Professor BA Denian is an elected member of the Chinese Academy of Engineering and the Institute of Medicine of the U.S. National Academies. He has dedicated his academic career to tumor immunology research. In the 1980s, he discovered a natural thymocytotoxic autoantibody, and proposed a theory to illustrate the relationship between abnormal immune function and hypertension, and thus is recognized as a pioneer of cancer biology and theory in China. Dr. Ba had practiced medicine for many years and trained numerous medical professionals. He served as the president for both Peking Union Medical University and the Chinese Academy of Medical Sciences for nine years. Dr. Ba served as the Dean of Zhejiang University School of Medicine from 2003 to 2009. Although Dr. Ba has retired from these positions, he remains active and at the forefront of health research in China.
1. Educational Experience
Dr. Ba has mentioned his tough path to education when he was young in many of his speeches. After graduating from middle school, he planned to attend a professional program in order to support his family. Encouraged by his middle school teacher and financially supported with a scholarship, he chose to attend high school instead. He managed to fulfill the prerequisite requirements for medical school in one year and was admitted into Harbin Medical College. He was a graduate student at Beijing Medical College during the Cultural Revolution, yet was able to remain true to his dream of becoming a physician. In 1978, at 40 years old, he was selected to study abroad. It then took him a mere two years to become the first foreign medical doctor of Hokkaido University School of Medicine in Japan.
Yi: Dr. Ba, you are known as an expert in immunology and have dedicated yourself to the study of cancer immunology for decades. What prompted you to choose immunology as your life-long career?
Dr. Ba: It was a special time when I first started my career. A lot of students nowadays may not understand what we were going through. Back in 1973, I was a surgeon and loved my job. I was asked to help establish a cancer institute in Heilongjiang Province as I specialized in tumor immunology. I switched from surgery operation to tumor immunology research because of duty assignments rather than personal interest. However, I have decided for myself that no matter what I work on, I should always try my best. If I had another opportunity to make the choice, I would have continued as a surgeon, working with patients to save lives.
2. Class of BA Denian
Yi: Dr. Ba, although you did not have the opportunity to be a surgeon again, you served as the vice president of Harbin Medical College, the president of Peking Union Medical College, the president of the Chinese Academy of Medical Sciences for nine years and the Dean of Zhejiang University School of Medicine from 2003 to 2009. You have trained many talented researchers in medicine. In 2005, a special eight-year medical program named after you started recruiting medical students for a dual MD/PhD degree. Over the years, the college entrance exam scores of students admitted to this eight-year program ranked among the highest in Zhejiang University. What was your expectation about this program?
Dr. Ba: At that time, the president of Zhejiang University, Dr. PAN Yunhe, proposed that we start a "southern Peking Union Medical College" at Zhejiang University. We knew that more than 100 years ago, the modern medical education system started in the United States. We truly hoped the eight-year dual MD/PhD program would continue its commitment to training future Chinese leaders in medicine for 20, 30 years and beyond. As to its name, I did not agree on naming it after me. But there was a mathematics program which was named after Dr. Shing-Tung Yau, a renowned mathematician, so they insisted on naming the medical program after me. It had already been printed in the national college enrollment brochure. Today I know this program attracts students with the highest college entrance exam scores in Zhejiang University. I am glad to see so many young students who have the determination and enthusiasm to join the medical professional in China, and yet I also feel a great responsibility. The better the students, the harder we need to work in order to train them to become the best doctors.
Yi: Dr. Ba, when you were the Dean of Zhejiang University School of Medicine, you always insisted on recruiting the best students to study in medical school, as well as training those students to become the best physicians. How has this been implemented in the eight-year Ba Denian program?
Dr. Ba: This has been successfully implemented in Zhejiang University by following two principles. First of all, we take advantage of the fact that Zhejiang University is a comprehensive university. We are able to provide diverse training for students in sciences, social sciences, arts and sports. This is important because we know that a good doctor not only has medical knowledge from books, but also has strong physical and psychological qualifications. So we have our best students be trained in science, art and sports at the Kezhen College of Zhejiang University. We do not focus on test scores. Instead, we stress the process of medical training, as we want to make sure that those young scholars can develop into excellent physicians and researchers. We have also adapted a training system from UCLA and we send several faculty members there every year. In addition, there are six affiliated hospitals in Zhejiang University which provide ample internship opportunities for our students.
