Guidance

Country policy and information note: medical treatment and healthcare, China, July 2022 (accessible)

Updated 16 October 2024

Version 1.0

July 2022

Preface

Purpose

This note provides country of origin information (COI) for decision makers handling cases where a person claims that to remove them from the UK would be a breach of Articles 3 and/or 8 of the European Convention on Human Rights (ECHR) because of an ongoing health condition.

It is not intended to be an exhaustive survey of healthcare in China.

For general guidance on considering cases where a person claims that to remove them from the UK would be a breach of Article 3 and/or 8 of the European Convention on Human Rights (ECHR) because of an ongoing health condition, see the instruction on Human rights claims on medical grounds.

Country of origin information

The country information in this note has been carefully selected in accordance with the general principles of COI research as set out in the Common EU [European](http://www.refworld.org/docid/48493f7f2.html) [Union] Guidelines for Processing Country of Origin Information (COI), dated April 2008, and the Austrian Centre for Country of Origin and Asylum Research and Documentation’s (ACCORD), Researching Country Origin Information – Training Manual, 2013. Namely, taking into account the COI’s relevance, reliability, accuracy, balance, currency, transparency and traceability.

The structure and content of the country information section follows a terms of reference which sets out the general and specific topics relevant to this note.

All information included in the note was published or made publicly available on or before the ‘cut-off’ date(s) in the country information section. Any event taking place or report/article published after these date(s) is not included.

All information is publicly accessible or can be made publicly available, and is from generally reliable sources. Sources and the information they provide are carefully considered before inclusion. Factors relevant to the assessment of the reliability of sources and information include:

• the motivation, purpose, knowledge and experience of the source

• how the information was obtained, including specific methodologies used

• the currency and detail of information, and

• whether the COI is consistent with and/or corroborated by other sources.

Multiple sourcing is used to ensure that the information is accurate, balanced and corroborated, so that a comprehensive and up-to-date picture at the time of publication is provided of the issues relevant to this note.

Information is compared and contrasted, whenever possible, to provide a range of views and opinions. The inclusion of a source, however, is not an endorsement of it or any view(s) expressed.

Each piece of information is referenced in a brief footnote; full details of all sources cited and consulted in compiling the note are listed alphabetically in the bibliography.

Feedback

Our goal is to continuously improve our material. Therefore, if you would like to comment on this note, please email the Country Policy and Information Team.

Independent Advisory Group on Country Information

The Independent Advisory Group on Country Information (IAGCI) was set up in March 2009 by the Independent Chief Inspector of Borders and Immigration to support him in reviewing the efficiency, effectiveness and consistency of approach of COI produced by the Home Office.

The IAGCI welcomes feedback on the Home Office’s COI material. It is not the function of the IAGCI to endorse any Home Office material, procedures or policy. The IAGCI may be contacted at:

Independent Advisory Group on Country Information
Independent Chief Inspector of Borders and Immigration
5th Floor
Globe House
89 Eccleston Square
London, SW1V 1PN

Email: [email protected]

Information about the IAGCI’s work and a list of the documents which have been reviewed by the IAGCI can be found on the Independent Chief Inspector’s pages of the gov.uk website.

Overview

1. Sources and prices

1.1 MedCOI

Section 1 updated: 20 May 2022

1.1.1 This note makes extensive use of medical country of origin information (COI) compiled by Project MedCOI, which was set up and operated by the immigration authorities in Belgium and the Netherlands until 31 December 2020, and since then by the European Asylum Support Office (EASO) (now known as the European Union Agency for Asylum (EUAA)).

1.1.2 The EUAA MedCOI sector website explains how the project has and currently operates:

‘EUAA MedCOI relies on a worldwide network of medical experts that provides up-to-date medical information in countries of origin. Based on this information and combined with desk research, the EUAA MedCOI Sector produces responses to individual requests from EU+ countries, general medical country reports, and maintains a portal with a specific database where the information can be found…The database is only accessible to trained personnel in EASO and the EU+ countries’ relevant administrations…

‘The high quality and medical accuracy of the information is guaranteed by specifically trained medical advisors and research experts who also provide guidance to the users of the portal.

‘The MedCOI Sector at EUAA has incorporated all services that were previously delivered by project teams in Belgium and the Netherlands in an ERF/AMIF funded project until 31/12/2020 (MedCOI4).’^{[footnote 1]}

1.1.3 The UK Home Office ceased to be able to make requests to or access the database of MedCOI on 31 December 2020.

1.1.4 The UK Home Office has, however, retained copies of all MedCOI documents referred to in this note should they be required in individual cases.

1.2 Costs and currency

1.2.1 This note includes the cost for various medications and treatments.

These prices have been converted into British pounds whenever possible. The exchange rate as of 20 May 2022 was £1 = 8.34 Chinese Yuan Renminbi^{[footnote 2]}.

Section 2 updated: 27 May 2022

2. The healthcare system

2.1.1 The study paper, What can we learn from China’s health system reform?, published by the British Medical Journal in June 2019, stated:

‘China has implemented a comprehensive health system reform over the past decade which focused on strengthening the capacity of primary care, extending and improving social health insurance coverage, providing basic public health services to everyone, reforming public hospitals, and improving medicines policies.

‘Both central and local governments have mobilised substantial political and financial resources to implement the reform. Almost everyone has been covered by the social health insurance system and basic public health service package. Mark-up of drug prices has been stopped in public hospitals and primary healthcare providers. Unmet health needs and inequities in some health indicators have decreased.

‘Some challenges remain. The quality of care in primary healthcare has not improved greatly, mostly because of the inadequate training of the healthcare providers. The cost of medical care is still increasing as a result of incomplete reform of public hospitals including ineffective utilisation of the payment system. Inefficient use of health resources is prevalent mainly because of overuse of healthcare and uneven distribution of health resources. Healthcare delivery and financing systems are fragmented because of constraints in the governance structure.’^{[footnote 3]}

2.1.2 See also ChinaPower, Is China’s Health Care Meeting the Needs of its People?

2.1 Public health insurance

2.1.1 The publication Towards universal health coverage: lessons from 10 years of healthcare reform in China, published in 2020 by British Medical Journal (BMJ) Global Health, noted that in 2018: ‘…more than 95% of the population were covered by social health insurance schemes [and]…a total of ¥42.46billion [£5.12 billion] was spent from medical assistance funds nationwide to subsidise 76.739 million people to participate in basic medical insurance…’^{[footnote 4]}

2.1.2 The Commonwealth Fund International Health Policy Centre (CFIHPC) report about the Chinese healthcare system, dated 5 June 2020, stated:

‘China achieves near-universal [healthcare] coverage through the provision of publicly funded basic medical insurance. The urban employed are required to enroll in an employment-based program, which is funded primarily via employer and employee payroll taxes. Other residents can voluntarily enroll in Urban-Rural Resident Basic Medical Insurance, financed primarily by central and local governments through individual premium subsidies. Local health commissions organize public and private health care organizations to deliver services. The basic medical insurance plans cover primary, specialty, hospital, and mental health care, as well as prescription drugs and traditional Chinese medicine. Deductibles, copayments, and reimbursement ceilings apply.’^{[footnote 5]}

2.1.3 The study paper, An overview of the Chinese healthcare system, published on the National Centre for Biotechnology Information (NCBI) (United States) website in January 2021, stated:

‘The national medical security system in China is a multilevel system, with the basic medical insurance (BMI) as the pillar and medical aid as the backup, and commercial health insurance, charitable donations, and medical mutual aid activities as supplementary services.

‘The BMI system serves two groups of people: employees and residents. Employees are enrolled in the employee basic medical insurance (EBMI) program, and non-working residents are enrolled in the residents basic medical insurance (RBMI) program…As of September 2020, more than 1.35 billion people (over 95% of China’s population) are covered by one of the BMI programs, making it the world’s largest healthcare security network…

‘Medical aid ensures all citizens have fair access to basic medical services by supporting the section of the low-income populace to participate in the BMI by subsidizing the medical expenses that they cannot afford. Since 2018, medical aid has benefited 480 million low-income citizens, helped reduce their medical burden by approximately CNY ¥330 billion [£39.6 billion], implemented targeted poverty reduction measures for 10 million people in need who were impoverished due to illnesses, and ensured their basic medical security.’^{[footnote 6]}

2.2 Private health insurance

2.2.1 The CFIHPC report, in relation to private health insurance, stated:

‘Purchased primarily by higher-income individuals and by employers for their workers, private insurance can be used to cover deductibles, copayments, and other cost-sharing, as well as to provide coverage for expensive services not paid for by public insurance.

‘No statistics are available on the percentage of the population with private coverage. Private health insurance is provided mainly by for-profit commercial insurance companies…

‘Services covered: The benefit package is often defined by the local governments. Publicly financed basic medical insurance typically covers:

• Inpatient hospital care (selected provinces and cities)

• Primary and specialist care

• Prescription drugs

• Mental health care

• Physical therapy

• Emergency care

• Traditional Chinese medicine.

‘A few dental services (such as tooth extraction, but not cleaning) and optometry services are covered, but most are paid out-of-pocket. Home care and hospice care are often not included either. Durable medical equipment, such as wheelchairs and hearing aids, is often not covered.

‘Preventive services, such as immunization and disease screening, are included in a separate public-health benefit package funded by the central and local governments; every resident is entitled to these without copayments or deductibles. Coverage is person-specific; there are no family or household benefit arrangements.

‘Maternity care is also covered by a separate insurance program; it is currently being merged into the basic medical insurance plan.’^{[footnote 7]}

2.3 Organisation and provision of healthcare

2.3.1 The Bain and Company (global consultancy) article, How the Coronavirus Will Transform Healthcare in China, dated 4 March 2020, stated:

‘China’s tiered healthcare system – in which smaller community health centers (CHCs) and Class I institutions provide first-contact care, and larger Class II and III institutions provide specialist referral services – is designed to distribute patients based on need, freeing up resources at big, congested facilities…While Beijing and other cities have made some headway with recent decreases in Class III visits, patients still habitually seek treatment from large hospitals…’^{[footnote 8]}

2.3.2 The CFIHPC report stated:

‘China’s central government has overall responsibility for national health legislation, policy, and administration. It is guided by the principle that every citizen is entitled to receive basic health care services. Local governments — provinces, prefectures, cities, counties, and towns — are responsible for organizing and providing these services.

‘Both national and local health agencies and authorities have comprehensive responsibilities for health quality and safety, cost control, provider fee schedules, health information technology, clinical guidelines, and health equity.’9

2.3.3 The CFIHPC report also stated: ‘Primary care is delivered primarily by:

• Village doctors and community health workers in rural clinics

• General practitioners (GPs) or family doctors in rural township and urban community hospitals

• Medical professionals (doctors and nurses) in secondary and tertiary hospitals…

‘Hospitals can be public or private, nonprofit or for-profit. Most township hospitals and community hospitals are public, but both public and private secondary and tertiary hospitals exist in urban areas.

‘Rural township hospitals and urban community hospitals are often regarded as primary care facilities, more like village clinics than actual hospitals.’^{[footnote 10]}

2.3.4 The CFIHPC report further stated:

‘The National Health Commission directly owns some hospitals in Beijing, and national universities (directly administrated by the Ministry of Education) also own affiliated hospitals. Local government health agencies in each province may have a similar structure and often own provincial hospitals.

‘Hospitals are paid through a combination of out-of-pocket payments, health insurance compensation, and, in the case of public hospitals, government subsidies.’^{[footnote 11]}

2.3.5 For more information on the central government’s healthcare structure and the responsible agencies, see the CFIHPC report.

2.4 Number of facilities and personnel

2.4.1 OECD [Organisation for Economic Cooperation and Development] data indicates that there were 2.24 doctors per 1,000 of the population in 2020^{[footnote 12]}, and there were 3.1 nurses per 1,000 of the population in 2020^{[footnote 13]}.

2.4.2 The CFIHPC report stated: ‘In 2018, there were approximately 12,000 public hospitals and 21,000 private hospitals (excluding township hospitals and community hospitals), of which about 20,500 were nonprofit and 12,600 were for-profit.’^{[footnote 14]}

2.4.3 The CFIHPC report also stated:

‘In 2018, there were 506,003 public primary care facilities and 437,636 private village clinics. Village doctors, who are not licensed GPs, can work only in village clinics. In 2018, there were 907,098 village doctors and health workers. Village clinics in rural areas receive technical support from township hospitals…

‘In 2018, China had 308,740 licensed and assistant GPs, representing 8.6 percent of all licensed physicians and assistant physicians.’^{[footnote 15]}

2.4.4 Information on hospitals in different provinces can be found on the National Health Commission of the People’s Republic of China webpage^{[footnote 16]}.

2.5 Non-governmental Organisations (NGOs) and other support

2.5.1 A number of NGOs have been active in China – constructing hospitals^{[footnote 17]}, providing access to medical care services^{[footnote 18]}, and helping vulnerable persons^{[footnote 19]}.

2.5.2 The CFIHPC report stated:

‘Safety nets: For individuals who are not able to afford individual premiums for publicly financed health insurance or cannot cover out-of-pocket spending, a medical financial assistance program, funded by local governments and social donations, serves as a safety net in both urban and rural areas.

‘The medical financial assistance program prioritizes catastrophic care expenses, with some coverage of emergency department costs and other expenses. Funds are used mainly to pay for individual deductibles, copayments, and medical spending exceeding annual benefit caps, as well as individual premiums for publicly financed health insurance. In 2018, 76.7 million people (approximately 5.5% of the population) received such assistance for health insurance enrollment, and 53.6 million people (3.8% of the population) received funds for direct health expenses.’^{[footnote 20]}

2.6 Availability and accessibility to medical treatment and drugs

2.6.1 The publication, Towards universal health coverage: lessons from 10 years of healthcare reform in China, published in 2020 by British Medical Journal (BMJ) Global Health, noted that:

‘As the base of drug supply and security system, the national essential medicines system reform is comprehensive and includes but is not limited to the following: the selection, production and distribution of essential medicines; quality assurance; reasonable pricing; tendering and procurement; a zero mark-up policy on sales; rational use and reimbursement; and monitoring and evaluation. The government issued a revision of the National Essential Medicines List (NEML) in 2009 including a list of 307 essential medicines, and constantly expands the list to fully meet the needs of basic healthcare. These on-list medicines should be available at all primary care institutions. To improve access to medicines, China boosted the research and development of generic drugs, and required the evaluation of generics to prove they are equivalent to the originator products in terms of quality and efficacy. A ‘two invoice policy’ tendering system was developed to avoid higher mark-up and reduce circulation during the process of distribution. All medicines in the NEML are included in health insurance reimbursement lists, which are reimbursed at higher rates compared with non-essential medicines.’^{[footnote 21]}

2.6.2 The study paper, An overview of the Chinese healthcare system, published on the National Centre for Biotechnology Information (NCBI) website in January 2021, stated:

‘The NHSA [National Healthcare Security Administration] has implemented dynamic adjustments to the catalog of medicines covered by the national health security system and issued the Interim Measures on the administration of Medicines under the Basic Medical Insurance…

‘An example of this has been in the management of hepatitis-related drugs. In recent years, with the continuous efforts of the government, the price of drugs for viral hepatitis has been reduced substantially. In 2015, the annual treatment cost of hepatitis B antiviral drugs, tenofovir disoproxil fumarate (TDF) and entecavir, was about CNY ¥20,000 [£2,396] and CNY ¥9,000 per [£1,078] person, respectively. In 2018, after the “4+7” Pilot Program was launched, the annual treatment cost of TDF and entecavir was decreased to CNY ¥210–240 [£25.16 - £28.75] per person. In 2019, after more cities were included in the pilot program, the cost of the two drugs was further decreased to CNY ¥70 [£8.38].’^{[footnote 22]}

2.6.3 The US-China Economic and Security Review Commission (US-C ESRC) Staff Research Report, China’s Healthcare System: Addressing Capacity Shortfalls before and after COVID-19, published in March 2021, stated:

