The National Reform Commission (NDRC) of China has proposed sweeping changes in
the country’s healthcare policy, establishing as a policy the goal of covering
all 1.3 billion of China’s citizens with medical insurance by 2020 and 90% of
the population within just two years. In the past twenty years, China’s
healthcare has swung from government-controlled to market-oriented. As an
unintended result of the new direction, rural citizens currently suffer from
much lower levels of medical care delivery, and all of the population, urban and
rural, is upset about its cost.
Some of the statistics are appalling.
Reuters reports that infant mortality in rural districts of China is 123 per
1,000 live births, against a figure of 26 in the world’s richest counties (the
study was originally published in Lancet). A significant 64 children out of
1,000 who are born in China’s countryside will not reach their fifth birthday.
In China’s cities, the number drops to just 10.
The NDRC report seeks to
address four major problems (according to Xinhua): soaring medical fees, lack of
access to affordable medical service, poor doctor-patient relationships and low
rates of medical insurance coverage.
Public comment on the draft
proposal (proposal is here) remains open until November 14, 2008.
When
medical care in China became market-oriented, the central government cut funding
for hospitals. Hospitals began aggressively selling drugs as a major source of
revenue. The proposed plan makes government more responsible for healthcare by
increasing payments to providers, lowering the burden on individuals.
Overall, the new NDRC plan was criticized on two grounds: it is not
understandable, and to the extent that it can be understood, it lacks
specificity. On the latter point, how much of the burden would be shifted? How
much money would go to providers? The draft proposal does not give clear
answers. The proposal did say that government’s healthcare expenditures will
rise gradually. The money will be split among four areas: public health, rural
areas, city community health services and basic medical insurance, leaving
intact the basics of the market-oriented approach.
However, the draft
proposes that control over public hospital fees will be tightened, and a “basic
medicine system” will be established. The “basic medicine system” will include a
catalogue of important drugs to be produced under government control and,
presumably, government pricing. The high cost of drugs is one of the sore points
of the present medical system.
The healthcare proposal included heavy
input from government officials. Experts from 16 departments participated,
including the Ministry of Health and the National Development and Reform
Commission. In addition, the NDRC consulted with the World Health Organization,
the World Bank, McKinsey & Co., and academic experts in China’s
universities. The plan has been in development for two years.
