Medical care reform - China

Medical care reform: making it easier to see a doctor

In spite of the improved benefits experienced by Song, the medical care system of China has long been criticized. The focus is on the soaring medical fees, lack of access to affordable medical services, poor doctor-patient relationships and low medical insurance coverage.

Statistics from the Ministry of Health show that the personal spending on medical services has doubled from 21.2 percent in 1980to 49.3 percent in 2006, while the government funding dropped to 18.1 percent from 36.2 percent in 1980.

For this reason, medical services, along with tuition fees and housing, is called one of the "three new mountains" that greatly diminish Chinese citizens' sense of happiness, after the reform and opening up.

In 1997, the State Council issued a historic decision, defining medicine as a social welfare sector, which for the fist time meant to correct the previous concept that medical services were a type of commercial product.

In the next ten years, China implemented a series of medical reforms, such as the basic medical insurance for urban employees and the new cooperative medical scheme for farmers.

But the Development Research Center of the State Council, an influential think-tank, concluded in a report in 2005 that "the medical reform in the past decade is basically unsuccessful".

In October this year, the long-awaited health care reform plan was released for public debate. A main target is to set up a health care system that covers all urban and rural residents by 2020. Breaking with the market-oriented reform over the past 20 years, the new plan defines government's responsibility by saying that it plays a dominant role in providing public health and basic medical service.

"Both central and local governments should increase health funding. The percentage of government's input in total health expenditure should be increased gradually so that the financial burden of individuals can be reduced," the draft says.

The plan also promises to tighten government control over medical fees in public hospitals and to set up a "basic medicine system" to quell public complaints about rising drug costs.

Different from the past when the policy was solely made by the authorities, the central government entrusted nine domestic and overseas organizations to conduct independent research, including the World Health Organization and Mckinsey Company, whose ideas were incorporated into the draft.

In just one month, the draft received 35,000 pieces of advice. But it once again aroused heated debate. An online survey by Sohu, a major portal site, finds that as many as 87.83 percent of pollster were unsatisfied or could hardly understand the 10,000-word document, a compromised product of experts and officials involving 16 departments.

Bai Yansong, a famous anchor of China Central Television, says the draft is characteristic of its "obscure language, academic expressions and emptiness in substantial content".

Observers are more concerned of the new plan's effectiveness.

Liao Xinbo, deputy director of Guangdong Provincial Bureau of Health, says the draft has no new highlights as compared with the guiding policy in 1997, and that it does not touch on the key issues of unbalanced distribution of medical resources and mounting personal expenditure. The crux of the problem, according to him, is the insufficient government funding.

Echoing his words, the total health expenditure by the government made up 4.76 percent of GDP in 2006, seeing a noticeable decline from 5.33 percent in 2000.

"Insufficient government funding will result in the disorientation of public health institutions and inadequate provision of medical service for the public," he writes.

But Gu Xin, a professor of government management from Peking University, voices concerns that the government-dominated plan, if approved, would return China's public health service back to the planned economy, which might "consolidate the power of bureaucracy and create a hotbed for corruption."

For the Guizhou farmer Song, messages sent by the drafted plan may be felt in years ahead. "My only hope is that I will not be tormented by serious illness any more."

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