Yi (Zhuo): Dr. Ba, China’s medical education system is currently undergoing changes, and there are a variety of different training models. Can you share your thoughts on promoting the eight-year MD and the MD/PhD program?
Dr. Ba: Yes, the Chinese medical education system has room for further improvement. My main proposal is as in the following: (1) General medical schools should continue to provide 5 years of undergraduate education. (2) We can try to promote the eight-year MD/PhD program in top universities, and particularly in comprehensive universities, such as Peking, Fudan, Nanjing, Shanghai Jiao-Tong, and Sun Yat-sen Universities. Currently, there are ten universities with an approved eight-year medical program. But I do not think that is enough and it should be extended to at least twenty schools.
3. The Development Path of China's Public Health System
Yi: You were active in promoting medical sciences, and now you are concerned about the development of public health policy and systems. What do you think is the biggest challenge to China's current medical and health system? You advocated universal health care in the past; what do you think about the current situation in China?
Dr. Ba: Since 2001, I have started to address equity of the health system in order to let everyone enjoy the fruits of economic reform in China. I advocated universal health. Things has been improved significantly in the past ten years. This is mainly reflected in the following: (1) 96% of China’s population is already enjoying varying degrees of health insurance coverage. China's health insurance is now divided into three schemes-- one is rural cooperative medical insurance, one is medical insurance for urban residents, and the third is employer sponsored health insurance. I propose to merge the three programs to let Chinese people enjoy a unified health insurance program. Of course, this would take time. (2) Starting this year [note: 2012], farmers in most counties can be reimbursed at least 60,000 RMB if hospitalized for a catastrophic condition. This is a major progress, but it is still below what I hoped for. I was thinking, with the advances in modern information technology, we can use only one insurance card to receive medical care all over the country without out-of-pocket payment. Therefore, China's medical insurance has improved in terms of equity, but this can be improved further. (3) In recent years, the hospitals at the county level developed very well. The government has invested a lot in developing hospitals in each county, and as such has promoted standardization of medical care in the countryside. The salary and benefits are the same whether you are a physician at the county, township or village level. But there are too few qualified physicians and nurses. More medical professionals are needed in the rural areas. (4) Hospital reform in the cities is far from complete. Regardless of serious illness or minor ailments, people prefer major hospitals, which is inefficient. Many minor illnesses can be addressed at the community hospitals, and do not have to be brought to a major hospital. But the service in the community hospitals should be improved to attract more people from the major hospitals. In summary, there has been a lot of progress in healthcare reform since 2009 and the government has increased investment in solving the fairness and access in health system. But there are still a lot of things that need to be worked out.
Yi: What role do you think the field of public health policy and health systems play in China's health care reform? How important is policy, knowledge and talent in this area?
Dr. Ba: This is extremely important. I will attend a national conference on October 8th and 9th (2012). I plan to propose a new program to train public health professionals. I do not think it is a good idea to enroll public health students from high school graduates. I believe that it is better to recruit public health students from those who have already been trained in medicine. There are two individuals I admire the most, Dr. Margaret Chan, Director-General of the World Health Organization, and Dr. Lincoln Chen, the President of the China Medical Board. Both are prominent graduates of MD/MPH programs. I argue that we need to select the best medical graduates to work in public health after further training in leadership, vision, and management. Such talents will be the backbone of China’s healthcare reform and future development.
Yi: China Health Policy and Management Society (CHPAMS) is a fast-growing professional society. Do you have any words to our members and readers?
Dr. Ba: The Chinese Health Review is great and informative. I hope it can be more objective, in-depth and honest, keep track of the development in China's health sector, attend to China's healthcare reform, and introduce health management to Chinese medical scholars, and serve as a platform of exchanges between China and the world in the area of public health.
By Yi Pan, PhD, Emory University