China will ensure that comprehensive community health services
are established in all major cities by 2010.
The announcement was made on February 9 during a State Council
executive meeting that discussed and approved in principle the
State Council's suggestions on developing urban community
health services.
The State Council urged local governments to establish a stable
investment system for community health services. The central
government will allocate some funds towards the building of
community health services in cities in west China. But private
funding has also been encouraged.
According to statistics released by the Ministry of Health on
February 10, China has already set up more than 3,400 community
medical service centers and nearly 12,000 community hygiene
stations.
However, this still doesn't meet the people's needs. Complaints
of expensive medical fees and the general inconvenience of seeking
medical help are plenty. This had led some to argue that the
government should involve more private enterprise or market
participation in the reformation of the country's health
system.
Alternatively, a government-managed set of reforms might be the
way forward, according to Prof. Gu Xin with the?Institute of Social
Development and Public Policy under Beijing Normal University.
But such a system would require understanding the role that the
government should play.
In his article published in China Youth Daily on
February 7, Gu suggests three key roles for the government in
healthcare reform:
1.?Representative of the insured
The public health system in China comprises two main parts, each
with its own challenges: one is the compulsory public health
insurance scheme for urban employees where half of the premium
payments are made by employers. The other is the voluntary health
insurance scheme that applies in the rural areas, and where
residents have a choice as to whether or not to purchase insurance
cover.
If an urban resident is between jobs, unemployed or
self-employed, he would not be able to purchase any public health
insurance cover. And if a rural resident decides not to purchase
any public health insurance, he would not be entitled to any public
health welfare.?
According to results from the third national public health
survey conducted in 2003, 44.8 percent of urban residents and 79.0
percent of rural residents do not have any form of medical or
healthcare insurance.
The government should set up a more comprehensive system that
covers all citizens.
Under such a comprehensive scheme, the government would take on
the role of representative of the insured. In insurance terms, the
insured isn't just an individual of a group of individuals from a
certain company, but the Chinese people collectively.
2. Provider of subsidized medical services
In August 2005, China Youth Daily conducted a survey of
people above 30 years of age to find out their thoughts on the
existing public health system. 89.8 percent of respondents said
that the ratio between the cost of medicine and health services and
incomes has increased tremendously in the last 10 years. 81.2
percent felt that hospitals had become too profits oriented when
they should be public welfare oriented.
Under the current system, patients are only reimbursed for all
or a portion of medical fees upon submission of all necessary
receipts and paperwork, a process which can be
time-consuming.?
Further, there have been allegations that local governments are
more concerned with numbers of insured than with supervising the
quality and service standards of hospitals.
In this respect, calls have been made for the government to
impose a system that relieves patients of having to foot their
bills first.
On February 9, the State Council also urged that supervision of
the operations of community health services should be tightened,
including more stringent checks on the qualification of medical
staff and medicines dispensed.
3. Supporter of the community health center
The same survey showed that 90.0 percent of respondents are
unsatisfied with reforms made over the last 10 years; 78.9 percent
believe that there are more hospitals than before; and 60.1 percent
think that visiting a hospital now is much harder than 10 years
ago.
Because it is not the practice in China to have a family doctor,
hospitals are overcrowded with people with ailments as serious as a
broken leg to something a little less so like a runny nose. The
problem of overcrowding at hospitals can be resolved with the
establishment of more community health clinics, particularly to
deal with the less serious conditions.?
It has been suggested that the government should ensure
non-profit public welfare through community health services, which
can be co-sponsored by the government and private or non-government
organizations.
(China.org.cn by Wang Ke, February 13, 2006)