6 List of selected 1,000 Hospitals

Tables and Figures

Hospital System and Medical Equipment Market

1 China's Public Health System

1.1 Administrative System for Hospitals

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1.1.1 Three levels

China's healthy care institutions are managed according their grades. Ministry of Health (MOH) leads the healthy work of the whole nation, and responsible for formulating healthy regulation and policy as well as state program of healthy undertakings.

Local Health Bureaus of provincial governments and county governments are responsible for healthy work belonging to oneself region, and report regularly conditions of healthy reform and development to local People's Congress.

MOH began to formulate and issue judging and examining regulations of managing hospitals according to their grades in 1993, and at present China has possessed 29 ¡°Committees of Judging and Examining on Hospital¡± in grades of province, and they have judged and examined 17,708 hospitals, of which Class A hospitals take 56.79 percent.

1.1.2 Five Categories

Chinese Hospitals can be classified into following five kinds:

1. Hospitals of public health system

   Including the hospitals under the leadership of Ministry of Health or Health Bureaus of local governments at provincial or county level.

2. Military hospitals

Figure 1 Military hospital System

5. Hospitals funded by Ministries

   The hospitals founded and managed by Ministries or State Bureaus of metallurgy, electricity, machinery, aviation, post and telecommunication, nuclear industry, coal , civil affairs and etc.

6. Private, share holdings and Sino-foreign J.V. hospitals

7. Hospitals affiliated to medical education and research institutes

1.2 Ministry Of Health Of China

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1.2.1 Minister and vice ministers

Minister: Zhang Wenkang

Vice Ministers: Wang Longde, Yin Dakui, Cao Ronggui, Peng Yu,

Number of Stuff: 225

Address: No.44 Houhai Beiyan, Xicheng District, Beijing

Phone: 8610-64076100

Fax: 8610-64012369

Post Code: 100725

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1.2.2 Functions of the Ministry

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1. Studying and promulgating laws, regulations as well as policies of guiding line in healthy work; setting up the strategically target in healthy undertaking; enacting technical standards and healthy standards.

2. Studying and making plans and policies for development of regional health, rural health and maternity and child care; adjusting the distribution of resources;

3. Enacting the preventive treatment project of disease; organizing integrated control of important disease; publishing the name list of infectious disease of quarantine and monitoring infectious disease.

4. Directing the reform of medical organizations, enacting standards of profession and the standards of medical service quality.

5. Supervising and managing blood collection.

6. Studying and drawing up the developing project of medical science and technology.

7. Supervising and managing the preventive care of infections disease; enacting the quality standards for foods and cosmetic products.

8. Enacting the developing project of healthy experts training; drawing up the organizational standards for healthy organizations and the standards for medical worker qualifications.

9. Organizing and directing the international cooperation in public health areas.

10. Controlling the spreading of rapidly happened epidemic disease.

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¡¡ 1.2.3 Departments of the Ministry

1. General Office
2. Human Resources Bureau
3. Planning and Finance Bureau
4. Public Health Regulatory Bureau
5. Maternity and Child Care Bureau
6. Public Health Institutions Administrative Bureau
7. Diseases Prevention and Control Bureau
8. Science, Technology and Education Bureau
9. International Cooperation Bureau

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1.2.4 Key Decision-makers of the Ministry

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Table 1 Key Decision-makers of Ministry of Health of China

Name	Position	Department	Phone Number
Zhang Wenkang	Minister	¡¡	64018645
Wang Longde	Vice-Minister	¡¡	64012330
Yin Dakui	Vice-Minister	¡¡	64012371
Cao Ronggui	Vice-Minister	¡¡	64033120
Peng Yu	Vice-Minister	¡¡	64015651
Zhu Qingsheng	Vice-Minister	¡¡	64012358
Li Hongshan	Deputy Director	General Office	64076800
Liu Xinming	Director	Planning and Finance Bureau	64011602
Qi Xiaoqiu	Director	Public Health Regulatory Bureau	64074620
Li Changming	Director	Maternity and Child Care Bureau	64015611
Wu Mingjiang	Director	Public Health Institutions Administrative Bureau	64012889
Wang Zhao	Director	Diseases Prevention and Control Bureau	64015605
Qi Guoming	Director	Science, Technology and Education Bureau	64033114

