How an overburdened medical system in China can receive relief

As China’s population continues to increase and universal healthcare access becomes a goal enshrined in Healthy China 2030, the feasibility of this has been called into question. To ensure sustainable healthcare, a tactic like self-care can be vital to alleviating an already strained system. Grace Xu, the head of communications in Bayer’s consumer health division, outlines what needs to be done to improve individual health and ensure an overburdened medical system leaves no one behind.

The greatest healthcare challenge in the coming decades is not improved access to care, but the instability of the healthcare system as a whole. Aging populations, combined with rising incidences of chronic disease, have placed an unprecedented amount of financial stress on healthcare systems around the world.

Healthcare systems in both developed and emerging economies face the same problem – insufficient resources to meet anticipated healthcare needs. An increase in the number of healthy people over the last century has been nothing less than astounding. However, as a World Health Organization (WHO) report outlines, despite “increasing health expenditures and unprecedented advances in modern medicine”, people today are “not necessarily healthier; nor are they more content with the healthcare they receive”. There is a crucial need, the report adds, to “improve the capacity for self-management and self-care”.

There has never been a more urgent need, or greater opportunity, to unleash self-care’s potential for improving individual health and making healthcare more sustainable. In China, the government has recently put in place the Healthy China 2030 initiative, which aims to provide equal access to health services for every citizen by 2030. Self-care will be one of the key drivers to providing universal healthcare access in China.

It is important to note that self-care does not mean that a person chooses to not seek out medical care or treat any medical malady that may arise. Instead, this style of care is the first step in moving away from depending on overburdened doctors for medical treatment and to enable people to take care of themselves by providing the average citizen with the appropriate tools and knowledge to be able to self-diagnose and provide treatment. With the growing amount of resources required for the treatment of long-term conditions and the providing of end-of-life care, the consensus has never been stronger that self-care must be a part of a medical regiment to maintain health, promote wellness and treat minor ailments. Self-care can be defined as:

• healthy lifestyle choices, including physical activity and healthy eating;
• effectively using pharmaceuticals;
• self-diagnosis, which involves making an assessment of symptoms based on access to proper information and self-care learning tools—and, when properly informed—maintaining health with the responsible use of self-care medicines;
• self-treatment with the responsible use of medication for minor ailments along with self-monitoring to detect if there is a change in one’s health; and
• access to tools that improve health literacy, nutrition, overall wellness, and the prevention and management of chronic diseases.

The economic value of self-care

There is a growing consensus that a greater emphasis on prevention, health promotion and self-care can help healthcare systems better cope with aging populations, fiscal pressures and the increased prevalence of chronic diseases. A wider adoption of self-care practices can also direct resources to the patients who need them the most. In other words, self-care has an increasingly important role in strengthening the sustainability of global healthcare systems. Evidence suggests self-management interventions, including self-monitoring and decision-making, result in superior patient satisfaction and reduced hospital and emergency care costs.

For example, a May 2012 UK report titled, Self-care and Self-care Support for People who Live with Long Term Conditions, concluded that engaged patients “tend to have better clinical outcomes, a higher quality of life and make more informed use of public services than those with lower levels of activation.”

Various studies have been done to estimate the economic impact of self-care on minor ailments. The results from some of these studies on the economic ramifications of self-care are as follows:

• According to a 2012 economic analysis conducted by Booz & Company for the Consumer Healthcare Products Association, each United States dollar (USD) spent on over-the-counter (OTC) medicines saves the United States (US) healthcare system USD 6.00 to USD 7.00. The current purchases of OTC medicines adds USD 102 billion annually, in profit, to the US healthcare system.
• A study conducted in China that tested self-care education on more than 950 people with hypertension, diabetes and other chronic diseases revealed improvements in self-care behaviours, self-efficacy and health outcomes. The results also showed a reduced number of hospitalisations in the first six months of self-care education.

The barriers to making self-care more accessible

In order to make healthcare more sustainable, the principal barriers to greater adoption of self-care health habits must be addressed.

A review of more than 30 independent surveys conducted by the World Self-Medication Industry found that “there appears to be no fundamental difference between developed and developing countries in people’s aspirations to participate to their level of ability and preference in self-care activities.” In a survey on self-care, conducted with people in several different countries, the majority of respondents believe they are capable of making more decisions regarding their own personal health and wellness.

Yet, many of these similar surveys show a noticeable gap between people’s desire in taking greater control over their health and their confidence in actually doing so. A 2013 consumer survey, given in 10 European Union countries, by the Brussels-based think tank Epposi found that nearly 90 per cent of respondents believed that self-care was necessary to remaining healthy and managing illnesses. However, fewer than 20 per cent of those surveyed actually engaged in self-care practices due in large part to a lack of confidence. Some people feel they lack the essential knowledge, skills, tools and encouragement to make self-care a way of life. For people to have the self-confidence needed to practice self-care, two critical gaps must be addressed:

1. The knowledge gap: There is a clear link between a person’s ‘health literacy’ and their willingness to take greater responsibility for their health. Currently there is a gulf between people’s desire to care for themselves and the knowledge and skills they need to do so.
2. The leadership gap: As the Epposi study noted, “It is inappropriate to expect people to take on greater responsibility for their health and well-being without greater guidance and leadership.” Self-care requires encouragement, support and promotion on the part of policymakers, as well as a commitment to provide people with the necessary tools to take care of themselves.

Global policy recommendations

To make self-care an integral component of a comprehensive health policy, the following things need to be done:

1. Develop a universal definition and framework for self-care in order to guide future research and policy reform.
2. Help people to help themselves by fostering greater self-care literacy.
3. Make self-care integral to overall health policy by increasing investment in health promotion and disease prevention.
4. Build-up institutional and leadership capacity for self-care promotion with a focus on developing countries.
5. Encourage healthcare professionals to support and facilitate the practice of responsible self-care.
6. Add to the body of literature on self-care effectiveness, and use this to guide self-care policies and practices.
7. Build stronger public-private partnerships and collaborations.

Right now, is a turning point for healthcare. Demographic changes, the emergence of new health conditions and the increased prevalence of non-communicable chronic diseases are creating substantial challenges both for individuals and healthcare systems globally. Absent important changes in how people around the world take care of their health, a potential health crisis might arise which could overwhelm health systems in the years ahead.

When it comes to addressing these challenges, self-care has a vital role to play. As stated in a WHO report, “promotion of effective self-care is…important to reduce health care costs, in an era of high medical technology and medical treatment, the concept has not been much emphasised and implemented.”

Grace Xu is the head of communications in the consumer health division. Bayer is a global enterprise with core competencies in the life science fields of healthcare and agriculture. Its products and services are designed to benefit people and improve their quality of life. Bayer is committed to the principles of sustainable development and to its social and ethical responsibilities as a corporate citizen. At pharmaceuticals, we focus on researching, developing and marketing specialty-focused innovative medicines that provide significant clinical benefits and value. In this way, we are addressing the growing requirements of patients, physicians, healthcare payers and regulatory agencies.