Evidence-Based Medicine in China

Abstract

China is the biggest country in the world that has 1.3 billion population. The health of the population has been one of the issues most relevant to sustainable development of the economy and society. However, limited availability of health services is unable to meet the enormous health needs. The estimated annual incidence of cancers 1.3%, cardiovascular diseases 50%, infection diseases 2.7% in 2003, whereas only 1.50 clinicians, 1.03 nurses and 2.40 ward beds per thousand are available to provide services in 2004 [1]. With the rapid shift of infectious diseases to chronic diseases in the Chinese population, the health spending is increased dramatically. The national health expenditure in 2003 has been tripled to 658.41 billion Renminbi (RMB) compared to that in 1995 [1], whereas an increase of national health budget from 38.734 billion in 1995 to 111.694 billion in 2003 [2] cannot cope with the steep climbing of health expenditure. It is a big challenge to utilize the limited health-care capacity to keep all the population healthy. On the other hand, the health resource use is highly imbalanced across China. In the economically developed regions, the health-care services are improperly and excessively utilized, whereas health professionals and technologies are less available in regions with less developed economy. This situation has been further complicated by the low efficiency of utilizations of health services, on which a large number of avoidable adverse events of medications occur each year to cause additional health resource use. Since early 1990s, these problems have been increasingly evident in China. Although the central and local government paid great efforts to address these problems, the health-care system is yet to be improved. The World Health Organization (WHO) Report [2] ranked China 144th place out of 191 member countries for the overall health services. Both policymakers and clinicians feel the strong need to make policy and clinical decisions based on solid evidence. Coincidently occurred in the world was the burgeoning of the international organization in 1993—the Cochrane Collaboration—which aims to produce, maintain, and disseminate the best evidence to improve the effects of health care, and a new field in clinical medicine in 1992—EBM—that focuses on improving the health-care pattern. These historical events have become the incentives that promoted the introduction and development of EBM in China.