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1.3 Provincial Health Bureaus and Key Decision -Makers

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Table 2 Key Decision-makers of Provincial Health Bureaus

Provincial Health Bureau	Director	Address	Post Code	Phone Number
Beijing	Zhu Zonghan	No.2 Huaibaishu St. Xuanwu District, Beijing	100053	010 63039025
Tianjin	Zhang Yu	No.98 Nanjing Rd. Heping District, Tianjin	300040	020 23317527
Shanghai	Liu Jun	Hankou Rd. Shanghai	200002	021 63212410 - 205
Hebei	Hu Jingran	No.6 Hezuo Rd. Shijiazhuang, Hebei	050051	0311 7045942
Shanxi	Zhao Zhenhuan	No.23 Donghuamen, Taiyuan City, Shanxi	030013	0351 3070951
Inner Mongolian	Hasi Bagen	No.6 East Zhongshan Rd. Hohhot, Inner Mongolian	010020	0471 6925678
Liaoning	Ma Xiaowei	No.82 South Heping St. Shenyang City, Liaoning	110005	024 23389499
Jilin	Chi Daming	No.47 Sidalin Dajie, Changchun City, Jilin	130051	0431 2725699
Heilongjiang	Song Zhaojin	No.47 Minyi St. Harbin City, Heilongjiang	150001	0451 3637310
Jiangsu	Zhou Min	No.42 Zhongyang Rd. Nanjing City, Jiangsu	210008	020 3374343
Zhejiang	Li Lanjuan	No.634 Qinggongchun Rd. Hangzhou City, Zhejiang	310006	0571 7077551
Anhui	Dai Guangqiang	No.85 Changjiang Rd. Hefei City, Anhui	230001	0551 2601937
Fujian	He Ming	No.61 Guping Rd. Fuzhou City, Fujian	350003	0591 7853183
Jiangxi	Zhou Biao	No.2 Beijing Rd. Nanchang City, Jiangxi	330046	0791 6213595
Shandong	Wang Tianrui	No.1 East Qingnian Rd. Jinan City, Shandong	250011	0531 2956921 - 2803
Henan	Liu Quanxi	No.45 Weiwu Rd. Zhengzhou City, Henan	450003	0371 5953488
Hubei	Wang Zongxian	No.165 Donghu Rd. Wuchang, Wuhan City, Hubei	430077	027 87821791
Hunan	Zeng Fanyou	No.16 Beizhan Rd. Changsha City, Hunan	410008	0731 4471720
Guangdong	Huang Qingdao	No.17 South Xianlie Rd. Guangzhou City, Guangdong	510060	020 83820675
Guangxi	Wang Rongci	No.35 Taoyuan Rd. Nanning City, Guangxi	530021	0771 2800430
Hainan	Jian Liangsheng	No.42 Haifu Rd. Haikou City, Hainan	570203	0898 5340207
Chongqing	Li Xianglong	No.234 Renmin Rd. Yuzhong District, Chongqing	400015	023 63852716
Sichuan	Zhuo Kaixing	No.80 West Wenmiao St. Chengdu City, Sichuan	610041	028 6646924
Guizhou	Li Jiahu	Bldg.5 Province Government, Bageyan, Guiyang City, Guizhou	560004	0851 6860374
Yunnan	Yao Huibin	Bldg.2 East, Wuhuashan, Kunming City, Yunnan	650021	0871 3137492
Tibet	Tudeng	No.248 West Beijing Rd. Lasa City, Tibet	850000	0891 6836631
Shaanxi	Liu Aimei	No.34 Lianhu Rd. Xi'an City, Shaanxi	710003	029 7319392
Gansu	Liang Shizhang	No.63 Changjia Xiang, Chengguan District, Lanzhou City, Gansu	730030	0931 8825811
Qinghai	Yu Lixuan	No.66 West St. Xining City, Qinghai	810000	0971 8233739
Ningxia	Ma Yuzhang	No.37 Jiefang Dajie, Yinchuan City, Ningxia	750001	0951 6042221
Xinjiang	Yasen Tuersun	No.66 Longersi, Urumqi City, Xingjiang	830001	0991 2824211

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1.4 State Drug Administration