‘China’s healthcare system is underequipped to handle the growing burden of chronic disease. It is over-reliant on urban hospitals to provide basic care, and the primary care system, which should play a significant role in chronic disease management, is underutilized. Beijing’s healthcare policies have long tried to foster preventative and primary care as the most cost-effective way to provide healthcare services to China’s large population. However, primary care physicians, particularly those in rural areas, typically receive less training and are consequently less trusted by patients, who prefer to visit urban hospitals even for relatively minor conditions such as fevers and headaches. Moreover, the expansion of healthcare coverage has enabled more patients to self-refer to facilities with a higher quality of care, leading to overcrowding at urban hospitals.’^{[footnote 23]}

2.6.4 The US-C ESRC Staff Research Report, China’s Healthcare System: Addressing Capacity Shortfalls before and after COVID-19, also stated:

‘Although the Chinese government claims to provide universal health insurance to its population, many Chinese people still struggle to afford quality healthcare. About 95 percent of the population receive some form of public health insurance, but the level of coverage varies significantly with geography and rural residents tend to receive less coverage than their urban compatriots…

‘In theory, healthcare is less expensive in rural areas, but since rural residents seeking higher quality care travel to visit physicians at urban hospitals, the cost of treatment is disproportionately high for the rural population…

‘The financial burden for those with serious illnesses is considerably higher. For example, the average cost of a hospitalization in 2019 was $1,389 (RMB 9,848) [£1,170.23]^{[footnote 24]}, or 12.6 percent of the average annual wage. To fill the gap, Chinese insurance giants like Ping An and China Life offer commercial products that cover critical illness, medical reimbursement, disability income, and long-term care.’^{[footnote 25]}

2.6.5 The US-C ESRC Staff Research Report also stated:

‘Corruption among China’s hospitals and doctors is a widely acknowledged problem…In many cases, doctors accept illicit payments, known as hongbao, from patients in exchange for a higher quality of care…

‘In addition to accepting these payments from patients, doctors and hospital officials also receive kickbacks for purchasing certain types of medical equipment or pharmaceutical products, a practice that has been described as “endemic” in China…

‘Corruption in China’s healthcare system is driven by persistent funding shortfalls that have created strong incentives for hospital systems and doctors to accept bribes…

‘Hospitals in China have similarly struggled with resource shortfalls. In 2018, only 10 percent of funding for public hospitals came from government subsidies. The majority of funding comes from service charges and drug sales; however, Chinese regulations place ceilings on the markups that may be charged on many medical treatments and drugs. These price controls cut down on an important potential revenue stream and lead many hospitals to seek funds through illicit payments.’^{[footnote 26]}

2.6.6 The Australian government Department of Foreign Affairs and Trade (DFAT) Country Information Report – People’s Republic of China, published on 22 December 2021, noted: ‘Bribery in healthcare is also reported, for example offering cash for prioritised procedures’^{[footnote 27]}.

2.6.7 The DFAT Country Information Report – People’s Republic of China, also stated: ‘Health care varies significantly between urban and rural areas. Urban centres have better quality healthcare, but only for those with the relevant urban hukou (household registration).’^{[footnote 28]}

2.6.8 The Foreign and Commonwealth Development Office (FCDO) on its website designed to provide British nationals with an overview of medical treatment in China, noted: ‘…medical care is generally good in major cities in China, though some hospitals can be very crowded and have long waiting times… Outside major cities, the standard of healthcare is variable; it can sometimes be poor and disorganised. With the exception of clinics oriented towards foreign patients, GP clinics are an uncommon phenomenon.’^{[footnote 29]}

2.7 Emergency healthcare

2.7.1 The Allianz Care article, Healthcare in China, undated, stated: ‘Some rural areas have very limited emergency services, but urban areas are generally well serviced…Emergency response personnel are well trained and professional…’^{[footnote 30]}

2.7.2 The HMP Global Learning Network article, EMS Around the World: China Prioritizes Better EMS, published in January 2020, stated:

‘Despite a significant increase in investment by the government in the national EMS [emergency medical services] sector in recent years, the quality of services provided in China remains generally low, even compared with other emerging nations…

‘According to experts at the Chinese University of Hong Kong—a leading institution of research and higher education located in Shatin, Hong Kong— the biggest problems of Chinese EMS are an acute shortage of ambulances in the country and existing services that can’t meet the needs of the country’s nearly 1.4 billion people.

‘Those problems remain pressing despite an order last year from the Ministry of Health that specified every city should have at least one ambulance for every 50,000 people. The majority of Chinese cities and provinces do not meet these requirements.

‘The situation is slightly better in large industrial cities of the country, such as Beijing and Shanghai, where official responses can be supplemented by unofficial services for those who can pay. However, in rural, remote areas of the country, the levels of accessible EMS are close to catastrophic. In rural areas and smaller cities, prehospital emergency services—accessed in China through the emergency number 1-2-0—may not be available at all…

‘Currently the Chinese EMS system is divided into three parts: prehospital emergency services, emergency departments, and intensive care units.

Prehospital emergency services include ambulance services and prehospital care funded primarily by provincial and city bureaus of public health…

‘The cost of emergency treatment is usually covered by patients themselves, although roughly 25% of the urban population has medical insurance.’^{[footnote 31]}

2.7.3 The West China Hospital of Sichuan University (Chengdu) (WCHSU) website stated:

‘The West China Hospital Emergency Department (WCHED) enjoys a reputation nationally and internationally as one of the premier academic Emergency Medicine facility…WCHED provide emergency services 24 hours a day, 7 days a week for almost all the emergency patients, except the stomatological, obstetric and gynecologic patients, and the pediatric patients.’^{[footnote 32]}

3. Paediatric diseases and healthcare

3.1 Paediatric hospital care services

Section 3 updated: 16 May 2022

3.1.1 The Children’s Hospital Zhejiang University School of Medicine website stated the following about the hospital:

‘The Children’s Hospital Zhejiang University School of Medicine (ZUCH), founded in 1951, is a non-for-profit public hospital and the largest comprehensive center of pediatric health care in Zhejiang Province. It is one of the top children’s hospitals in China…

‘The hospital runs 48 sub-specialties in the pediatric field. The clinical departments include gastroenterology, cardiology, hematology & oncology, pulmonology, neurology, endocrinology, nephrology; general surgery, cardiothoracic surgery, orthopedics, urology, plastic surgery, neurosurgery; neonatology; pediatric development/behavior clinic, psychology, neonatal disease screening clinic, rehabilitation clinic. Other divisions include the emergency medicine, dermatology, dentistry, ophthalmology, ENT, and traditional Chinese medicine.’^{[footnote 33]}

3.1.2 The West China Women’s and Children’s Hospital website stated:

‘The Division of Pediatric Infectious Diseases at West China Second University Hospital provides inpatient and outpatient consultation on the diagnosis and management of all types of acute and chronic pediatric infections, such as tuberculosis in children, infectious diarrhea, sepsis, hepatitis, Infantile hepatitis syndrome, congenital syphilis, central nervous system infection, mumps, especially of epidemic cerebrospinal meningitis, toxic bacillary dysentery, tuberculous meningitis, extensive drug resistant TB, tuberculosis complicated with drug-induced liver injury, CMV [cytomegalovirus] hepatitis, and etc.’^{[footnote 34]}

3.1.3 A MedCOI response, dated 8 April 2019, stated there were paediatric doctors and paediatric surgeons available at the Shanghai Paediatric Hospital of Fudan University in Shanghai (public facility) in April 2019^{[footnote 35]}.

3.2 Paediatric cardiology and heart surgery

3.2.1 The West China Women’s and Children’s Hospital website stated the following about its services and facilities:

‘We have a team of cardiac professionals with specialized skill and rich experience. The division/center is equipped with state of the art equipments [sic], and provides a wide range of diagnostic and therapeutic services to children with known or suspected heart disease. And we take the lead in the diagnosis and treatment of pediatric congenital heart disease, viral myocarditis, rheumatic carditis, idiopathic cardiomyopathy, and coronary arterial injury in Kawasaki disease in the country.’^{[footnote 36]}

3.2.2 The World Journal of Paediatric Surgery (WJPS) 2019 report, Pediatric heart surgery in China: progress and challenges, stated:

‘China has 700 pediatric cardiac centers which can operate on children with CHD [congenital heart disease] in China…

‘In the recent 10 years, the specialty of pediatric cardiac surgery has achieved staggering developments in China. The progress is embodied by increased success rate of surgeries and steadily growing cardiac surgeons team. We also have made a great progress in treating severe complex CHD including TOF [tertralogy of fallot], pulmonary atresia and ventricular septal defect, coarctation of the aorta, etc. These complex CHD procedures have been established in pediatric cardiac centers.’^{[footnote 37]}

3.3 Paediatric nephrology

3.3.1 The West China Women’s and Children’s Hospital stated:

‘We are outstanding in the diagnosis and management of pediatric renal diseases, such as acute glomerulonephritis, nephritic syndrome, acute and chronic renal failure, allergic purura, anaphylatic purpura nephritis, systemic lupus erythematosus, lupus nephritis, acute and chronic urinary tract infection.

‘Equipped with dialysis machine, continuous renal replacement therapy machine and plasmapheresis machine, our blood purification therapy has developed quickly for the past 5 years, which plays an important role in treating children suffering toxication, bees or wasp stings, acute and chronic renal failure, inflammatory reaction syndrome, multiple organ failure, septicemia, pyemia, toxemia, as well as other immunological diseases.’38

3.4 Paediatric cancer treatment

3.4.1 The West China Women’s and Children’s Hospital website stated:

‘Pediatric Hematology and Oncology was established in 1973 in the Department of Pediatrics of the First University Hospital, West China University of Medical Sciences…

‘As the biggest center in West China for child hematology-oncology diseases, the division receives about two hundred new patients every year. We are outstanding in China for the diagnosis and treatment of child anemia, hemorrhagic diseases, leukemia, and other malignant solid tumors. Our hematopoietie stem cell transplantation laminar flow ward is best equipped in China, covering a floor area of 200 square meters…With this technology, we have successfully treated children with acute leukemia, chronic granulocytic leukemia, Thalassemia major, severe aplastic anemia, refractory lymphoma, neuroblastoma, Rhabdomyosarcoma and so on.’^{[footnote 39]}

3.4.2 See also Eye conditions and diseases.

4. COVID-19

Section 4 updated: 18 May 2022

4.1.1 The Biomedcentral report, COVID-19 and healthcare system in China: challenges and progression for a sustainable future, published in January 2021, stated:

‘Physical hospitals failed to efficiently function both for patients infected with COVID-19 and those with other diseases during the epidemic.

‘In some of the hardest-hit cities, medical resources were not available for every COVID-19 patient…

‘A considerably wider hospital-related transmission of the virus was reported in physical hospitals. Patients with atypical clinical manifestations were also contagious during the incubation period. Similarly, frontline healthcare workers were exposed to a high risk of infection, increasing the transmission to patients hospitalized for other diseases. To control the nosocomial spread of the virus, a large number of physical hospitals postponed or canceled outpatient appointments…

‘As the epidemic progressed, almost all tertiary and secondary hospitals across the country experienced a serious dearth of medical resources… The number of beds available in the hospitals designated for treating coronavirus patients was insufficient. The scarce supply of qualified medical resources further aggravated the healthcare burden…

‘To solve the dilemma between the demand for medical care and the inaccessibility of medical services, the Chinese government has issued a series of policies, such as the incorporation of online medical services and long-term prescription into medical insurance, to empower Internet hospitals and thereby address public health emergencies…

‘Most Internet hospitals are based on physical hospitals where patients receive almost the same medical services as those in physical hospitals, such as prescriptions and health insurance programs. The COVID-19 epidemic is the first instance in which Internet hospitals were involved in a public health emergency caused by an infectious disease.’^{[footnote 40]}

4.1.2 The Blavatnik School Working Paper, Chinese Provincial Government Responses to COVID-19, dated 25 January 2022, stated:

‘Five major waves of COVID-19 outbreaks have hit China since the beginning of 2021, tied to imported sources. The second, third, and fourth surges were caused by the Delta variant, two of which spread to more than ten provinces, and both the Delta and Omicron variants spread across provinces during the latest wave.

‘In coping with the Delta variant, China has maintained the policy target of “dynamic clearance”, aiming to halt all community transmission of COVID- 19, while the response patterns have gradually transitioned along five stages through 2021 and into 2022: 1) widespread preventative measures in January 2021 in anticipation of greater mixing during the Chinese New Year season, 2) A relatively low baseline level of prevention and control measures from March to June, 3) A reactive response in July to the Delta variant, 4) relatively high baseline prevention and control measures from August to October, and 5) more targeted measures in November and December…

‘Apart from Non-Pharmaceutical Interventions (NPIs), China has fully vaccinated more than 85% of people, and more than 0.33 bn (23%) people have received booster shots by 6 January 2022. The government is now working to promote booster shots further.’^{[footnote 41]}

4.1.3 The Voice of America report, Much of Shanghai Locked Down as Mass COVID-19 Testing Begins, reported on the lockdown imposed in Shanghai in March 2022:

‘Already, many communities within the city of 26 million have been locked down, with their residents required to submit to multiple tests for COVID-19…

‘In response to its biggest outbreak in two years, China has continued to enforce what it calls the “dynamic zero-COVID” approach…

‘That requires lockdowns and mass testing, with close contacts often being quarantined at home or in a central government facility. The strategy focuses on eradicating community transmission of the virus as quickly as possible, sometimes by locking down entire cities…

‘National data released earlier this month showed that over 52 million people aged 60 and older have yet to be vaccinated with any COVID-19 vaccine. Booster rates are also low, with only 56.4% of people between 60-69 having received a booster shot, and 48.4% of people between 70-79 having received one.’^{[footnote 42]}

4.1.4 The Independent report, Nearly half of Hong Kong infected with Covid as city struggles to contain new outbreak, dated 16 March 2022, stated:

‘Nearly half of Hong Kong’s population have been infected with Covid-19 so far, according to researchers…

‘Hong Kong has been in the grip of a spiralling outbreak of the Omicron variant of Covid, with a fifth wave sweeping the city since December end last year, overwhelming healthcare facilities. Hospitals have been swamped with an influx of Covid patients and morgues are at breaking point.

‘Researchers at the University of Hong Kong have estimated that about 3.6 million residents of Hong Kong – out of a total population of 7.4 million – have been infected with Covid through 14 March [2022]…

‘On Wednesday, Hong Kong reported 29,272 new infections and 217 deaths. It has so far recorded about 790,000 Covid infections and close to 5,000 deaths, most in the past three weeks…

‘Local reports suggest that elderly residents of care homes have accounted for 59 per cent of the total deaths. Most of them were unvaccinated…

‘The city is facing its most draconian measures since the pandemic started in 2020. More than two people are not allowed to gather anywhere, while schools and most other venues are shut.’^{[footnote 43]}

4.1.5 Our World in Data provides a range of health information including information related to the Covid-19 pandemic.

4.1.6 See also Reuters Covid-19 Tracker,

4.1.7 See also China: WHO Coronavirus Disease (COVID-19) Dashboard With Vaccination Data

5. Cancer

5.1 General

Section 5 updated: 26 May 2022

5.1.1 The Zhejiang Cancer Hospital in Hangzhou can provide a wide range of cancer treatment services, as explained in the hospital’s website:

‘Founded in October 1963, Zhejiang Cancer Hospital (ZJCH) is one of the earliest four cancer specialized hospitals in China to maintain the highest standards of excellence in patient care, cancer prevention, research, education and rehabilitation and is ranked among the Top 10 Best Cancer Hospitals of China for 8 consecutive years…

‘Patient care in 2020:

• Over 563,007 outpatients, 60,353 of whom were new patients,

• Nearly 134,840 inpatient stays,

• Approximately 22,156 surgerical [sic] operations,

• Over 9,588 radiotherapy cases and 70,647 chemotherapy cases respectively…

‘With 1,910 inpatient beds, the hospital is home to 51 medical departments, including surgery, medical oncology, and radiation oncology, etc.’^{[footnote 44]}

5.1.2 MedCOI advised in a response of 31 May 2019 that oncologists (cancer specialists) were available in China, at the China-Japan Friendship Hospital in Beijing (public facility), in 2019^{[footnote 45]}.

5.1.3 A MedCOI response, dated 3 December 2019, stated that dacomitinib (anti-cancer drug) was available in China (Beijing United Family Hospital and Clinic [public facility]), in 2019^{[footnote 46]}.

