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)