Healthcare Reform in China
On February 7, the Chinese press reported that Gao Qiang, former minister of health and most recently party secretary at the Ministry of Health (MOH), is moving to a finance post at the National People’s Congress (NPC). Gao was recruited to the MOH from his previous position as vice minister of finance in 2003 during the uproar about the SARS epidemic. As he announced his exit from the MOH, the congenial Gao laughingly noted that he had used up all his brain cells in the past six years over healthcare reform and the many problems with the transitioning health system. Indeed, Gao presided over a period of increasing public dissatisfaction with the cost of care and access to care, as well as deteriorating physician-patient relations and growing impatience while the public waits for the long anticipated healthcare reform plan to be unveiled. At the press meeting announcing his departure from the MOH, he noted that the State Council had just approved the budget necessary for the reform and, following the annual NPC meeting in March, a national conference will be convened to focus on moving the new plan forward.
Shortly before Gao’s departure from the MOH, he responded to numerous posts on the Internet that resulted from the Chinese government’s effort to solicit public input about healthcare reform. Of 63,296 people who cast their votes online, 40.3 percent believe that the root of healthcare problems in China is the lack of government financial support and the commercialization of hospitals, which were previously owned and operated by the government. “Every time I go to the hospital, I feel like I’m entering a market, where doctors are like salespeople, except that the prices are not negotiable,” commented one of the respondents. Another 25.4 percent believe that the culprit is the practice of hospitals undercharging for physician consults based on an archaic fee structure and then making up the loss with pharmacy and procedure charges. “The doctor’s mission is to help the wounded and save lives. Yet, in today’s environment, doctors are forced to become merchants,” reads another comment. In summary, “Most countries around the world have government-funded healthcare. China is the world’s third largest economy. Why can’t we do likewise?”
Gao agreed that inadequate government funding for healthcare is the primary reason for patient dissatisfaction with physicians and overall care. “Government funding for healthcare has been seriously lacking for a long time. As a result, hospitals have to focus on revenue from patients to maintain operations and fund any development. This puts the healthcare workers and the public on opposite sides, and is a key reason for the tension between physicians and patients,” according to Gao’s analysis. He further stated that healthcare couldn’t rely on market forces alone. “The market system can be a driver, but such principles cannot be applied en bloc in our situation. Protecting the public good and adjusting the classification [compensation] for healthcare workers are two key issues that must be addressed, but we cannot sacrifice one to satisfy the other.” In his view, many elements of a market system, such as encouraging orderly competition and rewarding performance, are necessary, as is the deployment of public funding to advance healthcare. Therefore, the appropriate solution will require a balance of market forces and government intervention/investment. He suggested that all of this begins with government leadership and commitment through substantive investment in healthcare. The social forces that follow will drive improvements in healthcare workers and then increase the support, understanding and active involvement of the public.
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