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China last month unveiled a blueprint for healthcare over the next decade, kicking off a much-anticipated reform to fix the ailing medical system and to ensure fair and affordable health services for all 1.3 billion citizens.
The Central Committee of the Communist Party of China and the State Council (China’s Cabinet) jointly endorsed and issued the Guidelines on Deepening the Reform of Healthcare System after about three years of intense debate and repeated revision.
By 2020, the world’s most populous country will have a basic healthcare system that can provide “safe, effective, convenient and affordable” health services to urban and rural residents, according to the tone-setting document.
This will be supplemented by a more detailed implementation plan for the three years until 2011. The plan has yet to be published, but the State Council announced earlier this year an investment plan of 850 billion yuan ($124 billion) for the reform over the next three years.
The core principle of the reform is to provide basic healthcare as a public service to the people, which requires much more government funding and supervision.
The document said the government role in “formulating policies and plans, raising funds, providing service, and supervising” must be strengthened in order to ensure the fairness and equity of the service.
“This is the first time that basic medical services in China are clearly defined as a public service for all citizens, which is part of the essential rights of the people,” said professor Li Ling of Peking University.
The reform is aimed at “solving pressing problems that have caused strong complaints from the public,” the document said, referring to long-standing criticism that medical services are difficult to access and increasingly unaffordable.
Many factors were blamed for causing problems — huge development gaps between cities and rural areas, low government funding, poor healthcare facilities in small-scale hospitals and clinics and increasing disease burdens - despite the country’s effort to double the average life expectancy over the past 60 years.
Such problems force many ordinary Chinese to save money for health emergencies, instead of spending on consumer goods, as a precautionary measure.
“The government’s decision to spend more on public sectors such as healthcare comes at a crucial moment as the country strives to expand the domestic markets to offset negative impacts from the global economic downturn,” said professor Zhao Xijun of the Renmin University of China.
After the founding of the People’s Republic of China in 1949, governments covered up to 90 percent of medical expenses for urban residents who worked in government departments and institutions, schools and hospitals — which were all public — and State- or collectively-owned businesses, while rural people enjoyed simple but essentially free healthcare.
But when China began its economic reforms in the early 1980s, the system gradually fell apart as the country attempted to switch to a market-oriented healthcare system.
Due to low government funding, doctors at State-run hospitals were forced to “generate” incomes for the hospitals through prescribing highly-profitable, sometimes unnecessary, drugs and treatment. In many places this accounts for 90 percent of a hospital’s income.
Soaring fees plunged many into poverty and medical services became less affordable to ordinary citizens.
Statistics from the Ministry of Health show that personal spending on medical services has doubled from 21.2 percent in 1980 to 45.2 percent in 2007, while government funding dropped to 20.3 percent from 36.2 percent in 1980.
The State Council started a series of medical reforms in 1997, such as basic medical insurance for urban employees and a new cooperative medical scheme for farmers.
But the central government admitted in 2005 that previous reforms were “basically unsuccessful,” then promised to embark on a new round of reforms, which led to the current plan.
The long-awaited document has been repeatedly delayed since the government unveiled a preliminary version for public scrutiny in October last year. It has drawn wide attention and debate and, accordingly, was revised many times.
The blueprint calls for establishing a basic healthcare system to cover all Chinese citizens.
The government will improve the public health network for disease prevention and control, health education, mother and infant healthcare, mental health and first aid services, according to the blueprint.
Public, non-profit hospitals will continue to be the dominant providers of medical services, while more priority will be given to the development of small-scale hospitals and clinics in cities and rural areas, which are currently often ill-equipped and under-staffed.
Patients will be encouraged to use more local-level hospitals and clinics, which will be improved to provide more accessible and affordable services. Comprehensive hospitals in big cities will be asked to provide more support to small-scale hospitals in terms of personnel, expertise and equipment.
The government plans to set up diversified medical insurance systems in order to have urban employees, urban residents who do not work or are self-employed, and rural residents covered by some sort of insurance plan.
The ratio of those covered by the basic medical insurance is expected to surpass 90 percent of the country’s population by 2011. The reform aims to improve the medicine supply system so that public hospitals can get essential medicines with prices regulated by the government.
Dr Sarah Barber, a World Health Organization official, said the plan to improve equitable access to essential healthcare for all in China was laudable.
Xinhua