5.1.4 A MedCOI response, dated 31 May 2019, stated that nilotinib hydrochloride monohydrate (chemotherapy drug) was available in China (Shanghai Ruijin Hospital [public facility]), in 2019^{[footnote 47]}.

5.2 Lung cancer

5.2.1 The Journal for Thoracic Oncology (JTO) report, Lung Cancer in People’s Republic of China, dated 1 October 2020, stated:

‘There are 1413 radiotherapy centers in the People’s Republic of China. Three-dimensional conformal radiation therapy and intensity-modulated radiation therapy (IMRT) are available in 86.2% and 67.4% centers, respectively, and most are academic cancer centers or with university affiliation. Advanced technologies, including four-dimensional CT [computed tomography] or PET [positron emission tomograpy]–CT simulation, IMRT [intensity modulated radiation therapy] /volumetric- modulated arc therapy, image-guided radiation therapy, and motion management, are widely used for lung cancer across the country, and the IMRT technique has been reported to have a significantly improved locoregional recurrence-free survival and comparable OS [overall survival] than three-dimensional conformal radiation therapy in locally advanced NSCLC [non-small cell lung cancer treatment], along with reduction of pulmonary toxicity…

‘The use of radiation therapy for lung cancer has been significantly increasing in the People’s Republic of China in the past decades. Nevertheless, there is still a gap between availability and demand of radiation therapy.’^{[footnote 48]}

5.2.2 The JTO report, Lung Cancer in People’s Republic of China, also stated:

‘Surgery for lung cancer has been evolving very rapidly in the country in the past two decades. In most provincial or regional medical centers, minimally invasive approaches, such as VATS [video-assisted thoracic surgery], are widely applied in routine cases…Surgical incisions became “fewer and smaller,” whereas resection procedures went up to becoming “more complicated and faster.” More surgeons are challenging uniportal VATS on the basis of three portal techniques and practical improvements of surgical instruments to minimize the surgical damage to patients, both physically and psychologically.’^{[footnote 49]}

5.2.3 The WCHSU website stated the following about the hospital’s lung cancer treatment services:

‘The Lung Cancer Center is the largest lung cancer diagnosis and treatment center in western China, also a demonstration base for lung cancer screening and early-stage diagnosis and treatment, a base of drafting the Guidelines for Clinical Treatment of Lung Cancer in China, the origin of new technologies and methods for lung cancer treatment, an innovative platform for China’s lung cancer fundamental research, a center for R & D [research and development] of innovative medicines and study of translational medicine, a center of preventing and treating lung cancer in China and a talent training base…

‘Institutional features: The Lung Cancer Center is the first single-cancer comprehensive treatment center of the hospital. Senior experts from Thoracic Surgery, Medical oncology, Radiation oncology, Respiratory, Pathology, Imaging, Tumor Radiation Physical Technology Center, etc., are working together to render comprehensive medical services for patients…the diagnosis, treatment and recovery of the lung cancer are completed at the same department, thus providing optimal individualized treatment solutions for patients with lung cancer…

‘Lung cancer medical oncology: It includes pre-operative chemotherapy, post-operative adjuvant chemotherapy, chemotherapy for advanced patients, combined chemoradiotherapy, molecular targeted therapy, immunotherapy and anti-angiogenesis therapy.

‘Lung cancer radiation oncology: It includes pre-operative radiotherapy, post-operative adjuvant radiotherapy, and radical radiotherapy.’^{[footnote 50]}

5.3 Breast cancer

5.3.1 A China Daily article, New breast cancer drug now available in China, dated 26 November 2018, stated:

‘Advanced breast cancer patients in China now have another treatment option other than chemotherapy to choose from following the approval of a new oral drug called Ibarnce by the China Food and Drug Administration.

‘Developed by US-based pharmaceutical company Pfizer, Ibarnce is presently available to patients in 35 Chinese cities…

‘The report also showed that about one-tenth of patients already suffer from advanced breast cancer when diagnosed, while about one-third of those who detect the condition early and have undergone surgery or standardized treatment will still develop advanced breast cancer.’^{[footnote 51]}

5.3.2 The WCHSU website provided the following information:

‘The Department [of Breast Surgery] has become a diagnosis and treatment center of breast diseases in southwestern China combining medical care, teaching & learning and research. It has an annual outpatient volume of 60,000-70,000, and an annual operation volume of 5,000, including about 2,000 surgeries of breast cancer.

‘As a national treatment center for complicated and critical diseases, the Department has established a comprehensive multidisciplinary collaborative diagnosis and treatment system (Oncology, Medical Imaging, Nuclear Medicine, Pathology, Plastic Surgery and State Key Laboratory of Oncology) to provide individualized diagnosis and treatment services for patients.’^{[footnote 52]}

5.4 Prostate cancer

5.4.1 The China Daily report, New medicine for prostate cancer available in China, dated 28 November 2019, stated:

‘New medicine to treat patients with non-metastatic castration-resistant prostate cancer (nmCRPC) is available in China to save those at high risk of developing metastases.

‘The Xian Janssen Pharmaceutical Ltd announced on Wednesday [27 November 2019] that Erleada (apalutamide) was put on the market in China after being granted by the China National Medical Products Administration (NMPA) in September [2019], recognizing the urgent unmet need for patients with nmCRPC who currently have few treatment options.

‘Erleada is an androgen receptor inhibitor that works by preventing androgen from binding to the androgen receptor. It has been shown to delay the time to distant metastasis. Treatment with Erleada has also shown to result in the control of Prostate-Specific Antigen (PSA) levels, which is an important indicator during the early treatment and prognosis of patients with prostate cancer…

‘Erleada is now available in major Chinese cities including Beijing, Shanghai, Guangzhou and Tianjin.’^{[footnote 53]}

5.4.2 A MedCOI response, dated 11 March 2019, stated that urologists (Shanghai Zhong Shan Hospital, Shanghai), and cancer specialists (China-Japan Friendship Hospital, Beijing) were available in China in March 2019, and can treat men with prostate cancer. In addition, radiation therapy, PSA testing, and PET [positron emission tomograpy]–-scan imaging were also available (China-Japan Friendship Hospital, Beijing)^{[footnote 54]}.

5.5 Brain cancer

5.5.1 The Beijing Puhua Hospital website stated the following about its cancer surgery treatment services:

‘The Center’s surgeons often operate on brain tumors that have been pronounced as “inoperable” by others…

‘Surgery Candidates: comprehensive treatment protocol to remove tumor maximally and prevent recurrence:

1. Surgery: to remove tumor maximally while protecting functional area.

2. Intra-operative Radiotherapy (IORT): local radiotherapy to kill the residual cancer cells and prevent recurrence.

3. Intra-operative Chemotherapy (IOCT): local chemotherapy to kill the residual cancer cells and prevent recurrence.

4. Photon Dynamic Treatment (PDT): applied to highly malignant tumor to kill the residual cancer cells and prevent recurrence.

‘Non-surgery Candidates: effective and safe therapies to lessen suffering, prolong survival, and improve life quality:

1. Targeted chemotherapy: based on genetic analysis, specific chemotherapy medicine to inhibit/kill tumor cell growth.

2. DC-CIK: CIK (Cytokine Inductive Killer-cell) and DC (Dendritic Cell) can fight tumor cells.

3. High dose vitamin C (IVC protocol): studies and clinical experience showed high dose vitamin C can inhibit cancer cell growth and improve patient’s overall condition.

4. Stem Cell Treatment: inhibit tumor cell growth.

5. Traditional Chinese Medicine (TCM): improving the patient’s overall condition by improving immune system and decreasing the toxicity of other therapies.’^{[footnote 55]}

5.6 Liver cancer

5.6.1 The WCHSU website stated:

‘Surgical and Interventional Treatment for Liver Cancer: The department carries out about 1,500 hepatectomy [sic] every year, of which about 1,200 cases for liver cancer recurrence of liver cancer and re-recurrent liver cancer, minimally invasive liver resection (laparoscopic and robotic assisted) reaches 30%. ALPPS [Associating Liver Partition and Portal vein Ligation for Staged hepatectomy] surgery is routinely performed. The Department has an intervention and minimally invasive treatment group, which routinely carries out hepatic arterial chemoembolization with liver iodized oil, drug-loaded microsphere chemoembolization and radiofrequency ablation. It works closely with the surgical team to induce the second stage resection by portal vein embolism (PVE). The Department is also the first one in China to carry out hepatic venous deprivation (LVD) to induce two-stage liver resection.’^{[footnote 56]}

5.6.2 See also Liver diseases section.

5.7 Cervical cancer

5.7.1 The Zhejiang Cancer Hospital’s Gynaecological Radiotherapy Department can provide treatment services to treat cervical cancer, as explained in the hospital’s website:

‘Our department has 2 wards receiving around 4000 inpatients of cervical cancer as well as other gynecological malignancies and serving nearly 80000 outpatients each year. With the development of new technologies and accelerators, we are able to offer a full range of both conventional and high-technology radiation treatment for patients, external beam radiotherapy including intensity modulated radiation therapy (IMRT), Image Guided Radiation Therapy (IGRT), Volumetric Modulated Arc Therapy (VMAT), Tomotherapy (TOMO) and stereotactic body radiation therapy (SBRT). Individualized radiotherapy is precisely served for those young patients who expect to keep the ovarian function…

‘We also provide chemotherapy, targeted therapy, immunotherapy and endocrine therapy. By working in a multidisciplinary team mode, we develop individualized treatment for many patients.’^{[footnote 57]}

5.8 Cancer of the head and neck

5.8.1 The Zhejiang Cancer Hospital’s Head and Neck Radiation Department can provide treatment services to treat head and neck cancers, as explained in the hospital’s website:

‘In the head and neck radiation department, our duty is to deliver the highest possible clinical care for patients with cancer of the head and neck. Using an interdisciplinary approach, experts from across disciplines come together in the head and neck center to provide state-of-the-art care for patients with all types and stages of head and neck cancer.

‘Our team of specialists treats patients with tumors of the nasopharynx, oropharynx, hypopharynx, larynx, central nervous system, paranasal sinus, oral cavity, salivary glands, as well as second malignancy of cervical lymph node with occult primary foci and mucosal melanoma.’^{[footnote 58]}

5.9 Thoracic surgery

5.9.1 The Zhejiang Cancer Hospital in Hangzhou can provide thoracic surgery to treat thoracic cancers, as explained in the hospital’s website:

‘The Department has particular expertise in the management of complex surgical conditions, including esophageal cancer, cardic [sic] cancer, lung cancer, tracheal tumors, mediastinum tumors and chest wall tumors. Currently, six medical groups are responsible for two and a half wards with a total number of 150 beds. There are 30 doctors including 6 chief physicians and 8 associate chief physicians. Every year, over 3000 surgeries are performed here, including over 2000 lung cancer surgeries and over 400 esophageal cancer surgeries.’^{[footnote 59]}

5.10 Urological cancers

5.10.1 The Zhejiang Cancer Hospital in Hangzhou can provide treatment services to treat urological cancers, as explained in the hospital’s website:

‘Our department specializes in treating patients with genitourinary (GU) system cancers, including prostate, bladder, kidney, adrenal gland, ureter, urethra, testis, penis and so on…

‘Our department carries out about 1000 operations of GU system tumors every year. With Multidisciplinary Team (MDT) and minimally invasive surgery as the core technology, we combine surgery with chemotherapy, radiotherapy, hormonal therapy, targeted therapy, immunotherapy and other treatments, which have greatly improved the survival rate and quality of patients with GU cancer. Most of the operations are minimally invasive surgeries such as laparoscopic cystectomy, radical prostatectomy, retroperitoneal lymph node dissection, inguinal lymph node dissection, partial nephrectomy, radical nephrectomy and nephroureterectomy, as well as some endourologic surgery including transurethral resection of bladder tumor, transurethral resection of prostate, ultrasound guided radioactive seeds implantation for prostate cancer and ureteroscopic surgery. Recently, we have performed robot-assisted surgery for urinary system tumors.’^{[footnote 60]}

5.11 Gastroenterological cancers

5.11.1 The Zhejiang Cancer Hospital’s Department of Abdominal Medical Oncology can provide treatment services to treat gastroenterological cancers, as explained in the hospital’s website:

‘The mission of our department [Department of Abdominal Medical Oncology] aims to provide comprehensive medical care for patients with gastric cancer, colorectal cancer, hepatobiliary and pancreatic cancer, advanced gastrointestinal stromal tumor and neuroendocrine tumor, in order to improve the prognosis and quality of life for patients. Our team is dedicated to providing, on the basis of multidisciplinary discussions, comprehensive and individualized treatments, including chemotherapy, targeted therapy, immunotherapy, hyperthermia and intervention therapy, which has created excellent demonstration effects.’^{[footnote 61]}

5.12 Bone and skin cancers

5.12.1 The Zhejiang Cancer Hospital’s Department of Bone and Soft Tissue can provide treatment services to treat bone and skin cancers, as explained in the hospital’s website:

‘The Department of Bone and Soft Tissue Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (CHUCAS, Zhejiang Cancer Hospital) is one of the earliest departments, [to] focus on the treatment of bone and soft tissue tumor, cutaneous tumor and retroperitoneal tumor in China. There are more than 40 beds in our department. Our team consists of 8 talented surgeons, holding master degree or PhD…

‘We pioneer in intraoperative high dose brachytherapy combined with hyperthermia therapy for soft tissue sarcoma in China…

‘We also operate on patients with spinal and limb metastasis following MDT review, to improve their quality of life. The operations involve PVP/PKP, arthroplasty and internal fixation including total en bloc spondylectomy (TES).

‘We are experienced in diagnosis and treatment of all kinds of cutaneous tumors, including melanoma, cutaneous squamous cell carcinoma, cutaneous basal cell carcinoma and Merkel cell carcinoma. We treat more than 400 cutaneous tumor patients per year…Targeted therapy and immunotherapy have been widely used in the department.’^{[footnote 62]}

5.13 Colorectal cancers

5.13.1 The Zhejiang Cancer Hospital’s Department of Colorectal Surgery can provide treatment services to treat colorectal cancers, as explained in the hospital’s website:

‘The department of Colorectal Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (CHUCAS), was established in 1984, which is one of the earliest specialty sections to provide the diagnosis and treatment of colorectal cancer (CRC) in China. The department is divided into two units with 124 inpatient beds and 60 medical staffs, including 4 chief and 7 deputy chief surgeons.

‘The department admits approximately more than 3,000 inpatients, handles 17,000 outpatient visits and performs nearly 2,000 colorectal operations annually (including 1,200 laparoscopic colorectal surgery).’^{[footnote 63]}

Section 6 updated: 24 March 2022

6. Cardiovascular diseases

6.1 Cardiology and high blood pressure

6.1.1 The WCHSU website provided the following information about its services:

‘…the Department of Cardiology of West China Hospital, SCU, has gradually developed into a national key clinical specialty, a diagnosis and treatment center for complicated and critical cardiovascular diseases in the Western China, and a quality control center for cardiovascular diseases in Sichuan Province. It is the only training base for interventional diagnosis and treatment of coronary heart disease, arrhythmia and congenital heart disease in Sichuan Province accredited by the National Health Commission.