1.4.1 Director and deputy directors

Director: Zheng Xiaoyu

Deputy Directors: Shao Mingli, Ren Dequan

Number of Stuff: 120

Address: 38A, Beilishi Rd. Xicheng District, Beijing

Phone: 8610-68316825

Fax: 8610-68310909

Post Code: 100810

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1.4.2 Functions

The State Drug Administration is responsible for administrative supervision and technological supervision of the R&D, production, distribution and application of medicines (including Chinese traditional medicine, chemical materials and their preparations, antibiotics, bio-chemical medicines, biological products, diagnostic agents, radioactive medicines, narcotic medicines, toxic medicines, psychiatric medicines, medical apparatuses and instruments, hygienic materials and medicine packaging materials, etc.). Its main responsibilities are as follows:

1. Formulation and revision of laws and regulations on administration of medicines and supervision of their implementation.

2. Formulation, revision and promulgation of legal standards of medicines and formulation of the State's basic medicines catalogue.

3. Registration of new medicines, imitated production of medicines, importation of medicines and protection of varieties of Chinese herb medicines. Organization for establishment of the non-prescription medicine system and examination and promulgation of the non-prescription medicine catalogue. Re-evaluation of medicines, monitoring and testing of negative reactions and the examination and approval of clinical experiments, clinical pharmacological bases and medicines to be weeded out.

4. Formulation, revision and promulgation (being authorized) of legal standards of medical apparatus and instruments and formulation of classified products catalogues for administration; registration of imported medical apparatuses and instruments as well as clinical experiment bases; issuing registration certificates and production permits for medical apparatuses and instruments. Certification of quality systems and products safety for medical apparatuses and instruments.

5. Formulation and revision of administrative specifications of medicines production quality, operation quality, and the management of preparations of medical institutions, and supervision of their implementation.

6. Formulation and revision of administrative specifications of non-clinical research quality and clinical experiment quality and supervision of their implementation.

7. Supervision, testing and sample-testing the quality of medicine production and operation and the quality of medicines of medical institutions and issuing the State's Bulletin of Medicine Quality, as well as punishing those who produce and sell spurious and poor medicines for administration of the market of Chinese herbs medicines.

8. Examination of medicines advertisement, administrative protection of medicines and giving instructions to medicine-inspection agencies of the country as a whole.

9. Supervision and administration of narcotic medicines, psychiatric medicines, and radioactive medicines, as well as special medicines and apparatuses.

10. Implementing the authentication system for medicines wholesale and retail business and formulation of rules for buy and sale of prescription medicines, non-prescription medicines, Chinese traditional medicine crops and Chinese medicine material, crude slices.

11. Formulation of qualification system for practicing pharmacists (incl. Practicing pharmacists of Chinese medicines) and giving directives for examination and registration of practicing pharmacists (incl. Pharmacists of Chinese medicine).

12. Carrying out the State's policy on the medicine industry in coordination with macro-controlling organs by means of administration and supervision.

13. Organization and direction of exchange and cooperation with foreign governments and international organizations in the aspects of medicines administration and supervision.

1.4.3 Departments

1. General Office

2. Medicines Registration Bureau

3. Medical Equipment Bureau

4. Safety Supervision Bureau

5. Market Supervision Bureau

6. Human Resource Bureau

7. International Cooperation Bureau

1.4.4 Key Decision-makers

Table 3 Key Decision-makers of the State Drug Administration

Name	Position	Department	Phone Number
Zheng Xiaoyu	Director	State Drug Administration	68313344ext 0902
Shao Mingli	Deputy Director	State Drug Administration	ext 0601
Ren Dequan	Deputy Director	State Drug Administration	ext 0905
Cao Wenzhuang	Director	General Office	ext 0909
Zhang Shiju	Director	Medicines Registration Bureau	ext 0401
Hao Heping	Director	Medical Equipment Bureau	ext 0805
Bai Huiliang	Director	Safety Supervision Bureau	ext 0601
Li Jun	Director	Market Supervision Bureau	ext 0701

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1.5 Financial Sources And Expenditures Of China's Health System

From beginning of 1950s, China established a free medical care system. The system was composed of two parts:

1. Free Medical Treatment System

The system provides free medical care for all government officials, stuff working for administrative institutions, as well as disabled servicemen, and university students. Approximately 40 millions of people enjoy the system. Government expended approximately RMB 11 billions yuan (US$ 1.31 billion ) in 1995. The funds came from government financial allocations.

