Chinese health care reformers aim to help rural areas but face hurdles

"We did this to survive, as the price is too expensive in hospitals," says Wei, 34. Authorities closed the illegal facility last month, but Wei and nine other patients refused to leave for several weeks until media coverage forced their local governments to offer financial help.

"I'm a farmer. I don't understand the terms of the new medical reform, but I believe our country is changing for the better," Wei says.

Heart-rending cases are all too common, as "there is no safety net in China," says David Wood, a former senior manager at hospitals in California and Colorado, who runs the ChinaCare Group health consultant in Beijing.

"If you don't have money, you just don't get treatment," says Wood, citing estimates that 70% to 80% of health care dollars come out of the patients' pockets.

The new plan "is the most progressive, intense reform effort I've seen," Wood says. The Chinese system is focused on state hospitals that have more than 1,000 beds, but the quality of care "rapidly disappears the farther you go into the countryside. Due to the lack of GPs (general practitioners), most patients self-refer to the large, impersonal institutions that offer no continuity of care," Wood says. "Directing money to community health clinics is by far the most effective way of providing better care."

He also hopes the promised controls on the price of medicines and increased funding to hospitals will remove the incentive to overcharge and overprescribe. In a sign of the problem, Yunnan health officials last month launched a "price honesty" campaign at provincial hospitals and asked the public to help monitor and help stop overcharging.

The new government plan was drafted over three years and included a month of public debate, which "was unusually democratic," says Gordon Liu, a health economist and professor at Peking University's Guanghua School of Management, who was an adviser on the plan.

"This is helpful for China moving forward, economically, socially and politically," Liu says.

The government decided against the expense of a welfare health system similar to that in the United Kingdom and opted for a social insurance approach, mobilizing resources from government, society and individuals, Liu says.

"The system offers the choice of the USA, but the financing of France or Germany to try to persuade everyone to join," he says. "China is on the right track now, but on the delivery side, we face a major challenge."

An increase in spending?

The plan offers good news to spur the economy here and in other countries, Liu predicts.

"Once Chinese have better health security, due to the new insurance programs, they will not put aside so much money and use more of their savings on consumption," Liu says. "This will substantially benefit the Chinese and world economy."

In recent years, China has been at the heart of outbreaks of bird flu and SARS. Barber of WHO welcomes the promise of $2.20 per person to be spent on public health and communicable-disease control. "This commitment could have an impact on control of communicable diseases," she says.

The new plan bears the WHO footprint of universal access and a people-centered approach, says Barber, who welcomes the emphasis on expanding health insurance and making essential medicines more affordable, but wants more focus on the actual benefits package patients can expect.

Deploying qualified staff to rural clinics and paying them remains a huge challenge, she says.

  • 1
  • |
  • 2
  • |
  • 3
  • |
  • 4
Join the Discussion
blog comments powered by Disqus
You Might Also Like...