China’s Bold Visions for Universal Healthcare
By 2020, the world’s most populous country will have a basic health-care system that can provide “safe, effective, convenient and affordable” health services to urban and rural residents….
The government initiated a series of market-based reforms for the healthcare system starting 1997. But the reforms were considered to be a failure by 2005. The same report explained,
After the founding of the People’s Republic of China in 1949, governments covered more than 90 percent of medical expenses for urban residents, while rural people enjoyed simple but essentially free health care.
But when China began its economic reforms in the early 1980s, the system was dismantled as the country attempted to switch to a market-oriented health care system.
Soaring fees plunged many into poverty and made medical services less affordable to ordinary citizens.
Statistics from the Ministry of Health show that the personal spending on medical services has doubled from 21.2 percent in 1980to 45.2 percent in 2007, while the government funding dropped to 20.3 percent from 36.2 percent in 1980.
The most recent set of proposals was delayed and revised many times since the government unveiled preliminary version for public scrutiny in October last year. The blueprint highlights the establishment of a basic universal health-care system to cover all Chinese citizens.
Under the plan, public health programs, such as those relating to prevention and control, health education, maternal and infant care, mental health and first aid services, will be expanded.
Public, non-profit hospitals will continue to be dominant providers of medical services, although development of “grass-root level” hospitals and clinics, which have traditionally been ill-equipped and understaffed will also be emphasized. A system with a more balanced mixture of public and grass-root hospitals and clinics is expected to deliver more comprehensive and affordable services.
Diverse medical insurance systems tailored for different sectors of the population, such as urban employees, urban residents who do not work, the self-employed, and rural residents will be provided. Price of essential medical supplies and medicine will be regulated.
The proportion of population covered by basic medical insurance is expected to surpass 90 percent by 2011.
Other highlights of the plan include:
– The government to enhance the management and supervision of the operation of medical institutions, the planning of health service development, and the basic medical insurance system.
– Public hospitals to receive more government funding and be allowed to charge higher fees for treatment. But they will be eventually banned from making profits through subscribing expensive medicines and treatment, which is a common practice at present.
– Central and local governments to increase investment in the public health sector, grassroots-level clinics, subsidies for public hospitals, and basic medical insurance systems.
– Governments to increasingly regulate the pricing systems of medical services and medicines, with particular control on the price of basic services at non-profit hospitals and essential medicines those hospitals use.
– Supervision of medical institutions, health insurance providers, and pharmaceutical companies and retailers to be strengthened. Governments will also tighten monitoring of drinking water and food safety, and safety in workplace.
Dr. Sarah Barber, a World Health Organization official, said that the aim to improve equitable access to essential health care for all in China is “laudable.” However, she warned, the success of the reforms will depend on how effectively this plan is implemented across China.
According to another government article, it appears particular efforts will be focused on four prongs of reforms, including:
- Creation of universal coverage and promoting of preventive care;
- Improved supervision of hospitals and other medical facilities to reduce corruption in China’s medical system;
- Expansion of primary care to the most remote areas of China; and
- Improved training and updating medical facilities throughout China.
Given that the healthcare reforms of 1997 were largely unsuccessful, does anyone here have any insight on whether these set of reforms will be more successful?
Given that the government has said the draft proposal is open to public debate until Novemeber, what reactions do people have to this set of proposals?
P.S. For a general background on healthcare reform in China, see this helpful backgrounder from xinhua.
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