‘The Department has 57 doctors, 134 nurses and 14 technicians, including 20 with senior professional titles, 16 with associate senior professional titles, as well as 9 Ph.D. tutors and 4 master tutors. It consists of 3 medical and nursing units…2 interventional catheterization labs (9 interventional operating rooms in total), and 2 auxiliary examination units (echocardiography room and noninvasive ECG examination room). It has 8 sub-specialty groups, including coronary heart disease, congenital heart disease, valvular heart disease, electrophysiology, heart failure and device treatment, hypertension, cardiac critical care and noninvasive heart examination.’^{[footnote 64]}

6.1.2 MedCOI stated that the following drugs, used to treat high blood pressure, were available in China in 2020 :

• Hydrochlorothiazide + Irbesartan (combination) (Peking University Third Hospital [public facility])^{[footnote 65]}

• Hydrochlorothiazide (Peking University Third Hospital)^{[footnote 66]}

• Irbesartan (Seventh People’s Hospital of Hangzhou [public facility])^{[footnote 67]}

• Lisinopril (Raffles Beijing Medical Clinic) (private facility)^{[footnote 68]}

• Captopril (Jishuitan Hospital) (private facility)^{[footnote 69]}

• Ramipril (Peking University Third Hospital) (public facility)^{[footnote 70]}

• Metoprolol (Peking University Third Hospital)^{[footnote 71]}

• Nifedipine (Peking University Third Hospital)^{[footnote 72]}

• Nitrendipine (Beijing Aerospace General Hospital) (public facility)^{[footnote 73]}

• Bumetanide (Fuwai Hospital, Beijing) (public facility)^{[footnote 74]}

• Furosemide (Peking University Third Hospital) (public facility)^{[footnote 75]}

• Spironolactone (Beijing Yanhua Hospital) (public facility)^{[footnote 76]}

• Triamterene (Jing Mei Hospital, Beijing) (public facility)^{[footnote 77]}

• Perindopril (Raffles Medical Beijing Clinic)^{[footnote 78]}

• Fosinopril (China-Japan Friendship Hospital, Beijing [private facility])^{[footnote 79]}

• Felodopine (Raffle Medical Beijing Clinic) (private facility)^{[footnote 80]}

• Amlodipine (Peking University Third Hospital) (public facility)^{[footnote 81]}

• Atenolol (Peking University Third Hospital)^{[footnote 82]}

• Bisoprolol (Peking University Third Hospital)^{[footnote 83]}

• Nicardipine (China-Japan Friendship Hospital)^{[footnote 84]}

• Indapamide (Peking University Third Hospital)^{[footnote 85]}.

6.1.3 MedCOI responses provided between April 2019 and August 2020 stated that the following drugs, used to treat cardiovascular diseases, were available in China:

• Rosuvastatin (Peking University Third Hospital) (public facility)^{[footnote 86]}

• Aspirin (anti-blood clotting) (Raffles Medical Beijing Clinic)^{[footnote 87]}

• Warfarin (China Peking Union Medical College Hospital) (public facility)^{[footnote 88]}

• Clopidogrel (anti-blood clotting) (Raffles Medical Beijing Clinic)^{[footnote 89]}

• Carbasalate calcium (China Peking Union Medical College Hospital)^{[footnote 90]}

• Ticagrelor (anti-blood clotting) (Raffles Medical Beijing Clinic) (private facility)^{[footnote 91]}

• Pravastatin (Peking University Third Hospital)^{[footnote 92]}

• Simvastatin (Peking University Third Hospital)^{[footnote 93]}

• Atorvastatin (Peking Union Medical College Hospital)^{[footnote 94]}

• Isosorbide mononitrate (used to treat angina pectoris) (Peking Union Medical College Hospital)^{[footnote 95]}

• Isosorbide dinitrate (used to treat angina pectoris) (Peking Union Medical College Hospital^{[footnote 96]}

• Nitroglycerin (used to treat angina pectoris) (Peking Union Medical College Hospital^{[footnote 97]}.

6.2 Heart surgery

6.2.1 The WCHSU website provided the following information about its services: ‘The Department of Cardiovascular Surgery of West China Hospital,…receives over 40,000 outpatients and performs about 3,300 cardiovascular surgeries annually, taking the lead among peer facilities in similar areas.

Cardiovascular surgeries performed include transapical aortic valve replacement (TAVR), heart transplantation, valvuloplasty and replacement, complex congenital heart disease and “hybrid” mosaic therapy in pediatric patients, minimally invasive occlusion of congenital heart disease, surgical ablation for atrial fibrillation, thoracoscopic minimally invasive cardiac surgery, coronary artery bypass grafting, open heart surgery, thoracic endovascular aortic repair (TEVAR) of aortic aneurysm and aortic dissection, and other heart disease surgeries.’^{[footnote 98]}

7. Dental treatment and conditions

Section 7 updated: 27 May 2022

7.1.1 The BMC Oral Health November 2020 research paper, Dentists’ entrepreneurial intention and associated factors in public hospitals in major cities in Guangdong (South China): a cross-sectional study, stated:

‘It is estimated that over 85% of the dental costs have to be paid out of pocket. Many urban middle-class residents, especially those in central cities, prefer to choose private dental clinics because they are willing to and can afford to pay for the better patient experience provided by private dental clinics. These private clinics can provide a facility with a patient-friendly environment, patient communications with patients, advanced diagnostic and treatment equipment, a short or no waiting time, flexibility in appointments, and so on.

‘At the current stage, the dental care supply in China is still insufficient to meet the rising demand. By 2018, there were 314,347 trained dentistry personnel in mainland China, among whom 171,587 (54.6%) were dentists, 37.8% were dental nurses and 7.6% were dental technicians. The density of dentistry personnel (per 1000 population) was about 0.129 in 2018, while the WHO standard is 0.2. There were in total 75,399 dental service units among all healthcare providers in mainland China. By institution number, 73.8% of these service units exist as dental departments of general hospitals.’^{[footnote 99]}

7.1.2 The BMC research paper also stated:

‘Dental clinics in Shanghai can provide the following dental care treatment and procedures:

• Examinations (with or without x-rays)

• Cleaning to remove tartar

• Fillings

• Inlays

• Crowns

• Bridges

• Implants

• Root canal treatment

• Extractions

• Orthodontic treatment

• Facings

• Bleaching.’^{[footnote 100]}

7.1.3 The scientific research report, Socio–Economic Disparities in Dental Health and Dental Care Utilisation Among Older Chinese, published in the International Dental Journal in February 2021, stated:

‘Dental care services have improved in China from the 1990s to date…New health-policy developments in China are redefining dental care to align with the standard of oral health found in developed countries in Europe. First, related to the supply side, private dental clinics are in a phase of rapid growth as a result of sustained policy support of private health care. Twenty years ago, dental services were only available in dental hospitals and in some tertiary and secondary general hospitals in major cities. Dental care services are now provided by both hospitals and standalone clinics throughout the country…

‘Dental hygiene, oral examinations, X-rays, root canal treatment, treatments for gum disease and provision of crowns are not covered by the social medical insurance. Moreover, from the supply side, most dental hospitals and dental departments in general hospitals are owned by local governments but have a high level of market orientation that focuses on meeting the needs of clients. Most standalone dental clinics are privately owned and managed.’^{[footnote 101]}

7.1.4 See also Private health insurance and Public health insurance.

Section 8 updated: 5 January 2022

8. Diabetes

8.1.1 A MedCOI response, dated 28 May 2020, noted that the following treatment was available in China (China-Japan Friendship Hospital, Beijing [public hospital]) in May 2020:

• Laboratory research of blood glucose (including HbA1C tests)

• Blood-glucose self-testing meters

• Blood-glucose self-testing strips

• Laboratory research of lipid profile (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides)^{[footnote 102]}.

8.1.2 MedCOI responses noted that the following diabetes-control drugs were available in China in 2020:

• Metformin (Peking University Third Hospital [public hospital])^{[footnote 103]}

• Gliclazide (Peking University Third Hospital)^{[footnote 104]}

• Insulin: long acting [24hr] (Raffles Medical Beijing Clinic [private facility])^{[footnote 105]}

• Insulin: rapid acting [2-5hr] (Raffles Medical Beijing Clinic)^{[footnote 106]}

• Glibencamide (Raffles Medical Beijing Clinic)^{[footnote 107]}.

9. Ear, nose and throat conditions (ENT)

Section 9 updated: 11 January 2022

9.1.1 The West China Hospital of Sichuan University website provided the following information about its ENT medical services:

‘The Department of Otolaryngology-Head and Neck Surgery of West China Hospital of Sichuan University has 40 doctors and 34 nurses, including 10 professors, 11 associate professors, 4 doctoral supervisors, and 10 master supervisors…

‘… the Department has a complete set of specialties

‘1. Otology: comprehensively carries out special examinations, diagnosis and medical and surgical treatment of various ear diseases (including facial nerve diseases), including hearing reconstruction, cochlear implantation and various hearing compensation technologies; develops various vertigo diseases special examination, diagnosis and medical and surgical treatment…

‘2. Rhinology: diagnosis and treatment of various nasal and sinus diseases, nasal endoscopic sinus surgery, cerebrospinal fluid rhinorrhea repair, nasal-sphenoid sinus-pituitary tumor resection, nasal skull base surgery, and nose-eye related operations Surgery…

‘3. Throat: The throat sub-specialty is divided into snoring and voice disease diagnosis and treatment centers…

‘5. Hearing center: It has 6 listening rooms, 4 auditory speech rehabilitation rooms, and world-class audiological testing equipment…Its services range from newborn babies to the elderly, from the discovery and diagnosis of hearing problems to counselling for hearing and speech rehabilitation and hearing protection issues…

‘6. Cochlear Implant Center…It is the first batch of designated centers for cochlear implantation in the National Financial Eleventh and Twelfth Five-Year Deaf Children’s Rehabilitation Rescue Project.’^{[footnote 108]}

Section 10 updated: 24 March 2022

10. Epilepsy and neurological conditions

10.1.1 A MedCOI response, dated 27 March 2019, stated that neurologists (who can treat people with epilepsy) were available in China in March 2019 (Xuan Wu Hospital, Beijing). Neurosurgeons were available in China in March 2019 (Peking Union Medical College Hospital, Beijing)^{[footnote 109]}.

10.1.2 MedCOI responses stated that the following anti-epileptic drugs were available in China in 2019/2020:

• Levetiracetam (Peking Union Medical College Hospital, Beijing)^{[footnote 110]}

• Gabapentin (Peking Union Medical College Hospital, Beijing)^{[footnote 111]}

• Lamotrigine (Peking Union Medical College Hospital, Beijing)^{[footnote 112]}

• Valproic acid (Peking Union Medical College Hospital, Beijing)^{[footnote 113]}

• Phenobarbital (Peking Union Medical College Hospital, Beijing)^{[footnote 114]}

• Topiramate (Beijing Children’s Hospital, Beijing) (public facility)^{[footnote 115]}

• Midazolam (Beijing Tiantan Hospital, Beijing) (public facility)^{[footnote 116]}

• Diazepam (Peking Union Medical College Hospital, Beijing) (public facility)^{[footnote 117]}.

Section 11 updated: 13 January 2022

11. Eye conditions and diseases

11.1.1 The WCHSU website provided the following information about its eye disease medical services:

‘The Department of Ophthalmology has 20 outpatient diagnosis rooms and 84 beds at the main campus, and another 47 day surgery beds and outpatient services at Yongning Branch Campus. The Department has subspecialties of retina, pediatric ophthalmology, glaucoma, cataract, corneal disease, orbital disease, eye plastic surgery, lacrimal disease and neuro-ophthalmology, a Refractive Surgery Center and an Optometry Center. With its state-of-the-art diagnostics and treatment equipment,the Department is capable of variety of ophthalmic surgeries, including micro-incision cataract phacoemulsification and intraocular lens implantation, corneal transplant surgery, micro-invasive vitreoretinal surgery, various antiglaucoma surgery and orthopedic surgery, besides the routine strabismus surgery and orbital diseases surgery, corneal and intraocular refractive surgery…

‘Optometry and Pediatric Ophthalmology Group…carries out the diagnosis and treatment of strabismus and amblyopia, the diagnosis and treatment of various children’s eye diseases, the correction of children’s refractive errors, the fitting of orthokeratology and RGP [rigid gas permeable lenses], and amblyopia treatment, vision training, children’s myopia prevention and control, and clinical medical and clinical research work for children’s eye care. The professional and technical level is leading in the country and in line with international standards.

‘At present, the group has specialty clinics such as pediatric ophthalmology clinics, children’s myopia clinics, and contact lens clinics…

‘At present, the specialty treatments include: micro-invasive strabismus surgery, painless strabismus surgery, ocular muscle surgery at early age (6 months after birth) and venerable age (over 80 years old), comprehensive rehabilitation treatment of nystagmus, and vertical strabismus. Surgical treatment of restrictive strabismus, treatment and rehabilitation of central eye movement and visual dysfunction.’^{[footnote 118]}

11.1.2 See also Paediatric diseases and healthcare.

11.1.3 For more information on the work the hospital undertakes in in relation to cataracts, eye surgeries and glaucoma, see the WCHSU website.

Section 12 updated: 24 March 2022

12. Gastroenterology

12.1.1 MedCOI responses stated that the following gastroenterological drugs were available in China, in 2019/2020:

• Metoclopramide (motion sickness/nausea) (Peking Union Medical College Hospital, Beijing [public facility])^{[footnote 119]}

• Ondansetron (China-Japan Friendship Hospital, Beijing [public facility])^{[footnote 120]}

• Domperidone (motion sickness/nausea)(China-Japan Friendship Hospital, Beijing)^{[footnote 121]}

• Macrogol (constipation) (Peking Union Medical College Hospital, Beijing)^{[footnote 122]}

• Bisacodyl (constipation) (Peking Union Medical College Hospital, Beijing)^{[footnote 123]}

• Lactulose (Peking Union Medical College Hospital, Beijing)^{[footnote 124]}

• Macrogol + electrolytes (laxative) (Peking Union Medical College Hospital)^{[footnote 125]}

• Sterculia (laxative) (Peking Union Medical College Hospital)^{[footnote 126]}

• Pantoprazole (used to reduce stomach-acid) (China-Japan Friendship Hospital, Beijing)^{[footnote 127]}

• Rabeprazole sodium (Raffles Medical Beijing Clinic [private facility])^{[footnote 128]}

• Sodium bicarbonate (Raffles Medical Beijing Clinic)^{[footnote 129]}

• Omeprazole (Raffles Medical Beijing Clinic)^{[footnote 130]}

• Lansoprazole (Raffles Medical Beijing Clinic)^{[footnote 131]}.

13. Gynaecology and obstetrics

Section 13 updated: 20 May 2022

13.1.1 The OASIS International Hospital website stated that the hospital can provide the following treatment services:

• Obstetric care

• Perinatal care

• Assessment of ovarian health

• Hysteroscopy procedures for issues leading to infertility or miscarriages

• Removal of uterine fibroids

• Removal of uterine polyps, uterine septum resection, bicornuate uterus (heart-shaped uterus), and intra-uterine adhesions

• Laparoscopy procedures for issues leading to infertility includes but is not limited to removal of uterine fibroids, endometriosis, uterine malformation, ovarian tumours, polycystic ovary syndrome, fallopian tube obstruction, pelvic adhesions

• Postpartum rehabilitation^{[footnote 132]}.

13.1.2 The West China Women’s and Children’s Hospital (WCWCH) website stated that the hospital can provide the following clinical services:

‘The division is divided into six parts: 1. Obstetric Outpatient Clinic, 2. Obstetric Ward A (VIP ward), 3. Obstetric Ward B (rooming-in), 4. Obstetric C(prenatal medicine), 5. Labor Room, 6. Obstetric Operation Room and ICU.

‘Obstetric Outpatient Clinics

‘In the outpatient clinics, we provide medical clients with all subspecialty services regarding high risky pregnancy, such as high risky pregnancy, hypertensive disorders in pregnancy, fetal growth restriction, endocrine disorders in pregnancy, genetic counseling, early pregnancy, twin pregnancy, prenatal counseling, and nutrition.

‘The expectant mother can choose a doctor in the clinic. And the doctor and his/her group will take care of the client in the process from prenatal to postnatal period…

‘In the Obstetric Division, we have over thirty doctors, including seven professors and three associate professors. Clinically, we have five medical groups and seven nursing groups, with each group headed by a highly experienced doctor or a senior nurse.

‘Obstetric Ward A is a well equipped ward where patients are given family centered high quality services, including a series of holistic nursing, such as pre-labor care, puerperal care, health education, psychological care, breast care, breastfeeding instruction, neonatal care, baby massage and swimming.

‘Obstetric Ward B is a rooming-in ward where newborns stay with mothers and doctors and nurses provide them professional services, which include puerperal care, health education, psychological care, breast care, breastfeeding instruction, neonatal care, baby massage and swimming.

‘Obstetric Ward C is a pre-labor ward, focusing on obstetric complications (such as gestational hypertension, ICP, premature rupture of membrane, placenta previa, premature labor, pregnancy associated with cardiac disease) and fetus health. The ward is equipped with fetus monitoring systems, fetal umbilical blood flow monitors, ultrasound instruments.

