., Nghiem, N., McLeod, H., Wilson, N. (2014). Health system costs by sex, age and proximity to death, and implications for estimation of future expenditure.Journal of the New Zealand Medical Association, 127(1393), 12-25. Available at http://journal.nzma.org.nz/journal/127-1393/6105/ Boulton, A., Tamehana, J., & Brannelly, T. (2013). Whanau-centred health and social service delivery in New Zealand.Mai journal,2(1), 18-32. Retrieved from: http://journal.mai.ac.nz/sites/default/files/Vol%202%20(1)%20024%20Boulton.pdf
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GLOBAL HEALTH SYSTEMS Brabyn, L. & Skelly, C. (2002). Modeling population access to New Zealand public hospitals.International journal of health geographics. Retrieved from https://ij- healthgeographics.biomedcentral.com/articles/10.1186/1476-072X-1-3 Breitbarth, T., Mitchell, R. & Lawson, R. (2010). Service performance measurement in a New Zealand local government organization.Science Direct. 53(4), 397- 403. doi:10.1016/j.bushor.2010.03.004 Britnell, M. (2015b). In search of the perfect health system (pp. 102-105). Basingstoke: Palgrave Macmillan. Retrieved April 25, 2017, from http://ebookcentral.proquest.com.libraryproxy.griffith.edu.au/lib/griffith/detail.action? docID=4763103 Chalmers, L.M., Ashton, T. & Tenbensel, T. (2017). Measuring and managing health system performance: An update from New Zealand. Health Policy, 121(8), 831-835. Retrieved from https://www-clinicalkey-com-au.libraryproxy.griffith.edu.au/#!/content/1-s2.0- S0168851017301501?scrollTo=%23hl0000370 Chen, M., Palmer, A. & Si, L. (2017).Improving equity in health care financing in China during the progression towards Universal Health Coverage.BMC Health Services Research, 17(1), 1-8. doi: 10.1186/s12913-017-2798-7 Douglas, B. (2012). Health Workforce, The New Zealand medical journal, 125(1355). Retrieved from https://search-proquest-com.libraryproxy.griffith.edu.au/docview/1034435889? https://search.proquest.com/central&pq-origsite=summon Dudek, Mitch, Chen, Tony &Zhang, O.X. (2004). Keeping China Healthy.The China Business Review, 31(6),18-24. Gleeson, D., Lopert, R., & Reid, P. (2013). How the Trans Pacific Partnership Agreement could undermine PHARMAC and threaten access to affordable medicines and health equity in New Zealand. Health Policy, 112(3), 227-233. https://doi.org/10.1016/j.healthpol.2013.07.021 Grigg, C. P., & Tracy, S. K. (2013).New Zealand's unique maternity system. Women and Birth, 26(1), e59-e64.
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GLOBAL HEALTH SYSTEMS Ramesh, M., Wu, X. and He, A.J. (2014). Health governance and healthcare reforms in China.Health Policy and Planning, 29(6), 663–672. doi: org/10.1093/heapol/czs109 Reserve Bank of New Zealand. (2018). New statistics on the insurance sector: The China Health Care System . Access date: 30th May 2019. Retrieved from: https://www.rbnz.govt.nz/news/2018/02/new-statistics-on-the-insurance-sector Tang, C., Zhang, Y., Chen, L. & Lin, Y. (2013). The growth of private hospitals and their health workforce in China: a comparison with public hospitals.Health Policy and Planning, 29(1), 30-41.doi: 10.1093/heapol/czs130 The Commonwealth Fund. (2019).International Healthcare Systems Profiles: The New Zealand Health Care System. Access date: 30th May 2019. Retrieved from: https://international.commonwealthfund.org/countries/new_zealand/ The Commonwealth Fund.(2019).International Healthcare Systems Profiles. Access date: 30th May 2019. Retrieved from: https://international.commonwealthfund.org/countries/china/ The World Bank. (2019).The World Bank in China. Access date: 30th May 2019. Retrieved from: https://www.worldbank.org/en/country/china/overview The World Bank. (2019).The World Bank in New Zealand. Access date: 30th May 2019. Retrieved from: https://data.worldbank.org/country/new-zealand?view=chart World Health Organisation. (2010).Monitoring the building blocks of health systems: A handbook of indicators and their measurement strategies. Retrieved April 26, 2017, from http://www.who.int/healthinfo/systems/WHO_MBHSS_2010_full_web.pdf World Health Organisation.(2016).New Zealand Statistics.Access date: 30th May 2019. Retrieved from: https://www.who.int/countries/nzl/en/ World Health Organisation.(2019).China Statistics. Access date: 30th May 2019. Retrieved from: https://www.who.int/countries/chn/en/ Yip, W. & Mahal, A. (2008). The Health Care Systems of China and India: Performance and Future Challenges.Health Affairs, 27(4), 921-932. doi: 10.1371/journal.pone.0201887
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