中国医療制度への激震/中国医療事情

 中国のセレブの妊娠写真を狙うパパラッチがしばしば United Family Hospitals 近くで潜伏する。
画像 特別な医療を求める中国のエリート層を目標にして、いかにして厳しく統制された中国の医療制度に外国の企業が入り込むかという点については多くのストーリーがある。Chindex International は、多数の海外駐在員と裕福な中国人の需要を満たすために、北京、上海、および広州で西欧型病院とクリニックを開いた。外国人医師と中国のエリート医師を配置し、1回の受診で数百ドルの料金である。中国国有病院が10-20ドルであるのに比べ多くの中国人にとっては極めて高額で一般人の月給に相当する。中国政府命令で、収益の10-30%を地域の中国のパートナーと共有する。会社は事業の売上の半分を医療用製品に依っているが、病院とクリニックが事業拡大の中心的な牽引車となっている。United Family Hospitals は外国資本の医療事業で中国のシェアを独占しているという。
 多くの手段で、中国政府は国民のために強い医療を提供している。病院は安価で良質のスタッフと十分な薬剤を配備している。しかし、流れ作業的な治療をする。多くの患者が列をなす大部屋で治療を受けたり、他の患者が見ている前で超音波検査を受けたりする。
 近年、北京の国立の中日友好病院のようにな裕福な病院は支払能力にかかわらず誰でも同じ治療をするシステムをとろうと努めてきた。ますます増加する中国の患者に対し新たな勢力を作り始め、Chindexの金持ち相手のプレミア治療に対して脅威となっている。
 Chindexは、International SOS, Global HealthCare, ParkwayHealth といったグローバルな医療企業による競争にも曝されている。
 増大する中国の上中流階級をターゲットにして、2010年に北京と広州の病床を3倍にする計画がChindexにより進んでいる。本物のグッチを買うのが好きな中国の消費者へのサービスを指向しているという。
 しかし、こうした拡大には、中国に事実上存在しない私的な医療保険の発展に依存している。Chindexの医療は国営の保険ではカバーされず、外国人患者は国際的な医療保険が使用できるが中国人は自費診療である。全ての施設が利用できる保険があれば中国人患者が増大するだろう。
 2006年に政府認可の中国の保険会社は包括的に使える中国で最初の医療保険パッケージを実験的に提供し始めた。しかし、年間のプレミア料金は5,000ドルであり、中国人には高額すぎる。
 今月初め、Chindexの270万ドルの第4四半期損失に続いて、約30パーセント株価を下げ、投資家はChindex株から撤退した。為替差損や、政府取り締まり強化による輸入機器売買の遅れと損失があった。しかし、毎期の収益は40%増、年間収益は1億3010万ドルと23%増加した。株価は再び上昇している。
 1981年に、Chindexは、西洋の輸入医療機器を開拓して、中国の新しく開いた経済に入る少数の会社の1つだった。1997年に、Chindexは私的で営利の医療を導入した。
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健康中国2020計画/中国医療事情
http://kurie.at.webry.info/200806/article_30.html
中国の医療事情
http://kurie.at.webry.info/200707/article_3.html
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Shaking Up China's Medical System
Bethesda Firm Breaks Into New Market With Western-Style Hospitals Catering to Wealthy
http://www.washingtonpost.com/wp-dyn/content/article/2008/06/22/AR2008062201742.html

Chindex CEO Roberta Lipson said it was her "moral imperative" to help improve health care in China. (By Lois Raimondo -- The Washington Post) Buy Photo

By Kendra Marr and Ariana Eunjung Cha
Washington Post Staff Writers
Monday, June 23, 2008; Page D01

Paparazzi looking to snap photos of China's pregnant rich and famous often lurk near United Family Hospitals.

"In a way it's great soft advertising for us," said Roberta Lipson, co-founder and chief executive of Chindex International, the Bethesda company that runs the facilities.

And, in a way, it speaks volumes about how a foreign company is breaking into the heavily regulated Chinese health-care system by targeting the elite, who are willing to pay premium prices for premium care. Chindex has opened Western-style hospitals and clinics in Beijing, Shanghai and Guangzhou to cater to affluent expatriates and wealthy Chinese. Staffed by foreign doctors and some of China's top physicians, its fees -- as much as several hundred dollars for a single visit, compared with just $10 or $20 at a state-owned hospital -- are too high for most Chinese, who make that much in a month. Under Chinese government mandate, United Family Hospitals share 10 to 30 percent of their revenue with local Chinese partners.