2. The Medical Insurance System

The system provides medical insurance for 140 million workers of state-owned enterprises. Expenditure for the system was approximately RMB 46.6 billion yuan (US$5.58 million) in 1995. And the funds were expended from enterprises' welfare funds.

The government's financial allocations and enterprises' welfare fund expended for medical insurance were major income sources of Chinese hospitals.

Following table shows the total income of hospitals.

Table 4 Total income of hospitals

Year	Income in RMB billion yuan	Income in US$ billion
1992	Approximately 37.2	6.750
1993	Approximately 46.0	7.986
1994	Approximately 55.8	6.248
1995	Approximately 57.6	6.898

Source: Ministry of Health of China

The Tendency of National Health Expenditure (NHE)

World Bank have invited some specialists to forest China's NHE. They forecast that NHE would make up 5 percent of GDP till 2010 and make up 7 percent of GDP till 2030.

China Health Economy Network estimated that NHE would make up 4.1 percent of GDP up to year 2000, 6.6 percent to 2010, 12 percent to 2020 and 24 percent to 2030.

About tendency of NHE in near future, China NHE Forecasting Group believes that the proportion of NHE will make up 4.2 percent of GDP up to year 2000 and approximate 5 percent up to 2010. In near future, the proportion of NHE making up GDP will not increase rapidly, There is less possible that the proportion of making up GDP gets to 5 percent.

It is believed that the ratio between NHE and GDP would continually increase to high degree from now till five years later, and will get to 4.3 percent up to year 2000.

Table 5 The Forecast of National Health Expenditure (NHE) Tendency

Unit: percent of GDP

Forecaster	year 2000	year 2010	year2020	year 2030
World Bank	¡¡	5	¡¡	7
China Health Economy Network (option 1)	4.1	6.6	12	24
China Health Economy Network (option 2)	3.1	6.2	¡¡	8.8
China NHE Forecasting Group	4.2	5	¡¡	¡¡

Source: Ministry of Health of China

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1.6 Urban Medical Services

1.6.1 Free Medical Care System

Since 1952, following urban people can enjoy free medical care or medical insurance:

people working in all-level governments, democratic parties, people's organizations, institutions of cultural, education, scientific research, health; retired people, disabled servicemen, university and college students, and workers working in state-owned enterprises.

However, Registration fee, nutrient medicine fee, and plastic surgery fee are not covered in the free medical care system.

Expenses for medical care are from the government financial budget.

1.6.2 New Medical Insurance System for Urban Areas

Since 1994 China has been carrying on a reform for its free medical care system. According to the new system, medical expenses will be shared by both employers and employees.

Enterprises or employers will contribute 10 percent of the entire staff's salaries for social medical care insurance. Of which, five percent will deposit into employees' personal medical care accounts. The rest five percent will be set aside as ¡°Social Overall Medical Funds¡± .

Employees will have to pay one percent of their monthly salaries into their personal medical care accounts.

Following figure shows the source of new social medical care insurance system.

Figure 2 Source of new social medical care insurance system 1

When medical costs for a person are less than five percent of the patient's average annual income, the money will be subtracted from that person's medical care accounts.

The Social Overall Medical Funds, the pool of money jointly created by the employer and employee, will pay 80- 90 percent of medical expenses when they exceed five per cent of that person's average annual income, but less then RMB 5,000 yuan. The country's average annual income for urban employee was 6,470 yuan (US$780) in 1997.

The Social Overall Medical Funds will pay 90-92 percent of medical expenses, in case the expenses exceeding RMB 5,000 yuan but less than 10,000 yuan; and 98 percent if expenses exceeding RMB 10,000 yuan.

The funds will not pay the bill if the expense goes beyond four times that of the local annual average income in case of serious illness, and patients will have to turn to commercial medical insurance. Details please see following table.

Table 6 Payment for Medical Expenses

¡¡ Personal Medical Expenses Range	Personal Medical Care Account	Social Overall Medical Funds
less than 5 percent of the patient's average annual income	100%	¡¡
exceeding 5 per cent of that person's average annual income, but less then RMB 5,000 yuan	10 - 20 %	80 - 90 %
exceeding RMB 5,000 yuan but less than 10,000 yuan	8 - 10 %	90 - 92 %
exceeding RMB 10,000 yuan, but less than four times that of the local annual average income	2%	98%

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The new medical insurance system will cover all of the country's 150 million urban employees.