‘Labor room and obstetric operation room are equipped with multi-function delivery beds and central fetal monitoring systems. Doula accompanied delivery and analgesic delivery are practiced here.’^{[footnote 133]}

14. HIV/AIDS

Section 14 updated: 23 May 2022

14.1.1 The National Centre for Biotechnology Information (NCBI) (United States) study paper, Optimizing Treatment for Adults with HIV/AIDS in China: Successes over Two Decades and Remaining Challenges, published in 2020, stated:

‘The introduction of the National Free Antiretroviral Therapy Program (NFATP) in 2003 by the China National Center for AIDS/STD Control and Prevention has led to dramatic increases in antiretroviral therapy (ART) coverage among HIV-infected Chinese patients…

‘Great progress has been achieved in the past 20 years in terms of access to and optimization of antiretroviral treatment [ART] in China…

‘Despite continued challenges with achieving early diagnosis of HIV among infected individuals in China, once diagnosed, improved access to ART has meant that HIV/AIDS is no longer a fatal condition for many patients, but a chronic disease that can be well managed with long-term treatment. As a result, the life expectancy of HIV-infected individuals has extended dramatically in China as it has in other regions of the world.’^{[footnote 134]}

14.1.2 The NCBI study paper, Optimizing Treatment for Adults with HIV/AIDS in China: Successes over Two Decades and Remaining Challenges, also stated that the following anti-retroviral drugs were available in China in 2020:

• Lamivudine (provided free)

• Tenofovir (provided free)

• Zidovudine (provided free)

• Abacavir (provided free)

• Efavirenz (provided free)

• Nevirapine (provided free)

• Lopinavir/Ritonavir (provided free)

• Emtricitabine (not provided free)

• Tenofovir alafenamide (not provided free)

• Rilpivirine (not provided free)

• Etravirine (not provided free)

• Darunavir/Cobicistat (not provided free)

• Atazanavir (not provided free)

• Raltegravir (not provided free)

• Dolutegravir (not provided free)

• Albuvirtide (not provided free)^{[footnote 135]}.

14.1.3 The NCBI study paper, Optimizing Treatment for Adults with HIV/AIDS in China: Successes over Two Decades and Remaining Challenges, also stated that the following anti-retroviral drugs were not available in China in 2020:

• Doravirine

• Fosamprenavir

• Nelfinavir

• Saquinavir

• Tipranavir

• Bictegravir

• Elvitegravir

• Enfuvirtide

• Maraviroc^{[footnote 136]}.

14.1.4 A MedCOI response, dated 15 August 2019, stated CD4 count testing, viral load testing, and HIV/AIDS specialists were available in China (Beijing Ditan Capital Medical Hospital [public facility]). Tenofovir alafenamide (ARV drug) was available at Beijing Ditan Capital Medical Hospital (public facility)^{[footnote 137]}.

14.1.5 A MedCOI response, dated 28 July 2020, stated that the ARV drugs - emtricitabine, Descovy, and nevirapine - were available at the Beijing You’an Hospital (public facility)^{[footnote 138]}.

15. Liver diseases

15.1 Liver disease surgery

Section 15 updated: 24 March 2022

15.1.1 The WCHSU website stated the following about its liver disease treatment services:

‘There are currently 31 doctors, including 8 doctoral tutors. The Department now has 92 beds at the main campus and 30 beds at Shangjin Hospital (a branch campus). The Department is especially well-known for its capability of treating difficult and complicated hepatobiliary diseases, and some leading technics domestically and internationally in the fields such as surgery and interventional treatment for liver cancer, minimally invasive liver resection.’^{[footnote 139]}

15.2 Liver transplants

15.2.1 The WCHSU website stated the following about its liver transplant services: ‘The Department is especially well-known for its capability of treating difficult and complicated hepatobiliary diseases, and…, DCD [donation after circulatory death] liver transplantation, living donor liver transplantation, exo-hepatectomy and auto-liver transplantation for hydatid disease.’140

15.2.2 The WCHSU website stated:

‘DCD [Donation after circulatory death ] Liver transplantation and live donor living transplantation:…In the past 2 decades, the Liver Transplant Center of West China Hospital, Sichuan University, performed nearly 1,700 cases of liver transplantation…Among these cases, there are nearly 600 cases of living donor liver transplantation, with the surgical success rate of 100% and the 1-year, 3-year and 5-year survival rates for benign liver diseases up to 87.4%, 85.2% and 80.5% respectively, at a leading level both at home and abroad.’^{[footnote 141]}

15.3 Hepatitis

15.3.1 The Lancet report, The hepatitis B endemic in China should receive more attention, dated 21 April 2018, stated:

‘China’s childhood hepatitis B virus (HBV) vaccination programme is a great public health success, resulting in a prevalence of HBsAg [surface antigen of the hepatitis B virus] of only 1% in children under 5 years…

‘Among the population with HBV infection in China, 28 million people require treatment, with 7 million of these being urgent because of advanced liver disease and the high risk of developing cancer. However, less than one in 50 patients in need of treatment receive it, with the biggest barrier to treatment being affordability…Six medications have been approved for the treatment of chronic HBV, but only lamivudine is included in the Chinese national drug list.’^{[footnote 142]}

15.3.2 The State Council of the People’s Republic of China (PROC) report, China makes progress in curbing hepatitis infection, dated 28 July 2021, stated:

‘More than 2,280 hepatitis B patients had been clinically cured as of June [2021] thanks to a project on chronic hepatitis B treatment launched in China.

‘A total of 13,679 patients were treated under this project by the end of June [2021] since it was launched in 2018 by the Chinese Foundation for Hepatitis Prevention and Control (CFHPC)…

‘China has made remarkable progress in viral hepatitis prevention and control. Programs to immunize the public against hepatitis B — especially vaccination for the newborn — since the 1990s and effective measures to reduce mother-to-child transmission have curbed infections at its source.

‘Through decades of efforts, China has cut the positive rate of hepatitis B virus surface antigen among people under five years old to 0.32 percent, achieving the World Health Organization (WHO) hepatitis B control target in the Western Pacific region ahead of schedule…

‘Most regions in China have included the treatment of viral hepatitis in the healthcare and medical insurance system and several direct acting antiviral drugs for hepatitis C treatment have been approved for sale in China since 2017.’^{[footnote 143]}

15.3.3 A MedCOI response, dated 6 October 2020, noted that the following drugs, used to treat hepatitis B, were available in China in October 2020:

• Tenofovir disoproxil (Beijing Dital Hospital) (public facility)

• Entecavir (Beijing Dital Hospital)

• Tenofovir alafenamide (Beijing Dital Hospital))

• Hepatitis B immunoglobins (Beijing Dital Hospital)^{[footnote 144]}.

16. Kidney diseases

Section 16 updated: 24 March 2022

16.1.1 A MedCOI response, dated 28 May 2020, noted that the following treatment was available in China (China-Japan Friendship Hospital, Beijing [public facility]) in May 2020:

• Inpatient treatment by a nephrologist (kidney disease specialist)

• Outpatient treatment and follow-up care by a nephrologist

• Laboratory research of kidney function (creatinine, ureum, proteinuria, sodium, potassium levels)

• Kidney surgery

• Kidney transplants including precare/aftercare

• Haemodialysis

• Laboratory research/acid-base balance in blood and urine

• Laboratory research: medication level in the blood^{[footnote 145]}.

16.1.2 A MedCOI response, dated 4 November 2020, noted that the following drugs, used in the treatment of kidney diseases, were available in China in November 2020:

• Darbepoetin alfa (China-Japan Friendship Hospital, Beijing) (public facility)

• Epoetin alfa (Peking Union Medical College Hospital) (public facility)

• Lanthanum carbonate (China-Japan Friendship Hospital, Beijing)

• Sevelamer (China-Japan Friendship Hospital, Beijing)146. Section 17 updated: 24 May 2022

17. Palliative care

17.1.1 The Sixth Tone report, China’s Rare Hospices Help Patients Die With Dignity, dated 13 March 2019, stated:

‘Although hospices have existed in China since 1987 and, according to the national health authority, the country had around 2,300 hospice organizations by June 2017, they generally remain in developed cities, inaccessible to most…

‘But Chengjiaqiao Community Health Service Center is trying to restore a measure of peace and dignity to the dying…Today, 76 similar facilities serve thousands of patients across the city, specially designed to provide people with much-needed affordable palliative care during their final days. Chengjiaqiao also offers patients and their families access to social workers and psychological counseling from both in-house staff and a local NGO, Chunhui. Although the facility is relatively small — the hospice facility provides only 66 beds for a district of more than half a million people — it’s still big for China, where most such wards contain a few beds at most. To date, the hospice has served more than 1,000 patients and their families.’^{[footnote 147]}

17.1.2 A MedCOI response, dated 3 December 2019, stated palliative care for people with terminal cancer was available in China (First Affiliated Hospital of Zhongshan University [public facility]), in December 2019^{[footnote 148]}.

17.1.3 The China Daily report, Hospice care sector needs more sustained efforts for development, say experts, dated 15 November 2019, stated:

‘Statistics released at a national hospice care pilot promotion meeting held in Chengdu in June showed that in 2018, 283,000 patients nationwide benefited from hospice care…

‘Qin Yuan, director of the hospice ward at Beijing Haidian Hospital, said that currently, China’s hospice care service is developing rapidly. However, according to the World Health Organization standards, many problems still remain…

‘According to Jing Jun, director at the Research Center for Public Health of Tsinghua University, around 9 million people die in China every year, 75 percent of which are chronic deaths. However, only 20,000 people get palliative care, or hospice care, in institutions.

‘Zhou Zhengshun, executive secretary general of the Palliative Care Council of China Association of Gerontological and Geriatrics, said: “Currently, there are more than 12 million totally disabled senior citizens in China. However, the average number of beds for hospice care in pilot hospitals is in single digit. The demand gap is huge.”…

‘Civil institutions are also taking active steps. According to Jiang Mingyin, from the YiYang Rehabilitation Nursing Care Center in Beijing, the center is now connected with 3A-grade hospitals and rehabilitation centers, so that the terminally ill can be sent from those medical institutions to the center for hospice care.’^{[footnote 149]}

17.1.4 The medical study paper, ‘Not Just Anybody Can Do It’: A Qualitative Study of the Lived Experience of Inpatient Palliative Care Professionals in China’s Mainland, published in May 2021, stated:

‘Over the past 5 years, China has invested substantially in palliative care to meet rising demand. After the introduction of the first national palliative care guideline in 2017, a nationwide pilot program was launched and expanded to 71 regions by the end of 2019. Despite these recent advancements, there are only 12 palliative care units operating in China’s mainland to serve a population of 1.4 billion, compared with 46 such units in Japan and 29 in South Korea.’^{[footnote 150]}

17.1.5 See also the Global Directory of Palliative Care Institutions and Organizations website for a list of palliative care institutions in China.

Section 18 updated: 18 January 2022

18. Tuberculosis (TB) and other lung diseases

18.1.1 The Infectious Diseases of Poverty Journal (IDP) article, Multi-source financing for tuberculosis treatment in China: key issues and challenges, dated 10 March 2021, stated:

‘China is among the top three countries in the world in terms of TB burden, and had 833,000 new cases of TB and 65,000 new cases of drug-resistant TB (DR-TB) during 2019. Payments for TB treatment in China are from the government, social funds, and patients themselves. Under the national TB program, earmarked funds from the central government pay for first-line anti-TB drugs and essential TB tests, including sputum smear tests and chest X-ray examinations. Social health insurance also covers part of the medical costs for TB treatment…TB patients must pay a deductible, a co-payment, and fees for medications and examinations that are not covered by government funds or health insurance. However, poor TB patients can apply for medical assistance from the Civil Affairs Agency, which often covers part of the medical costs for treatment after health insurance reimbursement.’^{[footnote 151]}

18.1.2 A MedCOI response, dated 3 December 2019, noted that pulmonologists (lung disease specialists) were available in China at the First Affiliated Hospital of Zhongshan University in Guangzhou (public hospital). Breathing machines (respirators and ventilators) were available at the First Affiliated Hospital of Zhongshan University. Oxygen therapy and nasal catheters were also available at the First Affiliated Hospital of Zhongshan University^{[footnote 152]}.

18.1.3 See also Lung cancer, Private health insurance and Public health insurance.

Section 19 updated: 24 February 2022

19. Thyroid diseases

19.1.1 The WCHSU website stated:

‘The Department of Thyroid Surgery is one of the largest diagnostic and treatmental center of thyroid surgical diseases in China, which serves nearly 40,000 outpatients and more than 3,000 inpatients of thyroid diseases patients national widely in every year, including complicated cases with the complete treatment system…The department is in the leading position in China, especially in the comprehensive treatment of advanced thyroid cancer, the treatment of secondary/tertiary hyperparathyroidism, the ablation of thyroid nodules, the endoscopic treatment of thyroid gland, and the postoperative follow-up. The department has formed a complete treatment system in the field…

‘The Department is at the advanced level both at home and abroad in the following areas:

‘1. Surgical treatment of advanced thyroid cancer. In this field, the Department has an excellent reputation in precise diagnosis and surgical treatment of complicated and challenging thyroid and parathyroid diseases. It treats more than 20% of patients with recurrent and challenging thyroid surgery nationwide every year. In recent years, it has strengthened the cooperation with thoracic surgery, otolaryngology, vascular surgery, burn surgery., which has unique features for vascular reconstruction, flap repair, and laryngeal reconstruction of challenging and complex thyroid cancer…

‘2. Protection of parathyroid function.

‘3. MDT [multi-disciplinary team] Treatment for hyperparathyroidism.

‘4. Endoscopic treatment of thyroid.

‘5. Ablation of thyroid nodules.

‘6. Postoperative follow-up for thyroid cancer.’^{[footnote 153]}

19.1.2 More information is available from the WCHSU website.

19.1.3 See also Cancer.

20. Haematological conditions

Section 20 updated: 25 March 2022

20.1.1 A MedCOI response, dated 13 August 2020, noted that there were haematologists available in China (Peking Union Medical College Hospital [public facility]) who could treat people with haematological conditions, such as anaemia, in August 2020. Venofer, used to treat anaemia, was available at the Peking Union Medical College Hospital (public facility)^{[footnote 154]}.

20.1.2 A MedCOI response, dated 11 March 2019, noted that transfusions of red blood cells could be carried out at the Sino-Japan Friendship Hospital in Beijing (public facility)^{[footnote 155]}.

21. Musculoskeletal conditions

Section 21 updated: 18 May 2022

21.1.1 The Raffles Hospital in Beijing provides the following physiotherapy services:

• Hand and upper limb rehabilitation

• Design and fabrication of splints

• Prescription of adaptive equipment

• Motor/sensory/functional retraining

• Home visits

• Neck and back pain management

• Peripheral conditions management

• Treatment for arthritic conditions. e.g. osteoarthritis, rheumatoid arthritis

• Post-surgical rehabilitation. e.g. arthroscopy, total knee replacement, total hip replacement, laminectomy, artificial disc replacement^{[footnote 156]}.

Section 22 updated: 17 January 2022

22. Painkiller medication

22.1.1 MedCOI responses noted that the following painkiller medication were available in China in 2019:

• Ibuprofen (Peking Union Medical College Hospital, Beijing)^{[footnote 157]}

• Naproxen (Peking Union Medical College Hospital)^{[footnote 158]}

• Oxycodone (Peking Union Medical College Hospital)^{[footnote 159]}

• Morphine (Dongfang Hospital, Beijing)^{[footnote 160]}

• Tramadol (Peking University Third Hospital, Beijing)^{[footnote 161]}

• Paracetamol (Peking Union Medical College Hospital, Beijing)^{[footnote 162]}

• Gabapentin (painkiller for neuropathic pain) (Peking Union Medical College Hospital)^{[footnote 163]}

• Diclofenac (Peking Union Medical College Hospital)^{[footnote 164]}

• Naproxen (Peking Union Medical College Hospital)^{[footnote 165]}.

Section 23 updated: 24 March 2022

23. Antibiotic medication

23.1.1 A MedCOI response noted that the following antibiotics were available in China in November 2020:

• Mupirocin (Beijing Guodu Hospital) (public facility)

• Doxycycline (Beijing Friendship Hospital Capital Medical University) (public facility)

• Rifampicin (Peking Union Medical College Hospital) (public facility)

• Trimethoprim (Beijing Institute of Tuberculosis Control) (public facility)^{[footnote 166]}.

