China Forging Ahead with Healthcare Reform
Since April this year, when the healthcare reform policy was announced, the Chinese government has spent 71.6 billion RMB on healthcare reform. Following is a snapshot of what is being reported in the Chinese media.
A focus on community health
In August, at the Work Group on Community Health convened in Xian, Minister of Health Chen Zhu announced that one of the near-term priorities is to build up the healthcare work force and, specifically, to train 160,000 community health workers by 2011. According to Minister Chen, by the end of 2008, a total of 7,232 community health centers and 21,895 community health stations had already been established, and this effectively covers 98 percent of all townships. In some areas, the community health facilities are meeting 30 percent of urgent care needs, providing much-needed relief to hospital urgent care departments. This relief is especially timely in light of other health crises such as those around infant formulas and swine flu. Minister Chen pointed out that there is still significant work to be done in building infrastructure. Aggressive goals for building the community health service system include the creation of 3,700 new and/or updated community service centers and 11,000 community health stations within three years; using government investment to move forward quickly in upgrading and standardizing the community health infrastructure; and a push toward uniformity in public health services. Minister Chen stressed the importance of local government in strengthening the public hospital system, building up the preventive health system and working with community health organizations in exploring the interface between health insurance and community health.
Note: Since China does not have a primary care or physician referral system, citizens can see any physician of their choice. The lack of healthcare facilities in less populated areas, combined with this “open” system, has resulted in congestion at big hospitals. In this context, “community health” refers to making healthcare more accessible to people living in smaller cities or more rural areas and relieving the congestion at big hospitals.
Getting to the root of the problem at big hospitals
In urban areas, one key area for reform is the contentious hospital business model, which relies on revenue from pharmaceuticals and medical device use to subsidize traditionally low service fees for physicians, and which is a major source of patient dissatisfaction, conflicts between physicians and patients, and outright malpractice. Toward this end, Opinions and Directions for Public Hospital Reform, to be published by the Ministry of Health in September, will launch a pilot program at about 100 hospitals in 12 cities. Significantly, best practices that evolve from programs such as these may well be written into the law to ensure implementation.
On a more tactical front, hospitals are also working to implement a heretofore nonexistent appointment system for outpatient visits. In August, the Ministry of Health published a “solicitation of public opinion” as a first step toward developing and implementing an appointment system, and in this solicitation, the Ministry stated the goal of having an appointment system in place at all Category IIIA hospitals by October. It further stipulated that hospitals may not increase charges for the appointment service without permission and may not work with intermediary organizations to implement the appointment system. Additionally, the solicitation asks hospitals to come up with a standard system for making specialists available to patients. (One of the issues with the current system, or lack of it, is that patients have to go to hospitals very early in the morning to get in line for a specialist of their choice. Depending on how hospitals assign patients to specialists, some patients may learn that they are not able to see the specialist of their choice only after they have spent hours waiting.) Lastly, to avoid fraud and scalping, the Ministry wants to see ways for verifying patient identity incorporated into the system. Meantime, trial appointment systems at hospitals in major cities such as Beijing have met with mixed responses.