An emergency room in rural Yunnan (photo by Lua Wilkinson)
“Medicine for the Masses — China’s Healthcare Reform: Progress and Future Steps”
A new report was recently published last month by . The report is a review of the state of healthcare in China as it approached the end of a three year reform initiative, where many impressive changes to the healthcare sector have occured. However, rural-urban inequities, overprescription of drugs by public institutions, and an un-equal distribution of healthcare human resources remain problematic.
- Rural-urban healthcare disparities
- Inadequate resources for China’s rapidly aging population
- Distorted priorities for China’s public hospitals due to skewed financial incentives
In order to resolve these three areas, over RMB850 billion is dedicated to five goals:
- Basic medical insurance expansion
- Establishment of an “Essential Drug List” (EDL)
- Grassroots medical infrastructure improvement
- Equitable access to medical services
- Pilot public hospital reforms
- Public health insurance will now cover 93% of the population, quite an impressive feat when compared with earlier years
- 836 million people were covered by China’s Rural Cooperative Medical System in 2010
- 833 million in 2009
- 179 million in 2004
Coverage is also being boosted in other healthcare resources to rural areas (including the construction of hospitals):
- Beijing and Shanghai, which make up 1.3% and 2% of China’s population (respectively), have 544 and 306 hospitals, or 4.5% of the nation’s total
- Henan, a poorer province, which accounts for 7% of the population has only 5% of the nation’s total hospitals. Therefore, the government has set a target to construct 2,000 new county-level hospitals and will ensure that each county has at least one hospital to service it. In addition to this, the government is construction 29,000 township hospitals and upgrading 5,000 (not to mention the clinics and other healthcare facilities being upgraded)
- In 2010, 627 new hospitals were built, bringing the total number to 20,918
The report also has a section on how the MOH is now incentivizing private hospital growth. Chinese physicians are currently licensed to work at only one hospital, and do not particularly want to give up affiliation with a prestigious center to work at a private clinic or hospital. I have seen this in my personal experience with medical students, who are not keen on working at private institutions due to limited opportunities for research, development, and funding. Being limited to only one hospital is a disadvantage to both physicians and patients, so the MOH is now undertaking pilot projects that will allow physicians to practice at multiple institutions.
This report also does a nice job of reviewing the different types of insurance, much changed from a few years ago (on page 4 of the report), and discusses the issues surrounding reimbursement rates for each program. It also discusses much on the supplier side of reforms and how this ties into the problematic overprescription of drugs in public hospitals. Chinese hospitals are notoriously underfunded, leading physicians and healthcare administrators to rely on drug “sales” (via prescriptions) to make up for low profit margins. The MOH recognizes this as a serious problem and has now set a list of 300 Western and Chinese drugs that are to be sold at government controlled prices. In theory, this means that hospitals will be held to a “zero-mark up” policy to these drugs. In reality, while the government is able to issue price cuts for prescription drugs, they have yet to find an acceptable way to maintain profit margins for hospitals that equal those by prescription drugs, with some hospitals losing up to 70% of their revenue (see page 6 of the report).
If you are interested in China’s healthcare reform, I highly recommend you read this 10 page report. It also covers much about changes to pharmaceutical supply chains and the consolidation of the pharm industry as a whole, medical equipment sales, and drug price reductions. Healthcare reforms are clearly never a straightforward task, and China’s are some to watch.
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Lua – Thanks for putting this up here – it’s been an invaluable resource for me since you made me aware of it. Are you by chance aware of any studies of public hospitals going private in China?
Haven’t heard any reports yet, but will keep my eyes out and post if I do.
Hey , the shirt word for all Pharma stuff is – In China all those one who live in the villages are much better off with real deal herbs that Pharma Mafia that pushes all those mind bending DNA twisting Narcotics down out Throats for so much and for so long . I take only Herbs from now on . In very critical situations I may take the Chem one ^_^ . Thanks for post though .
In chaina,healthcare field is increasing day by day. But it is affecting the other parts of the country like rural-urban inequities, overprescription of drugs by public institutions, and an un-equal distribution of healthcare human resources. So gradually which may affect the healthcare field in future.So better steps should be takent to prevent the problem.
You are very right to point out the hazards of massive healthcare expansion. Rural areas in particular get left behind. I am heartened by Ministry of Health efforts to study all of the world’s healthcare systems to find a solution that will work for China; as opposed to simply trying to clone the system of any particular country.
But rural healthcare inequalities are one of those problems that no country has really figured out how to solve yet. I hope that the promising future of cybermedical technologies and base of pyramid healthcare funding schemes will lead to breakthroughs that will help change this unfortunate and global status quo.