Section 24 updated: 26 May 2022

24. Geriatric care

24.1.1 The National Centre for Biotechnology Information (NCBI) (United States) study paper, Geriatric medicine in China: The past, present, and future, published in June 2018, stated:

‘As a result of the impressive achievements made in the last 30 years, geriatric medicine in China now serves as an integral part of the nation’s medical profession…

‘On close examination, however, a number of weaknesses still persist. In chronic care management, levels of awareness, treatment, and control for common diseases such as hypertension, diabetes, and hyperlipidemia among the elderly are very low. This is because the healthcare network is insufficient and fails to provide basic services to seniors, especially those in the countryside. Even at major hospitals, the principles of geriatric care have not been incorporated into clinical procedures. The prevailing practice is single‐disease–based management, while little thought is given to multimorbidity and comprehensive geriatric assessment is not routinely conducted. Another notable problem is a deficiency in the long‐term care structure, specifically the severe shortage of nursing homes and well‐trained personnel. Consequently, transitions between healthcare settings are often impractical.’^{[footnote 167]}

24.1.2 A MedCOI response, dated 14 April 2020, noted that homecare/assistance nursing, orthopaedic devices, and 24/7 care in a nursing home for vulnerable elderly persons were available in China^{[footnote 168]}.

24.1.3 The Voice of America report, In Fast-Aging China, Elder Care Costs Loom Large, dated 23 May 2021, stated:

‘According to the latest official census data, those 60 and over now make up 18.7% of the population, or 264 million people…Those 65 and above accounted for 13.5% of the population in 2020…

‘As the demand for elder care increases in China, so does the shortage of affordable assisted living facilities and nursing homes…According to The Rooth Law Firm of Chicago, in 2014, less than 3% of China’s aged population could find accommodation in nursing homes.

‘In cities such as Shanghai or Beijing, the cost of a nursing home ranges from $310 (2,000 RMB) (£236)^{[footnote 169]} per month to $3,100 (20,000 RMB per month) (£2,360)^{[footnote 170]}, with the requirement of purchasing at least a one-year lease.

‘In Shanghai, according to China Daily, only 3% of the city’s elderly population is cared for in nursing homes. The majority — 90% — remain at home, and they or their families hire a caregiver to provide some form of assistance at a monthly cost of $450-$700 (3,000-4,500 RMB) (£354 -£531)^{[footnote 171]}.

‘”Obtaining a spot in a nursing home has become incredibly competitive,” the law firm said, “The top social welfare home in Beijing has a waiting list of more than 10,000 applicants, and only approximately 1,100 beds in the facility, with only about 12 spots opening up annually.”.’^{[footnote 172]}

24.1.4 The World Health Organisation report, Caring for the health of the elderly in China, dated 28 May 2021, stated:

‘China has been innovating for improved access of older people to integrated care, by means of a community-based social and health care system that covers also chronic disease control and prevention, strengthened health services and is staffed with a large health workforce.

‘In March 2015, the former National Health and Family Planning Commission officially approved the establishment of the National Center for Gerontology. This made it possible to integrate scientific research, clinical care, rehabilitation services, public health policies and health management into one.

‘The Center is based at Beijing Hospital, an institution with long experience in gerontological research, training and care, networked with more than 60 medical institutions across the country.

‘The Center is responsible for the prevention and control of ageing-related poor health in China, primarily through: developing national strategies, leading critical research, promoting the health of older people in remote areas, training of health professionals, and international exchange of knowledge and ideas in the area of ageing.’^{[footnote 173]}

25. Mental healthcare

25.1 Overview

Section 25 updated: 4 February 2022

25.1.1 The Consortium Psychiatricum 2020 report, Promotion of Mental Health Rehabilitation in China: Community-Based Mental-Health Services, stated:

‘Mental health services are mainly provided by psychiatrists, psychiatric nurses, social workers and clinical psychologists in mental health centres, by general practitioners and community nurses in community health centres and by social workers, clinical psychologists, rehabilitation therapists and occupational therapists in other government or social organizations. These services cover inpatient and outpatient treatment, hospital and community rehabilitation, health education, psychotherapy and vocational rehabilitation. Patients with mental illnesses can seek mental health services both in mental health centres and community health centres…Psychiatric hospitals are mainly in charge of medical treatment for severe mental disorders, through inpatient and outpatient treatment, hospital-based rehabilitation and health education. When a patient’s condition has stabilized, they are referred to CHCs, which are responsible for rehabilitation and health education. If the patient is willing to accept follow-up services, mental health service providers will provide patients and their guardians advice on how to maintain stability. If the patient is relatively stable, they may attend community-based rehabilitation facilities. These facilities provide services including antipsychotic maintenance therapy, behaviour therapy, social skills training, vocational rehabilitation and family education. If the patient relapses, they are referred to hospital…

‘The quality and coverage of mental health services have been greatly improved.’^{[footnote 174]}

25.1.2 The China Daily report, Experts call for increased mental health funding, dated 7 October 2021, stated:

‘Health experts have called for increasing investment in mental health services in China, as a recent study has revealed that only 0.5 percent of people suffering depressive disorders received adequate treatment.

‘It is estimated that 9.5 percent of individuals diagnosed with different degrees of depressive symptoms used mental health services, much lower than about 57.3 percent in the United States and other high-income countries, according to a study led by Chinese researchers and published on the online version of The Lancet Psychiatry on Sept 21.

‘An even lower 3.6 percent of patients sought treatment from psychiatric specialists. About 7 percent visited healthcare institutions or took psychotropic drugs, 0.3 percent enlisted help from social services, and 2.7 percent turned to traditional Chinese medicine or other alternative therapies, the study said.

‘The findings were based on a survey conducted on the Chinese mainland from 2013 to 2015 involving more than 32,500 people aged 18 or above.

‘Researchers from the First Affiliated Hospital of Kunming Medical University, Peking University Sixth Hospital’s Institute of Mental Health and several other institutions analyzed data from the survey and co-authored the paper.

‘”Our study showed that only a small percentage of people with a depressive disorder accessed treatment and very few received adequate treatment,” it said.’^{[footnote 175]}

25.1.3 The Australian government Department of Foreign Affairs and Trade (DFAT) Country Information Report – People’s Republic of China, published on 22 December 2021, stated:

‘The government has increased investments in mental health services over the last decade but services remain inadequate. A 2019 article by Chinese academics published in the BMJ General Psychiatry journal found a 17.5 per cent prevalence of mood disorders. It found that, despite the high prevalence of disorders, the rate of people receiving treatment was low, in part due to social stigma, and a lack of funding, mental health beds and mental health professionals. Most of those resources were found in provincial capitals in the more developed east coast of the country.

‘Although demand for mental health services is growing, many people remain reluctant to seek help due to stigma associated with mental illness.’^{[footnote 176]}

25.2 Availability of facilities, medication and treatment

25.2.1 A MedCOI response, dated 11 November 2019, stated that psychiatrists, psychiatric crisis intervention in cases of suicide attempts and PTSD treatment related to sexual abuse, were available at the Seventh People’s Hospital of Hangzhou in Hangzhou Shi (public facility)^{[footnote 177]}.

25.2.2 MedCOI responses stated that the following drugs were available in China, in 2019/2020:

• Mianserin (anti-depressant) (Seventh People’s Hospital of Hangzhou)^{[footnote 178]}

• Fluoxetine (anti-depressant) (Seventh People’s Hospital of Hangzhou)^{[footnote 179]}

• Citalopram (anti-depressant) (Seventh People’s Hospital of Hangzhou)^{[footnote 180]}

• Setraline (anti-depressant) (Seventh People’s Hospital of Hangzhou)^{[footnote 181]}

• Mirtazapine (anti-depressant) (Seventh People’s Hospital of Hangzhou)^{[footnote 182]}

• Diazepam (anxiolytic) (Seventh People’s Hospital of Hangzhou)^{[footnote 183]}

• Oxazepam (anxiolytic) (Seventh People’s Hospital of Hangzhou)^{[footnote 184]}

• Lormetazepam (sedative) (Seventh People’s Hospital of Hangzhou)^{[footnote 185]}

• Zolpidem (sedative) (Beijing United Family Hospital and Clinics)^{[footnote 186]}

• Promethazine (anti-psychotic) (Huillongguan Hospital, Beijing) (public facility)^{[footnote 187]}

• Clozapine (anti-psychotic) (Huillongguan Hospital)^{[footnote 188]}

• Penfluridol (anti-psychotic) (Huillongguan Hospital)^{[footnote 189]}

• Haloperidol decanoate depot injection (anti-psychotic) (Huillongguan Hospital)^{[footnote 190]}

• Haloperidol (anti-psychotic) (Huillongguan Hospital)^{[footnote 191]}

• Risperidone depot injection (anti-psychotic) (Huillongguan Hospital)^{[footnote 192]}

• Temazepam (sedative) (Huillongguan Hospital)^{[footnote 193]}

• Lorazepam (sedative) (Huillongguan Hospital)^{[footnote 194]}

• Zopiclone (sedative) (Huillongguan Hospital)^{[footnote 195]}

• Olanzapine (anti-psychotic) (Peking University Sixth Hospital [public facility])^{[footnote 196]}

• Ripiprazole (anti-psychotic) (6th Hospital of Peking University [public facility])^{[footnote 197]}.

Annex A: List of available medication according to MedCOI

The list of drugs below has been compiled from MedCOI responses produced between 2019 and 2020 and researched by medical practitioners working in China. The information is limited to the availability of the medication, usually at a particular clinic/health institute, and does not provide information on accessibility. That a particular medication was identified as being available at one facility does not mean that it was only available at that clinic/health centre.

A

• Alendronate sodium^{[footnote 198]}
• Allopurinol^{[footnote 199]}
• Amlodipine^{[footnote 200]}
• Ascorbic acid^{[footnote 201]}
• Aspirin^{[footnote 202]}
• Atenelol^{[footnote 203]}
• Aripiprazole^{[footnote 204]}

B

• Baclofen^{[footnote 205]}
• Benzbromarone^{[footnote 206]}
• Bisacodyl^{[footnote 207]}
• Bisoprolol^{[footnote 208]}
• Bumetanide^{[footnote 209]}

C

• Calcitriol^{[footnote 210]}
• Calcium^{[footnote 211]}
• Calcium carbonate^{[footnote 212]}
• Calcium carbonate + colecalciferol^{[footnote 213]}
• Calcium phosphate^{[footnote 214]}
• Captopril^{[footnote 215]}
• Chlorpromazine^{[footnote 216]}
• Cholecalciferol^{[footnote 217]}
• Chlorhexidine^{[footnote 218]}
• Ciclosporin^{[footnote 219]}
• Citalopram^{[footnote 220]}
• Clopidogrel^{[footnote 221]}
• Clozapine^{[footnote 222]}
• Colchicine^{[footnote 223]}

D

• Dacomitinib (subject to supply problems)^{[footnote 224]}
• Darbepoetin alfa^{[footnote 225]}
• Descovy^{[footnote 226]}
• Dexamethasone^{[footnote 227]}
• Diazepam^{[footnote 228]}
• Diclofenac^{[footnote 229]}
• Docetaxel^{[footnote 230]}
• Domperidone^{[footnote 231]}
• Doxazosin^{[footnote 232]}
• Doxycycline^{[footnote 233]}

E

• Emtricitabine^{[footnote 234]}
• Enalapril^{[footnote 235]}
• Entecavir^{[footnote 236]}
• Epoetin alfa^{[footnote 237]}
• Esomeprazole^{[footnote 238]}

F

• Felodipine^{[footnote 239]}
• Febuxostat^{[footnote 240]}
• Ferrioxidesaccharate^{[footnote 241]}
• Fosinopril^{[footnote 242]}
• Furosemide^{[footnote 243]}

G

• Gabapentin^{[footnote 244]}
• Genvoya^{[footnote 245]}
• Glibenclamide^{[footnote 246]}
• Gliclazide^{[footnote 247]}
• Glimepiride^{[footnote 248]}
• Goserelin^{[footnote 249]}

H

• Haloperidol^{[footnote 250]}
• Haloperidol decanoate depot injection^{[footnote 251]}
• Hepatitis B immunoglobulins^{[footnote 252]}
• Hydrochlorothiazide^{[footnote 253]}

I

• Ibuprofen^{[footnote 254]}
• Immunoglobulin^{[footnote 255]}
• Indapamide^{[footnote 256]}
• Isosorbide dinitrate^{[footnote 257]}
• Isosorbide mononitrate^{[footnote 258]}
• Insulin^{[footnote 259]}

L

• Lactulose^{[footnote 260]}
• Lamotrigine^{[footnote 261]}
• Lansoprazole^{[footnote 262]}
• Lanthanum carbonate^{[footnote 263]}
• Linagliptin^{[footnote 264]}
• Lisonapril^{[footnote 265]}
• Leuprorelin acetate^{[footnote 266]}
• Levitiracetam^{[footnote 267]}
• Lometazepam^{[footnote 268]}
• Lorazepam^{[footnote 269]}
• Losartan^{[footnote 270]}

M

• Macrogol^{[footnote 271]}
• Macrogol + electrolytes^{[footnote 272]}
• Melatonin^{[footnote 273]}
• Metformin^{[footnote 274]}
• Metoclopramide^{[footnote 275]}
• Metoprolol^{[footnote 276]}
• Midazolam (injection/intravenous)^{[footnote 277]}
• Mianserin^{[footnote 278]}
• Mirabegron^{[footnote 279]}
• Mirtazapine^{[footnote 280]}
• Morphine^{[footnote 281]}
• Mupiracin^{[footnote 282]}
• Mycophenolate mofetil^{[footnote 283]}

N

• Naproxen^{[footnote 284]}
• Nevirapine^{[footnote 285]}
• Nicardipine^{[footnote 286]}
• Nifedipine^{[footnote 287]}
• Nilotinib hydrochloride monohydrate^{[footnote 288]}
• Nitrendipine^{[footnote 289]}
• Nitroglycerine^{[footnote 290]}

O

• Odansetron^{[footnote 291]}
• Olanzapine^{[footnote 292]}
• Omeprazole^{[footnote 293]}
• Oxazepam^{[footnote 294]}
• Oxycodone^{[footnote 295]}

P

• Pantoprazole^{[footnote 296]}
• Paracetamol^{[footnote 297]}
• Paricalcitol^{[footnote 298]}
• Penfluridol^{[footnote 299]}
• Perindopril^{[footnote 300]}
• Pioglitazone^{[footnote 301]}
• Phenobarbital^{[footnote 302]}
• Potassium^{[footnote 303]}
• Pravastatin^{[footnote 304]}
• Prazosin^{[footnote 305]}
• Prednisolone^{[footnote 306]}
• Prednisone^{[footnote 307]}
• Promethazine^{[footnote 308]}
• Psyllium seeds^{[footnote 309]}

Q

• Quetiapine^{[footnote 310]}

R

• Rabeprazole sodium^{[footnote 311]}
• Ramipril^{[footnote 312]}
• Rifampicin^{[footnote 313]}
• Risedronate sodium^{[footnote 314]}
• Risperidone depot injection^{[footnote 315]}
• Rosuvastatin^{[footnote 316]}

S

• Sertraline^{[footnote 317]}
• Sevelamer^{[footnote 318]}
• Simvastatin^{[footnote 319]}
• Sirolimus^{[footnote 320]}
• Sodium bicarbonate^{[footnote 321]}
• Sodium chloride^{[footnote 322]}
• Sodium polystyrene sulphonate^{[footnote 323]}
• Spironalactone^{[footnote 324]}
• Sterculia^{[footnote 325]}

T

• Tacrolimus^{[footnote 326]}
• Tamsulosin^{[footnote 327]}
• Temazepam^{[footnote 328]}
• Tenofovir alafenamide (subject to supply problems)^{[footnote 329]}
• Ticagrelor^{[footnote 330]}
• Topiramate^{[footnote 331]}
• Torasemide^{[footnote 332]}
• Tramadol^{[footnote 333]}
• Triameterine^{[footnote 334]}
• Trimethoprim^{[footnote 335]}

V

• Valproic acid^{[footnote 336]}
• Valsartan^{[footnote 337]}
• Vitamin B complex^{[footnote 338]}
• Vitamin D^{[footnote 339]}
• Vitamin D3^{[footnote 340]}

W

• Warfarin^{[footnote 341]}

Z

• Zolpidem^{[footnote 342]}
• Zopiclone^{[footnote 343]}

Terms of Reference

A ‘Terms of Reference’ (ToR) is a broad outline of what the country information note (CIN) seeks to cover. They form the basis for the country information section. The Home Office’s Country Policy and Information Team uses some standardised ToRs, depending on the subject, and these are then adapted depending on the country concerned.

