Health System Reform in China
The opening session of the Chinese Medical Association (CMA) Medical Science Conference in Beijing Sunday, January 27 was highlighted by an address to the CMA Council by Dr. Chen Zhu.
Dr. Chen Zhu, President of the CMA and Minister of Health for the Chinese Government, gave a report on progress implementing the five strategies for health system reform established in 2009 by the 80th party Congress.
Dr. Chen Zhu gave a generally optimistic but candid picture of the status of reform.
1. He reported that the goal of expansion of insurance coverage has been achieved with 95 per cent of Chinese now covered. However funding in rural areas is low and rural care is still a challenge.
2. A national essential medication system has been put in place in much of the country and for all private hospitals with a resulting reduction of per capita costs.
3. Improving the grassroots level medical and health care service system has been achieved by building facilities and integrating traditional and western medicine.
4. Promoting access to basic public health services is underway.
5. Reforms of the management systems of public hospitals are challenging. Currently hospitals derive compensation from three sources; medical services, government funds and sales of medicines. One of the goals is to remove sales of medicines as a source of income based on a conclusion that this represents a perverse incentive that detracts from the hospitals’ mission of public service.
Moving to phase two of implementation of the strategies will include reform of public hospitals; acceleration of insurance payment reform including DRG implementation; expanding essential medicine reform to include centralized bidding; expanding public programs especially in the area of noncommunicable disease putting prevention first, and expanding the use of electronic health records.
Dr. Chen Zhu described non-communicable disease (NCD) a major problem with a 20 per cent incidence in China, increasing by 20 million a year. For example: over 200 million Chinese have high blood pressure and only an estimated 8 per cent are effectively controlled. 92 million have diabetes, up from 20 million in 2000. The importance of addressing the social determinants of health, which have a major impact on NCDs was emphasized.
The solution, according to Dr. Chen Zhu, is prevention, which is best addressed by expansion of primary care, especially general practice that he described as one of the most important specialties. He called on members of CMA to promote the status of general practice.
He also called for innovation that includes developing a general practice structure, integration of services and team based care.
What is needed according to Dr. Chen Zhu is moving from disease treatment to prevention; from a focus on individual to population care, and from science and technology to human care, putting priorities on the health of people.
In a time when governments around the world are understandably struggling with the high and rising costs of health care, concern about costs should be balanced by an understanding of the critical importance of healthy citizens to the wellbeing of countries.
In his remarks Dr. Chen Zhu gave voice to that insight when he said, “Health is a prerequisite to social and economic health”.