The new medical insurance system, with a change in the rate of employers and employees' contribution to Social Overall Medical Funds and personal medical care account, will be standardized at city and county levels in 1999.

Of 1999 scheme, employees shall pay two percent of their salary to their personal medical care account, and employers shall contribute 6 percent of the entire staff's salaries for social medical care insurance. Of which, the percentage of money deposited into employees' account shall be determined by local government. Details please see following figure.

Figure 3 Source of new social medical care insurance system 2

1.7 Rural Medical Care System

1.7.1 Three-level Network

With 900 million people in rural areas, China places great emphasis on rural medical and health work. In rural areas, a 3-level network is formed: at county, township, and village levels.

County-level: general hospitals, health and anti-epidemic stations, Chinese traditional medicine hospitals, maternity and child health centers, medical service stations, and clinics.

Township-level: medical service in health care, anti-epidemic, maternity and child health service, family planning stations.

Village-level: medical stations -grassroots operation, staffed by village doctors, to provide services to villagers.

Rural networks provide training to the staff, organize public health campaigns and surveys.

1.7.2 Rural Medical Service System

It is operated on the principle of voluntary participation as part of the project ¡°Health for All by 2000¡± launched by the Ministry of Public Health.

It is a collectively-funded rural medical services system for China's 900 million farmers, and will be offered in 50 to 60 percent of the counties in the next few years.

World Health Organization has pledged US$350,000 for the program.

Each village is required to contribute a set amount to the local clinic each year, then villagers will be treated free of charge or have part of their medical expenses reimbursed.

1.8 Private Medical Cares

There were more than 120,000 private medical care institutions in China, and most of them are small-sized.

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Table 7 Private Medical Cares

Year	Private Medical Care Institutions		Employee in Private Medical Care Institutions
¡¡	Number	Percentage of National Total	Number	Percentage of National Total
1997	125,264	39.8	161,465	2.92
1998	126,068	40.1	164,727	3.73

Source: Ministry of Health of China

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1.9 Medical Education

China's medical education is organized at four levels: junior, secondary, higher, and advanced education in Western medicine and Chinese traditional medicine

1.9.1 Medical Training Center

The State has set up a Chinese medical training center for village doctors nationwide. Medium-level certificates are issued to those who have completed 2-year correspondence education.

Training is designed for off-work classes and on-job training. And there are now 723,000 village doctors and 982,000 midwives and medical workers in the countryside.

1.9.2 Secondary Medical Schools

There are 554 secondary medical schools, with an enrollment of 94,000, offering 3-year or 4-year courses. 83 kinds of text books are compiled and in use now.

1.9.3 Higher Medical Schools

There are 135 medical colleges with an annual enrollment of 45,000, bringing the total number of students in these schools to l97,000. And 11 of the colleges are under the direct supervision of the Ministry of Public Health. The length of courses extend from 3 years up to 8 years in different majors.

Major medical institutes:

