Spring 2001; Volume 2, Number 1
Health Care in Tibet: Clinical and Policy Perspectives (Cont.)
page 1 | page 2
Many people, however, are not yet enrolled in the CMS system that has been implemented within the last year. Moreover, unless a person is elderly, disabled, poor, orphaned, or has a family member that served in the military, everyone is expected to pay. For those people living in the larger cities, enrollment will not be difficult and education about the new health system will be possible. However, in the rural areas, however, implementation of this system will be difficult. In many rural areas, people have more than eight children and will not be able to afford to enroll the entire family. It will also be difficult to educate the people in the villages about how the system works and what they will get in return for their money.
As a result, most people cannot afford basic medical care at present. Patients wait until they are quite sick before they seek medical attention, and at this point, care becomes prohibitively expensive. For city dwellers, services and medications are available but often not affordable. In the rural areas, patients too sick to be treated by the township or village doctor have to find affordable transportation to the closest county or prefectural health facility. Tibetan transportation, however, is unreliable, difficult to find, and often unaffordable. Once at the hospital, most villagers will not be able to pay the required 1,000RMB deposit, not to mention the final cost for care and medications.Accessibility
As indicated above, access to health care is possible in the cities, but in the rural areas is most difficult. Patients who require care beyond that which is provided at the local level are often carried to cities on yaks or in vehicles that are passing by. It is often much too expensive for these individuals to afford transportation, let alone the bills they will acquire when they arrive at the city hospitals.Equity
The system, mainly as a result of accessibility issues, is clearly inequitable. Those poeple that can pay for more and have the means to be transported to better facilities clearly have access to better health care. This holds true for the diagnosis and treatment of pulmonary diseases. The diagnosis of TB, asthma and cancer is under-diagnosed everywhere in Tibet, but especially in the rural areas. At the village and township levels, the doctors do not have the facilities or the ability to recognize these respiratory diseases. And if they do happen to make proper dianoses, they have very few means to adequately treat their patients.Problems and Recommendations
Problems to Address
There are a vast number of problems in the Tibetan health care system that are preventing citizens from obtaining adequate medical care, especially for the treatment of pulmonary diseases. Changes in the overall structure of the system as well as in the policies that govern this structure are needed to provide sufficient medical services. In addition, changes at the clinical level are critical to improving patient care. The following is a focused list of problems that deserve immediate attention.
Under ideal circumstances the most salient issues could be addressed simultaneously. With limited time, money and resources, however, not all of the problems I've discussed will likely be eliminated in the near future. The following is a list of recommendations that are needed to help bring better health care to Tibet.
Since the Chinese Cultural Revolution, Tibet, like other parts of China, has been changing rapidly. The health care system is one area where these changes are very apparent, and where the system is currently in a state of disorganized flux. As one might expect, a shift of this measure is often fraught with difficulties, predictable and otherwise. However, when a component of society so fundamental as health is affected, steps must be taken to minimize harm and encourage rapid change that will benefit the people. There is no doubt that the intention of the Chinese government is to bring Tibet closer to Western Medicine and thereby improve the overall health status of the country. But during this time of transition, the Tibetan health care system is functioning poorly.
Progress has been made in some areas, but improvements are badly need in other areas. The new system of financing through the CMS should, to some extent, help resolve some of the basic issues of affordability and equity. Yet, the issue of deficient physician education and training, is not being addressed. Without some serious consideration of this critical issue, which I see as most critical of all, health care in Tibet will not improve. An uneducated doctor is as ignorant as an uninformed patient, and the combination is lethal. For improvement to occur, it is imperative the medical and public health communities recognize the extent of this problem and find solutions that will impact not only Tibet, but also other communities and nations who are facing some of the very same problems.page 1 | page 2
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