For this particular CIN, the following topics were identified prior to drafting as relevant and on which research was undertaken:

• Healthcare system
  • Overview of healthcare structure
  • Financing of healthcare
  • Health insurance schemes (costs of these/contributions)
  • Non-government organisations providing healthcare and assistance
• Doctors, hospitals, pharmacies, emergency care (the number of each of these, locations and any cost to access these services if relevant)
• Impact of Covid-19
• Specific diseases/conditions:
  • Cancer treatment (oncology)
  • Cardiology
  • Diabetes
  • Ear, nose and throat conditions
  • Eye treatment (ophthalmology)
  • Gastroenterological conditions
  • Gynaecological conditions
  • Obstetrics
  • Haematology (blood diseases)
  • Hepatitis
  • HIV/AIDs
  • Kidney diseases
  • Liver transplants and liver conditions (hepatology)
  • Lung diseases
  • Musculoskeletal conditions
  • Mental health, psychiatry (including type of facilities that can deal with mental health issues and locations, any costs)
  • Neurological conditions
  • Paediatrics
  • Palliative care
  • Nursing homecare
  • Geriatric care

Bibliography

Sources cited

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Bain and Company, ‘How the Coronavirus Will Transform Healthcare in China’, 4 March 2020. Last accessed: 12 May 2022

Beijing Puhua Hospital, ‘New Hope in the Battle against Brain Tumors’, no date. Last accessed: 21 December 2021

Biomedcentral, ‘COVID-19 and healthcare system in China: challenges and progression for a sustainable future’, Shuangyi Sun, Zhen Xie, Keting Yu, Bingqian Jiang, Siwei Zheng, Xiaoting Pan, 21 January 2021. Last accessed: 18 May 2022

Blavatnik School Working Paper, ‘Chinese Provincial Government Responses to COVID-19’, 25 January 2022. Last accessed: 31 March 2022

BMC Oral Health, ‘Dentists’ entrepreneurial intention and associated factors in public hospitals in major cities in Guangdong (South China): a cross-sectional study,’ Jiabi Wang, Bin Peng, Hongzhi Zhou, Jing Hua Zhang, Volume 20 (334), 23 November 2020. Last accessed: 5 January 2022

British Medical Journal,

• ‘What can we learn from China’s health system reform?’, 19 June 2019, Qingyue Meng, Anne Mills, Longde Wang, Qide Han. Last accessed: 12 May 2022

• ‘Towards universal health coverage: lessons from 10 years of healthcare reform in China’, revised version, 13 February 2020, Tao W, Zeng Z, Dang H, et al. Last accessed: 19 April 2022

Children’s Hospital Zhejiang University School of Medicine, ‘Patient Care’, no date. Last accessed: 7 January 2022

China Charity Foundation, homepage. No date. Last accessed: 23 March 2022

China Daily,

• ‘New breast cancer drug now available in China’, 26 November 2018. Last accessed: 4 January 2022

• ‘Hospice care sector needs more sustained efforts for development, say experts’, 15 November 2019. Last accessed: 24 May 2022

• ‘New medicine for prostate cancer available in China’, 28 November 2019. Last accessed: 4 January 2022

• ‘Experts call for increased mental health funding’, 7 October 2021. Last accessed: 2 February 2022

China Development Brief, ‘The Sudan-China Abu Ushar Friendship Hospital: China’s First Overseas Charitable NGO Project’, 23 January 2014. Last accessed: 22 March 2022

Commonwealth Fund, International Health Policy Centre, ‘China’, 5 June 2020. Last accessed: 30 March 2022

Consortium Psychiatricum, ‘Promotion of Mental Health Rehabilitation in China: Community-Based Mental-Health Services’, 2020, Volume 1, No. 2, Youwei Zhu, Xu Li , Min Zhao. Last accessed: 4 February 2022

Department of Foreign Affairs and Trade (Australian government), ‘Country Information Report – People’s Republic of China’, 22 December 2021. Last accessed: 9 February 2022

European Union Agency for Asylum, ‘MedCOI Sector’ (restricted access). Copies of responses available on request. Last accessed: December 2020

Foreign, Commonwealth and Development Office, ‘Medical treatment in China’, 23 September 2016. Last accessed: 19 April 2022

Health and Safety in Shanghai, ‘Shanghai Dentist Guide For Expats’, no date. Last accessed: 5 January 2022

HMP Global Learning Network, ‘EMS Around the World: China Prioritizes Better EMS’, January 2020. Last accessed: 23 March 2022

Infectious Diseases of Poverty Journal, ‘Multi-source financing for tuberculosis treatment in China: key issues and challenges’, Qian Long, Wei-Xi Jiang, Hui Zhang, Jun Cheng, Sheng-Lan Tang, Wei-Bing Wang, Volume 10, Article 17 (2021), 10 March 2021. Last accessed: 4 January 2022

International Dental Journal, ‘Socio–Economic Disparities in Dental Health and Dental Care Utilisation Among Older Chinese’, February 2021, Volume 71, Issue 1, Chaofan Li, Nengliang Aaron Yao. Last accessed: 27 May 2022

Journal of Thoracic Oncology, ‘Lung Cancer in People’s Republic of China’, 1 October 2020, Shugeng Gao, MD, Ning Li, MD, Shuhang Wang, MD, Fan Zhang, MD, Wenqiang Wei, MD, Ni Li, MD, Nan Bi, MD, Zhijie Wang, MD, Jie He, MD, PhD, Volume 15, Issue 10. Last accessed: 7 January 2022

Mary Ann Liebert Inc., ‘“Not Just Anybody Can Do It”: A Qualitative Study of the Lived Experience of Inpatient Palliative Care Professionals in China’s Mainland’, 4 May 2021, Rui Fu, Jia Lu Lilian Lin, Jianjun Jiang, Tingting Zhou, Jay Pan, Peter Coyte. Last accessed: 16 May 2022

National Centre for Biotechnology Information,

• ‘An overview of the Chinese healthcare system’, January 2021, Baokang Yi. Last accessed: 10 May 2022

• ‘Optimizing Treatment for Adults with HIV/AIDS in China: Successes over Two Decades and Remaining Challenges’, 14 January 2020, Wei Cao, Evelyn Hsieh, Taisheng Li. Last accessed: 23 May 2022

• ‘Geriatric medicine in China: The past, present, and future’, June 2018, Pulin Yu, Xiang Liu, Jianye Wang. Last accessed: 26 May 2022

National Health Commission of the People’s Republic of China, ‘Hospitals’, undated, Last accessed: 29 March 2022

OASIS International Hospital, ‘Departments – OB/GYB’, no date. Last accessed: 13 May 2022

Organisation for Economic Cooperation and Development, Data,

*‘Doctors’, 2022. Last accessed: 13 May 2022 * ‘Nurses’, 2022. Last accessed: 13 May 2022

Raffles Hospital, Beijing, ‘Physiotherapy & Rehabilitation’, no date. Last accessed: 18 May 2022

Sixth Tone, ‘China’s Rare Hospices Help Patients Die With Dignity’, 13 March 2019. Last accessed: 24 May 2022

State Council of the People’s Republic of China, ‘China makes progress in curbing hepatitis infection’, 28 July 2021. Last accessed: 17 March 2022

The Independent, ‘Nearly half of Hong Kong infected with Covid as city struggles to contain new outbreak’, 16 March 2022. Last accessed: 31 March 2022

The Lancet, ‘The hepatitis B epidemic in China should receive more attention’, 21 April 2018. Last accessed: 17 March 2022

United Foundation for China’s Health, ‘About Us’, no date. Last accessed: 23 March 2022

US-China Economic and Security Review Commission, Staff Research Report, ‘China’s Healthcare System: Addressing Capacity Shortfalls before and after COVID- 19’, 31 March 2021. Last accessed: 20 December 2021

Voice of America,

• ‘In Fast-Aging China, Elder Care Costs Loom Large’, 23 May 2021. Last accessed: 26 May 2022

• ‘Much of Shanghai Locked Down as Mass COVID-19 Testing Begins’, 27 March 2022. Last accessed: 30 March 2022

West China Hospital of Sichuan University,

• ‘Breast Surgery’, no date. Last accessed: 11 January 2022
• ‘Cardiology’, no date. Last accessed: 13 January 2022
• ‘Cardiovascular Surgery’, no date. Last accessed: 13 January 2022
• ‘Emergency’, no date. Last accessed: 23 March 2022
• ‘Lung Cancer Center’, no date. Last accessed: 13 January 2022 ‘Ophthalmology’, no date. Last accessed: 13 January 2022
• ‘Otolaryngology-Head and Neck Surgery’, no date. Last accessed: 11 January 2022
• ‘Liver Surgery’, no date. Last accessed: 18 March 2022
• ‘Thyroid Surgery’, no date. Last accessed: 24 February 2022

West China Women’s and Children’s Hospital,

• ‘Division of Children’s Healthcare’, no date. Last accessed: 7 January 2022

• ‘Division B of General Paediatrics’, no date. Last accessed: 7 January 2022 ‘Division of Pediatric Hematology and Oncology’, no date. Last accessed: 7 January 2022

• ‘Division of Pediatric Infectious Diseases’, no date. Last accessed: 7 January 2022

• ‘Paediatric Cardiac Interventional Treatment Centre’, no date. Last accessed: 7 January 2022

• ‘Division of Obstetrics’, no date. Last accessed: 20 May 2022

World Health Organisation, ‘Caring for the health of the elderly in China’, 28 May 2021. Last accessed: 26 May 2022

World Journal of Paediatric Surgery, ‘Pediatric heart surgery in China: progress and challenges’, 2019. Last accessed: 23 December 2021

XE Currency Converter, ‘British Pound/Chinese Yuan Renminbi’, 26 May 2022 Last accessed: 26 May 2022

Zhejiang Cancer Hospital,

• ‘Introduction’, September 2021. Last accessed: 25 May 2022

• ‘Thoracic Surgery’, March 2020. Last accessed: 25 May 2022

• ‘Head & Neck Radiotherapy’, March 2020. Last accessed: 25 May 2022

• ‘Urology Surgery’, March 2020. Last accessed: 25 May 2022

• ‘Gynaecological Radiotherapy’, March 2020. Last accessed: 25 May 2022

• ‘Abdominal Medical Oncology’, March 2020. Last accessed: 26 May 2022

• ‘Bone & Soft Tissue Surgery’, March 2020. Last accessed: 26 May 2022

• ‘Colorectal Surgery’, March 2020. Last accessed: 26 May 2022

Sources consulted but not cited

BBC News, ‘Coronavirus: Chinese official admits health system weaknesses’, 9 May 2020. Last accessed: 18 March 2022

Borgen Magazine, ‘The Healthcare System in China’, 27 July 2020. Last accessed: 18 March 2022

Chinese Ministry of Health, ‘Health Data’, no date. Last accessed: 18 March 2022

Encyclopaedia Britannica, ‘China – Health and Welfare’, no date. Last accessed: 18 March 2022

GlobalSurance, ‘China Health Insurance’, no date. Last accessed: 18 March 2022

World Health Organisation, ‘Health Financing’, no date. Last accessed: 18 March 2022

Version control

Clearance

Below is information on when this note was cleared:

• version 1.0

• valid from 5 July 2022

Changes from last version of this note

First version of this note

1. EUAA, ‘EUAA MedCOI’ webpage, no date ↩

2. XE Currency Converter, ‘British Pound/Chinese Renminbi’, 20 May 2022 ↩

3. British Medical Journal, ‘What can we learn from China’s health system reform?’, 19 June 2019 ↩

4. British Medical Journal Global Health, ‘Towards universal health…’ (page 5), 13 February 2020 ↩

5. CFIHPC, ‘China’, 5 June 2020 ↩

6. NCBI, ‘An overview of the Chinese healthcare system’, 2021 ↩

7. CFIHPC, ‘China’, 5 June 2020 ↩

8. Bain and Company, ‘How the Coronavirus Will Transform Healthcare in China’, 4 March 2020 ↩

9. CFIHPC, ‘China’, 5 June 2020 ↩

10. CFIHPC, ‘China’, 5 June 2020 ↩

11. OECD Data, ‘Doctors’, 2022 ↩

12. OECD Data, ‘Nurses’, 2022 ↩

13. CFIHPC, ‘China’, 5 June 2020 ↩

14. CFIHPC, ‘China’, 5 June 2020 ↩

15. National Health Commission of the People’s Republic of China, ‘Hospitals’, no date ↩

16. China Development Brief, ‘The Sudan-China Abu Ushar Friendship Hospital…’, 23 January 2014 ↩

17. United Foundation for China’s Health, ‘About Us’, no date ↩

18. China Charity Foundation, homepage, no date ↩

19. CFIHPC, ‘China’, 5 June 2020 ↩

20. British Medical Journal Global Health, ‘Towards universal health…’ (page 6), 19 March 2020 ↩

21. NCBI, ‘An overview of the Chinese healthcare system’, 2021 ↩

22. US-C ESRC, Staff Research Report, ‘China’s Healthcare System…’ (page 2), 31 March 2021 ↩

23. XE Currency Converter, ‘Chinese Yuan Renminbi/British pounds’, 23 March 2022 ↩

24. US-C ESRC, Staff Research Report, ‘China’s Healthcare System…’ (pages 5-6), 31 March 2021 ↩

25. US-C ESRC, Staff Research Report, ‘China’s Healthcare System…’ (page 6), 31 March 2021 ↩

26. DFAT, ‘Country Information Report - China’ (page 10), 22 December 2021 ↩

27. DFAT, ‘Country Information Report - China’ (page 9), 22 December 2021 ↩

28. FCDO, ‘Medical treatment in China’, 23 September 2016 ↩

29. Allianz Care, ‘Healthcare in China’, no date ↩

30. HMP Global Learning Network, ‘EMS Around the World: China Prioritizes…’, January 2020 ↩

31. WCHSU, ‘Emergency’, no date ↩

32. Children’s Hospital Zhejiang University School of Medicine, ‘Patient Care’, no date ↩

33. West China Women’s and Children’s Hospital, ‘Division of Pediatric Infectious Diseases’, no date ↩

34. MedCOI, 8 April 2019 ↩

35. West China Women’s and Children’s Hospital, ‘Paediatric Cardiac Interventional…’, no date ↩

36. WJPS, ‘Pediatric heart surgery in China: progress and challenges’, 2019 ↩

37. West China Women’s and Children’s Hospital, ‘Division of Pediatric Hematology…’, no date ↩

38. Biomedcentral, ‘COVID-19 and healthcare system in China:..’, 21 January 2021 ↩

39. Blavatnik School Working Paper, ‘Chinese Provincial Government Responses…’, 25 January 2022 ↩

40. Voice of America, ‘Much of Shanghai Locked Down as Mass COVID-19 Testing…’, 27 March 2022 ↩

41. The Independent, ‘Nearly half of Hong Kong infected with Covid as city struggles…’, 16 March 2022 ↩

42. Zhejiang Cancer Hospital, ‘Introduction’, September 2021 ↩

43. MedCOI, 31 May 2019 ↩

44. MedCOI, 3 December 2019 ↩

45. MedCOI, 31 May 2019 ↩

46. JTO, ‘Lung Cancer in People’s Republic of China’, 1 October 2020 ↩

47. JTO, ‘Lung Cancer in People’s Republic of China’, 1 October 2020 ↩

48. WCHSU, ‘Lung Cancer Center’, no date ↩

49. China Daily, ‘New breast cancer drug now available in China’, 26 November 2018 ↩

50. WCHSU, ‘Breast Surgery’, no date ↩

51. China Daily, ‘New medicine for prostate cancer available in China’, 28 November 2019 ↩

52. MedCOI, 11 March 2019 ↩

53. Beijing Puhua Hospital, ‘New Hope in the Battle against Brain Tumors’, no date ↩

54. WCHSU, ‘Liver Surgery’, no date ↩

55. Zhejiang Cancer Hospital, ‘Gynaecological Radiotherapy’, March 2020 ↩

56. Zhejiang Cancer Hospital, ‘Head & Neck Radiotherapy’, March 2020 ↩

57. Zhejiang Cancer Hospital, ‘Thoracic Surgery’, March 2020 ↩

58. Zhejiang Cancer Hospital, ‘Urology Surgery’ , March 2020 ↩

59. Zhejiang Cancer Hospital, ‘Abdominal Medical Oncology’, March 2020 ↩

60. Zhejiang Cancer Hospital, ‘Bone & Soft Tissue Surgery’, March 2020 ↩

61. Zhejiang Cancer Hospital, ‘Colorectal Surgery’, March 2020 ↩

62. WCHSU, ‘Cardiology’, no date ↩

63. MedCOI, 30 July 2020 ↩

64. MedCOI, 30 July 2020 ↩

65. MedCOI, 30 July 2020 ↩

66. MedCOI, 4 November 2020 ↩

67. MedCOI, 4 November 2020 ↩

68. MedCOI, 4 November 2020 ↩

69. MedCOI, 4 November 2020 ↩

70. MedCOI, 4 November 2020 ↩

71. MedCOI, 4 November 2020 ↩

72. MedCOI, 4 November 2020 ↩

73. MedCOI, 4 November 2020 ↩

74. MedCOI, 4 November 2020 ↩

75. MedCOI, 4 November 2020 ↩

76. MedCOI, 14 April 2020 ↩

77. MedCOI, 14 April 2020 ↩

78. MedCOI, 13 August 2020 ↩

79. MedCOI, 13 August 2020 ↩

80. MedCOI, 28 May 2020 ↩

81. MedCOI, 28 May 2020 ↩

82. MedCOI, 28 May 2020 ↩

83. MedCOI, 28 May 2020 ↩

84. MedCOI, 28 May 2020 ↩

85. MedCOI, 14 April 2020 ↩

86. MedCOI, 15 April 2019 ↩

87. MedCOI, 14 April 2020 ↩

88. MedCOI, 15 April 2019 ↩

89. MedCOI, 14 April 2020 ↩

90. MedCOI, 28 May 2020 ↩

91. MedCOI, 13 August 2020 ↩

92. MedCOI, 13 August 2020 ↩

93. MedCOI, 15 April 2019 ↩

94. MedCOI, 15 April 2019 ↩

95. MedCOI, 15 April 2019 ↩

96. WCHSU, ‘Cardiovascular Surgery’, no date ↩

97. BMC Oral Health, ‘Dentists’ entrepreneurial intention and associated factors…’, 23 November 2020 ↩

98. Health and Safety in Shanghai, ‘Shanghai Dentist Guide For Expats’, no date ↩

99. International Dental Journal, ‘Socio–Economic Disparities in Dental Health…’, February 2021 ↩

100. MedCOI, 28 May 2020 ↩

101. MedCOI, 28 May 2020 ↩

102. MedCOI, 28 May 2020 ↩

103. MedCOI, 12 May 2020 ↩

104. MedCOI, 12 May 2020 ↩

105. MedCOI, 14 April 2020 ↩

106. WCHSU, ‘Otolaryngology-Head and Neck Surgery’, no date ↩

107. MedCOI, 27 March 2019 ↩

108. MedCOI, 27 March 2019 ↩

109. MedCOI, 27 March 2019 ↩

110. MedCOI, 27 March 2019 ↩

111. MedCOI, 27 March 2019 ↩

112. MedCOI, 27 March 2019 ↩

113. MedCOI, 7 July 2020 ↩

114. MedCOI, 7 July 2020 ↩

115. MedCOI, 7 July 2020 ↩

116. WCHSU, ‘Ophthalmology’, no date ↩

117. MedCOI, 11 March 2019 ↩

118. MedCOI, 11 March 2019 ↩

119. MedCOI, 11 March 2019 ↩

120. MedCOI, 11 March 2019 ↩

121. MedCOI, 28 August 2020 ↩

122. MedCOI, 28 August 2020 ↩

123. MedCOI, 4 November 2020 ↩

124. MedCOI, 4 November 2020 ↩

125. MedCOI, 6 October 2020 ↩

126. MedCOI, 12 May 2020 ↩

127. MedCOI, 12 May 2020 ↩

128. MedCOI, 12 May 2020 ↩

129. MedCOI, 12 May 2020 ↩

130. OASIS International Hospital, ‘Departments – OB/GYB’, no date ↩

131. WCWCH, ‘Division of Obstetrics’, no date ↩

132. NCBI, ‘Optimizing Treatment for Adults with HIV/AIDS in China: Successes…’, 14 January 2020 ↩

133. NCBI, ‘Optimizing Treatment for Adults with HIV/AIDS in China: Successes…’, 14 January 2020 ↩

134. NCBI, ‘Optimizing Treatment for Adults with HIV/AIDS in China: Successes…’, 14 January 2020 ↩

135. MedCOI, 15 August 2019 ↩

136. MedCOI, 28 July 2020 ↩

137. WCHSU, ‘Liver Surgery’, no date ↩

138. WCHSU, ‘Liver Surgery’, no date ↩

139. The Lancet, ‘The hepatitis B epidemic in China should receive more attention’, 21 April 2018 ↩

140. State Council of the PROC, ‘China makes progress in curbing hepatitis infection’, 28 July 2021 ↩

141. MedCOI, 6 October 2020 ↩

142. MedCOI, 28 May 2020 ↩

143. Sixth Tone, ‘China’s Rare Hospices Help Patients Die With Dignity’, 13 March 2019 ↩

144. MedCOI, 3 December 2019 ↩

145. China Daily, ‘Hospice care sector needs more sustained efforts…’, 15 November 2019 ↩

146. Mary Ann Liebert Inc., ‘“Not Just Anybody Can Do It”: A Qualitative Study…’, 4 May 2021 ↩

147. IDP Journal, ‘Multi-source financing for tuberculosis treatment in China…’, 10 March 2021 ↩

148. MedCOI, 3 December 2019 ↩

149. WCHSU, ‘Thyroid Surgery’, no date ↩

150. MedCOI, 13 August 2020 ↩

151. MedCOI, 11 March 2019 ↩

152. Raffles Hospital, Beijing, ‘Physiotherapy & Rehabilitation’, no date ↩

153. MedCOI, 11 March 2019 ↩

154. MedCOI, 11 March 2019 ↩

155. MedCOI, 11 March 2019 ↩

156. MedCOI, 11 March 2019 ↩

157. MedCOI, 11 March 2019 ↩

158. MedCOI, 27 March 2019 ↩

159. MedCOI, 26 April 2019 ↩

160. MedCOI, 15 April 2019 ↩

161. MedCOI, 15 April 2019 ↩

162. MedCOI, 4 November 2020 ↩

163. NCBI, ‘Geriatric medicine in China: The past, present, and future’, June 2018 ↩

164. MedCOI, 14 April 2020 ↩

165. XE Currency Converter, ‘Chinese Yuan Renminbi to British Pounds’, 26 May 2022 ↩

166. XE Currency Converter, ‘Chinese Yuan Renminbi to British Pounds’, 26 May 2022 ↩

167. XE Currency Converter, ‘Chinese Yuan Renminbi to British Pounds’, 26 May 2022 ↩

168. Voice of America, ‘In Fast-Aging China, Elder Care Costs Loom Large’, 23 May 2021 ↩

169. World Health Organisation, ‘Caring for the health of the elderly in China’, 28 May 2021 ↩

170. Consortium Psychiatricum, ‘Promotion of Mental Health Rehabilitation in China…’, 2020 ↩

171. China Daily, ‘Experts call for increased mental health funding’, 7 October 2021 ↩

172. DFAT, ‘Country Information Report China’ (page 9), 22 December 2021 ↩

173. MedCOI, 11 November 2019 ↩

174. MedCOI, 11 November 2019 ↩

175. MedCOI, 11 November 2019 ↩

176. MedCOI, 11 November 2019 ↩

177. MedCOI, 11 November 2019 ↩

178. MedCOI, 11 November 2019 ↩

179. MedCOI, 11 November 2019 ↩

180. MedCOI, 11 November 2019 ↩

181. MedCOI, 11 November 2019 ↩

182. MedCOI, 11 November 2019 ↩

183. MedCOI, 21 October 2020 ↩

184. MedCOI, 21 October 2020 ↩

185. MedCOI, 21 October 2020 ↩

186. MedCOI, 21 October 2020 ↩

187. MedCOI, 21 October 2020 ↩

188. MedCOI, 21 October 2020 ↩

189. MedCOI, 21 October 2020 ↩

190. MedCOI, 21 October 2020 ↩

191. MedCOI, 21 October 2020 ↩

192. MedCOI, 15 August 2019 ↩

193. MedCOI, 15 August 2019 ↩

194. MedCOI, 11 March 2019 ↩

195. MedCOI, 28 May 2020 ↩

196. MedCOI, 13 March 2019 ↩

197. MedCOI, 12 May 2020 ↩

198. MedCOI, 13 March 2019 ↩

199. MedCOI, 13 March 2019 ↩

200. MedCOI, 31 May 2019 ↩

201. MedCOI, 14 April 2020 ↩

202. MedCOI, 28 May 2020 ↩

203. MedCOI, 13 March 2019 ↩

204. MedCOI, 13 March 2019 ↩

205. MedCOI, 4 November 2020 ↩

206. MedCOI, 26 April 2019 ↩

207. MedCOI, 12 May 2020 ↩

208. MedCOI, 12 May 2020 ↩

209. MedCOI, 6 October 2020 ↩

210. MedCOI, 6 October 2020 ↩

211. MedCOI, 7 July 2020 ↩

212. MedCOI, 12 May 2020 ↩

213. MedCOI, 13 March 2019 ↩

214. MedCOI, 13 March 2019 ↩

215. MedCOI, 28 May 2020 ↩

216. MedCOI, 11 November 2019 ↩

217. MedCOI, 11 March 2019 ↩

218. MedCOI, 21 October 2020 ↩

219. MedCOI, 28 May 2020 ↩

220. MedCOI, 3 December 2019 ↩

221. MedCOI, 4 November 2020 ↩

222. MedCOI, 28 July 2020 ↩

223. MedCOI, 28 May 2020 ↩

224. MedCOI, 13 March 2019 ↩

225. MedCOI, 15 April 2019 ↩

226. MedCOI, 11 March 2019 ↩

227. MedCOI, 11 March 2019 ↩

228. MedCOI, 26 April 2019 ↩

229. MedCOI, 4 November 2020 ↩

230. MedCOI, 28 July 2020 ↩

231. MedCOI, 13 March 2019 ↩

232. MedCOI, 6 October 2020 ↩

233. MedCOI, 4 November 2020 ↩

234. MedCOI, 28 May 2020 ↩

235. MedCOI, 28 May 2020 ↩

236. MedCOI, 7 July 2020 ↩

237. MedCOI, 13 August 2020 ↩

238. MedCOI, 14 April 2020 ↩

239. MedCOI, 13 March 2019 ↩

240. MedCOI, 27 March 2019 ↩

241. MedCOI, 15 August 2019 ↩

242. MedCOI, 14 April 2020 ↩

243. MedCOI, 14 January 2019 ↩

244. MedCOI, 14 January 2019 ↩

245. MedCOI, 11 March 2019 ↩

246. MedCOI, 21 October 2020 ↩

247. MedCOI, 21 October 2020 ↩

248. MedCOI, 6 October 2020 ↩

249. MedCOI, 28 May 2020 ↩

250. MedCOI, 17 September 2019 ↩

251. MedCOI, 11 November 2019 ↩

252. MedCOI, 28 May 2020 ↩

253. MedCOI, 15 April 2019 ↩

254. MedCOI, 15 April 2019 ↩

255. MedCOI, 13 March 2019 ↩

256. MedCOI, 13 March 2019 ↩

257. MedCOI, 27 March 2019 ↩

258. MedCOI, 12 May 2020 ↩

259. MedCOI, 4 November 2020 ↩

260. MedCOI, 14 January 2019 ↩

261. MedCOI, 13 March 2019 ↩

262. MedCOI, 11 March 2019 ↩

263. MedCOI, 27 March 2019 ↩

264. MedCOI, 11 November 2019 ↩

265. MedCOI, 21 October 2020 ↩

266. MedCOI, 13 March 2019 ↩

267. MedCOI, 13 March 2019 ↩

268. MedCOI, 4 November 2020 ↩

269. MedCOI, 12 May 2020 ↩

270. MedCOI, 14 January 2019 ↩

271. MedCOI, 11 March 2019 ↩

272. MedCOI, 13 March 2019 ↩

273. MedCOI, 7 July 2020 ↩

274. MedCOI, 11 November 2019 ↩

275. MedCOI, 30 July 2020 ↩

276. MedCOI, 11 November 2019 ↩

277. MedCOI, 17 September 2019 ↩

278. MedCOI, 4 November 2020 ↩

279. MedCOI, 6 October 2020 ↩

280. MedCOI, 15 April 2019 ↩

281. MedCOI, 28 July 2020 ↩

282. MedCOI, 28 May 2020 ↩

283. MedCOI, 4 November 2020 ↩

284. MedCOI, 31 May 2019 ↩

285. MedCOI, 4 November 2020 ↩

286. MedCOI, 15 April 2019 ↩

287. MedCOI, 11 March 2019 ↩

288. MedCOI, 15 August 2019 ↩

289. MedCOI, 12 May 2020 ↩

290. MedCOI, 13 March 2019 ↩

291. MedCOI, 17 September 2019 ↩

292. MedCOI, 28 May 2020 ↩

293. MedCOI, 27 March 2019 ↩

294. MedCOI, 26 April 2019 ↩

295. MedCOI, 21 October 2020 ↩

296. MedCOI, 13 March 2019 ↩

297. MedCOI, 13 August 2020 ↩

298. MedCOI, 27 March 2019 ↩

299. MedCOI, 12 May 2020 ↩

300. MedCOI, 28 May 2020 ↩

301. MedCOI, 26 April 2019 ↩

302. MedCOI, 11 March 2019 ↩

303. MedCOI, 11 March 2019 ↩

304. MedCOI, 21 October 2020 ↩

305. MedCOI, 13 March 2019 ↩

306. MedCOI, 15 August 2019 ↩

307. MedCOI, 12 May 2020 ↩

308. MedCOI, 4 November 2020 ↩

309. MedCOI, 4 November 2020 ↩

310. MedCOI, 11 March 2019 ↩

311. MedCOI, 21 October 2020 ↩

312. MedCOI, 28 May 2020 ↩

313. MedCOI, 11 November 2019 ↩

314. MedCOI, 4 November 2020 ↩

315. MedCOI, 7 July 2020 ↩

316. MedCOI, 6 October 2020 ↩

317. MedCOI, 12 May 2020 ↩

318. MedCOI, 12 May 2020 ↩

319. MedCOI, 12 May 2020 ↩

320. MedCOI, 13 March 2019 ↩

321. MedCOI, 4 November 2020 ↩

322. MedCOI, 6 October 2020 ↩

323. MedCOI, 30 July 2020 ↩

324. MedCOI, 21 October 2020 ↩

325. MedCOI, 15 August 2019 ↩

326. MedCOI, 11 March 2019 ↩

327. MedCOI, 7 July 2020 ↩

328. MedCOI, 4 November 2020 ↩

329. MedCOI, 17 September 2019 ↩

330. MedCOI, 4 November 2020 ↩

331. MedCOI, 4 November 2020 ↩

332. MedCOI, 27 March 2019 ↩

333. MedCOI, 13 March 2019 ↩

334. MedCOI, 7 July 2020 ↩

335. MedCOI, 12 May 2020 ↩

336. MedCOI, 4 November 2020 ↩

337. MedCOI, 13 March 2019 ↩

338. MedCOI, 12 May 2020 ↩

339. MedCOI, 12 May 2020 ↩