Beijing Medical Science Institute

• Beijing Traditional Medical College

• Shanghai Medical Science Institute

• Shanghai N0.2 Medical Science Institute

• Shanghai Traditional Medical College

• Tianjin Traditional Medical Institute

• Hubei Medical College

• Tongji Medical Science Institute

• Guangxi Medical College

• Medical Science University of China

• Nanjing Traditional Medical College

• Guangzhou Traditional Medical College

• Pharmaceutical University of China

1.9.4 Medical Research Institutes and Associations

(1) China Medicine Association

Add: 4 East Yinghua Road, Chaoyang District,

Beijing 100029, China

Tel: (8610) 64218316, 64212828

(2) Academy of Chinese Traditional Medicine

Add: 18 North Xicang, Dongzhimennei,

Beijing 100700, China

Tel: ( Acupuncture Institute) (8610) 64032682

( Chinese Traditional Medicine Institute) (8610) 64032658

(3) Medical Information Institute

Add: 3 Yabao Road, Chaoyang District,

Beijing 100020, China

Tel: (8610) 65127776

(4) Basic Medical Institute

Add: 3 Dongdan Santiao, Dongcheng District,

Beijing 100005, China

Tel: (8610) 65134466

(5) Zhonghua Medical Society

Add: 42 West St., Dongsi, Dongcheng District,

Beijing 100710, China

Tel: (8610) 65133311

(6) Shonghua Prevention Medical Society

Add: 11 Xiyuanli, Chaoyang District,

Beijing 100027, China

Tel: (8610) 64654109

(7) Beijing Chinese Traditional and Western Medicine Society

Add: 7 Dongdan Santiao, Dongcheng District,

Beijing 100005, China

Tel: (8610) 65250460

(8) Beijing Chinese Traditional Medicine Society

Add: 7 Dongdan Santiao, Dongcheng District,

Beijing 100005, China

Tel: (8610) 65256418

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1.10 Red Cross Society in the health system

China Red Cross Society

Honorary Chairman: Jiang Zemin

Chairman: Qian Zhengying

Vice Chairman: Zhang Wenkang, Pengyu

Add: 53 Ganmian Hutong, Dongcheng District, Beijing 100010, China

Tel: (8610) 65124447

• The China Red Cross Society celebrated its 94th anniversary in l998

• The China Red Cross Society has branches in 30 provinces.

• There are 130,000 grassroots chapters, with a total of 20 million members

• There are 6 regional rescue centers and 44 blood transfusion centers across the nation under its direction.

• The China Red Cross Society has sponsored training classes on health care and medical aid for people from all walks of life

• The society has actively participated in activities of the International Red Cross and joined world philanthropic aid work

1.11 Major Statistics of China's Health System

1.11.1 Health Care Institutions

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Table 8 Health Care Institutions

	1991	1992	1993	1994	1995	1996	1997
Total	209036	204787	193586	191742	190057	188803	315033
Hospitals	63101	61352	60784	67857	67807	67964	67911
of which at and above county level	13638	13917	14713	14762	14771	15056	15219
Sanitarium	642	639	600	587	582	528	506
Clinics	128665	125873	115161	105984	104406	103472	229474
Specialized stations	1818	1845	1872	1905	1895	1887	1893
Sanitation and disease control stations	3652	3673	3609	3611	3629	3635	3619
Maternity and child care centers	2854	2841	2791	2857	2832	2764	2748
Medicines and chemical reagent test labs	1927	1953	1976	1990	1995	2000	2014
Medical science institutions	335	339	436	437	427	427	426
Other institutions	6042	6272	6357	6514	6484	6126	6442

Source: China Statistical Yearbook

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1.11.2 Personnel Working in Health Care Institutions

Table 9 Personnel Working in Health Care Institutions

Unit : 1000 people

Source: China Statistical Yearbook

1.11.3 Number of Beds in Health Care Institutions

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Table 10 Number of Beds in Health Care Institutions

Unit: 1000 unit

¡¡	1991	1992	1993	1994	1995	1996	1997
Total	2992	3049	309.9	3134	3141	3100	3135
Hospitals	2689	2744	2795	2831	2836	2866	2903
of which at and above county level	1901	1953	2017	2051	2053	2083	2109
Sanitarium	125	125	119	118	116	109	104
Other health care institutions	178	180	185	184	188	125	128
Hospital beds per 1,000 persons (unit)	2.32	2.34	2.36	2.36	2.34	2.34	235

Source: China Statistical Yearbook

1.11.4 Health Care Institutions, Beds & Personnel by Type of Institutions

Table 11 Health Care Institutions, Beds & Personnel by Type of Institutions in 1997

