Dramatic Increase in Heart Disease Procedures in China
In an invited commentary in JAMA Internal Medicine, Commonwealth Fund President David Blumenthal, M.D., and colleagues remark on a study (Zheng et al.) that documented a dramatic increase in the number of procedures for coronary artery disease (CAD) in China. The procedures—coronary artery catheterizations and percutaneous coronary interventions—increased more than 15-fold in urban Chinese hospitals from 2001 to 2011.
Explaining the Numbers
The authors explain that during the 10-year period, China significantly expanded health insurance coverage for a population that had been largely uninsured and lacked access to even basic health care services. This expanded access likely uncovered substantial unmet need for CAD care. At the same time, increasing modernization, urbanization, and consumer wealth have led to lifestyle changes, like higher consumption of meat and dairy products, less exercise, and greater obesity. Additional risk factors include China’s high rate of smoking and severe levels of air pollution.
Finally, the authors point to China’s lightly regulated and highly profit-driven health care system, where hospitals and physicians are primarily paid fee-for-service and are financially intertwined with drug and device companies.
Implications for China’s Health Care System
The history of other modernizing countries suggests that, in addition to CAD, China will soon see a rise in conditions like cancer, diabetes, and pulmonary disease. Combined with increased access to care, this disease burden will put an extraordinary strain on the country’s health care system. To manage the demand for care, the authors say China will likely need to invest heavily in public health campaigns, take steps to promote high-value care, and alter incentives that encourage overuse of care.