By Mohnish Kedia, Scholar at Yenching Academy, Peking University, also associated with the George Institute for Global Health
China is one of the best performers in terms of achieving nationwide health targets set by the United Nation’s Millennium Development Goals (MDGs).
An exhibition featuring China’s achievements in the past five years was held at the Beijing Exhibition Center which highlighted the deepening of healthcare reforms.
President Xi Jinping said China’s development should go hand in hand with the health of the people. Accordingly, the following healthcare reforms have been announced:
Firstly, the government will focus on building a strong primary care system to reduce dependency on hospitals. The expansion of family doctor-based services is important in this regard. Developing a referral system can help reduce pressures faced by hospitals. It will help identify diseases at an early stage and reduce cases in which treatment at hospitals is needed. A community health system with service provided at the local level is one of the most cost-effective healthcare systems suggested by the WHO (the World Health Organization).
Secondly, the Healthy China 2030 Strategic Plan, published in the 2016 National Health Conference endorsed equality and accessibility in healthcare. In contrast to the action plan launched in 1996, which promoted a greater role of the market in the healthcare system, this plan envisages a greater role of government.
The 19th Party Congress of the Communist Party of China directed the Healthy China 2030 plan to integrated with government policies to support: a healthcare system that delivers healthy lifestyles for all, optimization of healthcare service delivery, and improving healthcare insurance.
Thirdly, the government favors expansion of the insurance system and continued reforms of the healthcare system. The three insurance plans launched since 2009 have been praised by the WHO for achieving almost 100% coverage compared to negligible coverage just a decade ago.
Fourthly, the government seeks to reduce hospital dependency on pharmaceutical revenues. Reliance on drug sales for hospital revenues had been in place for nearly fifty years in China, which has proved to be an unsustainable source of revenue for hospitals. Revenue from pharmaceuticals accounts for about 30%-40% of total hospital revenue, which will make the future reforms challenging.
Finally, the government should improve the health of its citizens by implementing development of a food safety strategy, traditional Chinese medicine, suitable demographic policy, old age care, human resources for health and healthy cities which will also ensure a sustainable Chinese healthcare system.
The People’s Republic of China (PRC) has come a long way since the 1950s.
Between 1950-1970s, the nation had witnessed major improvements in the health of its citizens as the government had focused on basic primary health care services. While ‘barefoot doctors’ were providing knowledge regarding basic hygiene and delivering basic health services, a huge number of high school graduates were given short-term training to provide primary care services in rural areas.
After this huge leap in control of communicable diseases, China moved on to reform its healthcare system in 1978. Since 1978, the government introduced market reforms and majority of government health service providers were granted financial autonomy. Reduced access to primary services led to increased reliance on hospitals and increasing healthcare costs. Between 1978-2005, China only saw minor improvements in public health, along with an increasing burden of non-communicable diseases combined with its aging population. The factors along with poor financing led to a huge strain on the healthcare system.
But in the last decade, the government has shown its renewed commitment to revive the public health system. The following reforms were announced in the past decade:
Aimed at financing healthcare
Three broad ranging insurance proposals, have provided coverage to over 95% of the Chinese population, which include the Urban Employee Basic Medical Insurance (UREMI-1998), Urban Residents Basic Medical Insurance (URBMI-2006) and New Cooperative Medical Scheme (NCMS-2009) for rural areas. These insurance plans cover on average 50% of healthcare costs for citizens at the moment.
Essential Drug List (EDL-2009)-which contains a list of more than 500 frequently used drugs, including both western and Chinese medicine. After the release of EDL, the government mandated community health centers had taken stock of the medicines, prescribing them before non-EDL drugs and selling them at a zero mark-up.
Improving quality of care
Hospital Reforms were initiated to separate management and regulations, make hospitals independent, shift from fee for service mechanism to case based/capitation method and encourage private investment.
Whereas Primary Care Reform (2009) had three major components-increased investments in infrastructure and human resources, separation of revenues from expenditures at the level of primary care and reduction of reliance on hospitals by making primary care center the first point of contact for citizens.
Regulating healthcare
Strengthening compliance (2013) - The government issued two sets of regulations to tighten control on pharmaceutical companies (‘Blacklist Regulations’) and healthcare providers and institutions (‘9 Prohibitions’).
The reforms have had a positive impact on the health care sector. According to the global ranking based on the Healthcare Access and Quality Index (HAQ) issued by Lancet, China’s HAQ index value rose from 49.5 in 1990 to 74.2 in 2015, indicating an improvement in the country’s ranking from 110 to 60 among all 195 countries.
As the epidemiological transition continues in China, a forward looking strategy is needed to manage the onset of non-communicable and lifestyle diseases. The Chinese government remains committed to it in the coming decade and offers plenty of lessons for the whole world as China manages the health of its large and aging population.
(The opinions expressed here do not necessarily reflect the opinions of Panview or CCTV.com. )
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