Type	Institutions	Beds (1000)	Personnel (1000 persons)
¡¡	¡¡	¡¡	Total	Medical tech. personnel	Managerial personnel
Total	315033	3135	5516	4398	448
Total number of hospitals	16376	2154	3067	2378	266
Hospitals at and above county level	15219	2109	3005	2330	260
General hospitals	10789	1486	2146	1672	180
Hospitals of Chinese medicine	2424	224	339	272	29
Hospitals attached to medical colleges	220	123	208	197	18
Infectious disease hospitals	120	25	29	20	3
Metal hospitals	485	98	71	50	8
Tuberculosis hospitals	99	25	23	16	3
Hospitals for maternity and child care	432	34	65	51	6
Children's hospitals	36	10	19	14	2
Hospitals for lepers	48	9	3	2	¡¡
Hospitals for occupational diseases	46	7	7	5	1
Tumor hospitals	61	17	23	16	2
Other specialized hospitals	459	52	75	15	8
Rural township hospitals	51535	749	1131	991	76
Sanitariums	506	104	48	24	8
Clinics	229474	26	574	561	7
Specialized stations	1893	31	61	46	7
Tuberculosis prevention stations	606	4	17	13	2
Occupational diseases prevention stations	99	3	6	4	1
Sanitation and disease control stations	4012	1	219	173	2
Maternity and child care centers	2748	26	87	71	8
Medicine and chemical reagent test labs	2014	¡¡	26	19	4
Institutions of medical sciences	426	6	35	20	5
Other health care institutions	6049	37	269	¡¡	¡¡

Source: China Statistical Yearbook

1.11.5 Death Rate of 10 Major Diseases in Rural Areas

Table 12 Death Rate of 10 Major Diseases in Rural Areas ( 1997 )

Source: China Statistical Yearbook

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1.11.6 Death Rate of 10 Major Diseases in Urban Areas

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Table 13 Death Rate of 10 Major Diseases in Urban Areas ( 1997 )

Rank	Cause of death	% of total death
¡¡	Total	91.31
1	Cerebrovascular disease	22.28
2	Malignant tumor	21.66
3	Heart trouble	16.37
4	Respiratory disease	15.28
5	Trauma and toxicosis	6.52
6	Digestive disease	3.22
7	Internal system , nutrition, metabolite and immunity disease	2.51
8	Urinary disease	1.51
9	Mental disease	1.12
10	Neuropathy	0.84
¡¡	¡¡	¡¡
¡¡	Total of male	92.33
1	Malignant tumor	24.45
2	Cerebrovascular disease	22.09
3	Heart trouble	14.99
4	Respiratory disease	14.61
5	Trauma and toxicosis	7.43
6	Digestive disease	3.53
7	Internal system , nutrition, metabolite and immunity disease	1.87
8	Urinary disease	1.44
9	Mental disease	0.97
10	Infectious disease (excluding pulmonary tuberculosis)	0.95
¡¡	¡¡	¡¡
¡¡	Total of female	90.16
1	Cerebrovascular disease	22.51
2	Malignant tumor	18.25
3	Heart trouble	18.06
4	Respiratory disease	16.09
5	Trauma and toxicosis	5.41
6	Internal system , nutrition, metabolite and immunity disease	3.29
7	Digestive disease	2.84
8	Urinary disease	1.59
9	Mental disease	1.31
10	Neuropathy	0.81

Source: China Statistical Yearbook

1.11.7 Developments in Public Health in 1998

By the end of 1998, there were 310,000 health care institutions (including clinics), with a total of 3.14 million beds, 2.91 million of which in hospitals and health-care stations. There were 4.42 million health workers in China, including 1.41 million doctors in hospitals and health-care stations, and 1.07 million senior and junior nurses. China also had 5,907 anti-epidemic and disease prevention stations employing 220,000 health workers, and 2,724 maternal and child health-care institutions employing 73,000 health workers. Health service network was strengthened and improved at county, township and village levels, and over 75 percent of all counties fulfilled targets in the rural primary health care program. There were 50,000 health-care institutions at township level in rural areas, with 740,000 beds and 1,000,000 health workers. Rural villages with medical-care stations made up 89.5 percent of all villages in China, employing 1,330,000 rural doctors and health workers.

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2 China's Medical Equipment Market

According to an estimation made by experts with MOH, China has more than 3,000 manufacturers producing about 47 categories 11,000 kinds of medical equipment. Total output value of medical equipment in 1997 was RMB 9.65 billion yuan (US$ 1.16 billion). The total sales revenue of medical equipment in 1998 reached RMB 12.3 billion yuan (US$ 1.49 billion), with annually increase rate about 30 percent. Some experts even predict that the market capacity for medical equipment will be RMB 35 billion yuan (US$ 4.24 billion) in year 2000.