While the company devotes half of its business to selling medical products, its exclusive hospital and clinic services are becoming the core vehicle for its expansion, as well as the target of competitors. United Family Hospitals are among the few foreign-invested medical institutions in China, and they have the "lion's share" of the market, said Cao Yanlin, a researcher at the China Academy of Medical Science and Peking Union Medical College.
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By many measures, China offers strong medical care for its citizens. Its hospitals are inexpensive, well-staffed and well-stocked with pharmaceuticals.

But they treat patients with an assembly-line mentality. Patients often receive treatment in massive rooms packed with rows of wheelchairs. Even procedures like sonograms are conducted with little privacy, with other patients in the same room looking on.

In recent years, some wealthier hospitals, such as the government-run China-Japan Friendship Hospital in Beijing, have sought to shake the system of treating everyone the same regardless of how much they pay. They have creating new wings for more affluent Chinese clients, threatening Chindex's hold on premium care for the rich.

Chindex faces additional competition from better-known clinics that also target business and diplomatic expatriates, such as those operated by internationally focused firms like International SOS, Global HealthCare and ParkwayHealth.

To expand its patient pool beyond the Western expatriate community, who fill a majority of United Family Hospitals beds, Chindex plans to open hospitals in Beijing and Guangzhou in 2010 that are three times larger and employ an all-Chinese staff. The target: China's growing upper and middle classes.

"We're aiming our services to the Chinese consumer that likes to buy a Gucci bag -- a real Gucci bag," said Lawrence Pemble, Chindex's chief financial officer.

But this expansion also depends on the development of private health-insurance products, which are practically nonexistent in China. Chindex visits are not covered by China's state-run insurance. Chinese pay out of pocket, while foreign patients are typically covered under international insurance policies. An insurance product that would cover some or all visits to Chindex facilities would significantly increase the number of Chinese patients, analysts said.

The company, with government approval and a Chinese insurance underwriter, in 2006 launched a pilot program offering China's first comprehensive medical-insurance package so that large multinational corporations could offer the same health-care benefits to all employees, both local and expatriate. But the annual premium of about $5,000 per person per year is too expensive for most locals, said analyst Julie Chen of CRT Capital Group.

Lewis Fan, an analyst with Brean Murray Carret & Co., questioned whether wealthy Chinese are willing to pay top-dollar for health care.

"I have my reservations whether they can get away with that kind of pricing," Fan said.

Earlier this month, following Chindex's $2.7 million fourth-quarter loss, investors backed away from Chindex stock, sending shares down nearly 30 percent to $6.17 that day. The company blamed the loss on one-time interest charges that it gained when it converted a J.P. Morgan bond that quarter and foreign exchange adjustment.

Its medical products division has experienced losses over the past three years caused by delays in product approvals from the Chinese government and the government's recent crackdown on imports that has caused many would-be equipment purchasers to stop buying.

Yet, the company's quarterly revenue rose 40 percent, to $34.6 million, and revenue for the year rose 23 percent, to $130.1 million. The stock has begun to climb again.

U.S. analysts credit the strong health-care services market.

"We expect China's healthcare environment will continue to grow as the Chinese government increases its healthcare spending budget in order to improve the quality of healthcare for the overall 1.3 billion population," Chen wrote in a research note.
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Analysts and Chindex officials pointed to other factors that could help the company: pending regulatory approval of advanced robotic surgery tools, China's baby boom and Chindex hospitals' strict privacy rules.

Though competition is mounting, analysts doubt Lipson's influence in China is about to wane. She is one of the few entrepreneurs to navigate China's heavily regulated world of health care.

"What was available was so inadequate," Lipson said. "It was my moral imperative, something I just had to do."

In 1981, Chindex was one of the few companies to enter China's newly opened economy, pioneering importing Western medical equipment. In 1997 Chindex introduced private, for-profit health care.

"A lot of people have tried and it didn't work," Fan said. "But she succeeded."

Cha reported from Shanghai. Researcher Wu Meng in Shanghai contributed to this report.

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