Focus

Radical treatment for healthcare

By Hu Yinan (China Daily)
Updated: 2010-09-16 07:43

For example, half of the grassroots health staff in Guzhen county were asked to leave their jobs under the pilot initiative - but only 13 actually did so. About 340 workers were instead put on a three-year paid probation period.

In an August report to provincial authorities, county officials argued that the compensation they need to pay for redundancies - an estimated 5.4 percent of the county's 2010 financial revenue - is too great a burden.

To avoid the issue spiraling into a crisis, Anhui authorities will inject 400 million yuan this year to pay off more than 20,000 unaccredited medical personnel, some of whom will receive administrative posts instead of being fired.

"I'm not even going to talk about the money problem the utmost concern is to ensure stability," said Gao. Yet, most of the challenges raised by the reform have to do with money.

Internal half-year self-assessments provided to China Daily show that 13 of the 32 pilot sites listed limited finances as the foremost barrier to further reforms.

Some also complained about the mounting debts of township health clinics due to over-expansion in recent years, an issue that has not been addressed by the reform.

"Grassroots health institutions in the 32 pilot sites carry a debt of more than 400 million yuan. Across Anhui, that figures is about 1.4 billion yuan," said Gao.

"The issue still hasn't been addressed too well but we're looking into it," he said, before stressing that the initiative for the entire province "will be proven effective in half a year".

Fall in patients

Health chiefs in all 32 pilot sites signed responsibility agreements in late June that bind them to "achieving comprehensive reform tasks" by March 31, 2011.

Bi Pumin, director of the city health bureau in Huangshan, said the most important indicator of success is whether or not people in towns and villages get cheaper access to healthcare.

However, this cannot be done quickly, he warned.

"Medical reforms in the 1990s and early 2000s attracted a great deal of money from (patients) and boosted health departments, but officials realized that if we left healthcare solely to the market, the people would suffer," said Bi. "That's why we must rebuild a public-purpose system led by the government. The problem becomes how we can introduce a competition mechanism to motivate workers."

The reform has reduced revenue considerably for a third of Huangshan's township clinics. Overall, the number of outpatients fell more than 60 percent during the first half of this year compared to the same period in 2009, which in turn has led to sharp decreases in the incomes of grassroots physicians.

Although township clinics have been stopped from profiting from drug sales, government subsidies have not yet caught up in many areas, posing a dilemma for managers.

Xincheng Community Health Center, Huangshan's highest-rated rural clinic in terms of performance, made 800,000 yuan in 2009 but has witnessed a dramatic decline in revenue following the reform.

Striking a balance between covering costs and providing public services is a challenge, said its director, Cheng Libin.

"With minimal subsidies, we're still pretty much on our own with operating costs," said the 37-year-old. "We can probably earn 400,000 yuan this year, provided each of our 30 or so staffers brings in about 15,000 yuan in revenue.

"Any more would be a stretch, unless we're determined to make profits again. There's still room for profit," he added, referring to the unnecessary infusions ordered by doctors looking to make extra money.

On average, about six out of 10 inpatients at rural clinics are given infusions, according to Ye Lianggui, Xincheng's deputy health director. His bureau has ordered all clinics to cut inpatient infusion rates by 70 percent this year.

Even Cheng's center still gives infusions to half of its patients, however.

"It's a conflict," said the health center boss. "If they want us to meet the revenue requirements, this is how we're going to do it. We would've been much better off had these missions not been assigned but that would be a great financial burden on the government."

In response, Ye acknowledged infusion rates are difficult to contain under the circumstances but insisted the reform is on the right track.

"If we just let it go and allow them to make profit, the tasks of grassroots health workers would've been extremely simple: Just go catch patients and butcher them," he added. "Without this reform, medical costs would only go up year after year."