The fastest development of 10 apparatus in the late decade of China are as followings:

1. Ultrasonic detector

2. CT detector

3. NMR detector

4. Linac

5. Ultrasonic vertical hydrotherapic equipment

6. Neuropotential diagnostic system

7. Positron dislocation scanning detector

8. X scalpel

9. Gamma scalpel

10. Gamma Cameras

General trends of market projection in 1996-2000

The market of China's principal medical instruments and equipment is in an elevating trends. The main reasons are:

1. There are some 310,000 medical institutions in China. Of these, equipment of 15 percent is produced in 60s-70s, which needs update.

2. Number of hospitals is increasing.

3. The continuous progress and development of medical and health course and clinical medical technology demands that new medical instruments should be equipped for clinical utilization.

4. To reach the goal of the project ¡°Health for All by 2000¡± launched by the Ministry

of Public Health, hospitals and clinics in rural areas are required to equipped with

laboratory test apparatus, small-sized Ultrasonic detectors, small-sized X-ray

equipment, dental equipment, small-sized high pressure sterilizing apparatus, and

etc.

5. The most prospective varieties in the market will be:

• sterilizing apparatus

• health recovery appliances

• large-sized instruments and equipment, X-CT, ECT, colored ultrasonic diagnostic instrument and high-end pacemaker.

• disposable medical apparatus, conduit apparatus, auxiliary apparatus of functional recovery, therapeutic equipment, etc.

• various kinds of new-typed polymer dressing: sponge type dressing, gel type dressing, thin-film dressing, compound type dressing, etc.

• apparatus of various biological medical engineering (BME) which can be planted into human body.

3 Distribution System For Medical Equipment

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3.1 Distribution Channels For Domestic Products

Basically medical equipment manufacturers sell their products to hospitals through their agencies. There are two types of agencies in China, authorized agencies (by MOH or provincial health bureaus) and non-authorized agencies.

Forty large-sized hospitals directly under the leadership of MOH, Sino-foreign JV Hospitals, private hospitals, and hospitals affiliated to medical education institutes can purchase medical equipment directly from manufacturers or their agencies.

For State-owned hospitals under provincial health bureaus, they must purchase equipment from authorized agencies on the fund of government financial allocation; while they can purchase their equipment from non-authorized agencies or form manufacturers on their own funded money.

Following chart shows the distribution channels for domestic made medical equipment.

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Figure 4 Distribution Channels For Domestic Products

3.2 Distribution Channels For Imported Products

Medical equipment importation is a monopoly trade in China. Importer must be approved by the related governmental body. At present, there are more than 1000 approved importers in which China Medicine & Health Care Im/Ex Corp and its provincial subsidiaries are the major importers of medical equipment. These importers sell the products to the end users. Hospitals must purchase the medical equipment they need from the companies approved by the government.

The large-sized hospitals directly under the Ministry of Health, hospitals affiliated to medical education and research institutes, Sino-foreign JV hospitals and private owned hospitals can import medical equipment directly from abroad for their own use, but is not allowed to resale and retail.

Following chart shows the distribution channels for imported medical equipment.

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Figure 5 Distribution Channels For Imported Products

4 Importation of Medical Equipment

In China, the imported medical equipment can be divided into following four major categories with 39 detailed H.S. codes:

• H.S.Code 9018:
  Instruments and appliances used in medical, surgical, dental or veterinary sciences, including scintigraphic apparatus, other electro-medical apparatus and sight testing instruments

• H.S.Code 9019:
  Mechano-therapy appliances; massage apparatus; psychological aptitude-testing apparatus; ozone therapy, oxygen therapy, aerosol therapy, artificial respiration or other therapeutic respiration apparatus;

• H.S.Code 9021:
  Orthopaedic appliances, including crutches, surgical belts and trusses; splints and other fracture appliances; artificial parts of the body; hearing aids and other appliances which are worn or carried, or implanted in the body, to compensate for a defect;

• H.S.Code 9022: Apparatus based on the use of X-rays or of alpha, beta or gamma radiations, whether or not for medical, surgical, dental or veterinary uses, including radiography or radiotherapy apparatus, X-ray tubes and other X-ray generators, high tension generators.

Following table shows detailed items of imported medical equipment under 39 H.S. Codes.

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Table 14 detailed items of imported medical equipment

Items	H.S. Code	Description of Equipment
1	90181100	Electrocardiographs
2	90181210	B-ultrasonic dia