To the Editor: The otherwise excellent article by Blumenthaland Hsiao (Sept. 15 issue)1 overlooks three critical pointsregarding Western medicine in China. First, institutions suchas ours serve as points of introduction for concepts such asinfection control, pain management, peer review, palliativecare, evidence-based medicine, quality control, and even primarycare — this last being arguably the most cost-effectiveway of dealing with emerging diseases of industrialization andurbanization, as documented in the same issue of the Journal.2I can personally vouch for ample experiences of this phenomenonduring the severe acute respiratory syndrome epidemic, and itis also evident in the ongoing regular visits of groups of hospital,medical, and nursing directors.
Second, that a small but growing minority of Chinese patientshas access to compassionate and patient-centered care, adequatepain relief, and treatment with clean instruments should notbe a point of indignation. The goal is to find a way to deliverthe same standard of care to every patient. Finally, to dismissChinese physicians' access to advances in technology deniesthe scientific contribution of this highly skilled and talentedgroup to the global understanding and progress of health andillness.3
Artin Mahmoudi, M.D. United Family Hospitals and Clinics Beijing 100016, China
References
Blumenthal D, Hsiao W. Privatization and its discontents -- the evolving Chinese health care system. N Engl J Med 2005;353:1165-1170. [Free Full Text]
He J, Gu D, Wu X, et al. Major causes of death among men and women in China. N Engl J Med 2005;353:1124-1134. [Free Full Text]
Hou FF, Zhang X, Zhang GH, et al. Efficacy and safety of benazepril for advanced chronic renal insufficiency. N Engl J Med 2006;354:131-140. [Free Full Text]
The authors reply: Dr. Mahmoudi suggests that private, investor-ownedhospitals in China play an important part by introducing newforms of technology and approaches to service and by meetingthe demands of a "growing minority" of affluent Chinese. However,the growth of a for-profit sector serving a society's eliteleads inevitably to inequalities in service. The single greatestproblem facing the Chinese health care system is how to reduceinequities by providing all citizens with basic protection againstthe cost of services and by making services of adequate qualityavailable throughout the country's vast expanse. Furthermore,Dr. Mahmoudi assumes that an investor-owned sector that providesservices modeled on the care provided in Western countries willnecessarily be more efficient than that provided in the mainstreamChinese sector. That assumption remains to be tested. Certainly,experience with high-technology medicine in the United Statessuggests that it is plagued with inefficiencies related to theoveruse of services. The struggling Chinese health care systemcan ill afford to replicate the inefficiencies found in muchmore affluent Western health sectors.
David Blumenthal, M.D., M.P.P. Massachusetts General Hospital Boston, MA 02114
William Hsiao, Ph.D. Harvard School of Public Health Boston,MA 02115
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