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Aiming at the Goal of Primary Health Care for All and Making Breakthroughs in the Reform of Medical System
2006-06-01
By Ge Yanfeng, Deputy Director-General of the Research Department of Social Development, the DRC
I. It Is Imperative to Further Improve China’s Medical System
1. In the past 20 years, China’s medical system has undergone all-round changes
Since reform and opening-up, based on the development goals and development modes as well as the fundamental system changes brought about by reform, China’s medical system has also witnessed and undergone all-round changes.
In terms of medical guarantee system, the rural cooperative medical system was developed mainly on the basis of the collective economy covering virtually all people, and it was gradually dissolved with the implementation of the household responsibility system with remuneration linked to output in the rural areas. In recent years, the governments at all levels began to promote a new type of rural cooperative medical system, but it is still in its initial stage. For most rural residents, they still have to rely on their own and their families’ financial capability for medical treatment. In the urban areas, with the reform of enterprise system and the fiscal system, the traditional system of labor protection, medical services and public health services for the staff and workers was also in a difficult situation. After several adjustments, a basic medical and insurance system combining social pool with personal accounts for urban staff and workers was gradually established. To date, only about one-third of the urban population is covered by this system, but for the majority of the urban residents, they still have to rely on their own and their families’ financial support for their medical treatment.
In terms of medical service system, the ownership of medical service institutions, on the one hand, has gradually changed from the single type of ownership to the coexistence of different types of ownerships, and on the other hand, the organizational and operating mechanisms of the medical service institutions and their goals of pursuit have also undergone fundamental changes. Apart from the private medical institutions, state-owned or collectively-owned medical service institutions all borrowed the corporate operation and management modes centered on "power delegation" and "emphasis on interest stimulus," and the goals of these institutions also changed: from the sole pursuit of public interests and welfare to an overall pursuit of economic interests. Furthermore, restrictions and control on the access to and withdrawal from various levels of medical services were weakened, the service prices were increasingly decided by the supply-demand relationship, and different medical service institutions became competitors.
The pharmaceutical system also underwent all-round reform. From the production to circulation, the traditional planned management was lifted, and the market plays its role in the sector.
Furthermore, the administrative system of medical and health was also gradually adjusted.
2. There are also many problems along with the results and achievements of the system reform
The all-round reform of the medical system has made some achievements, mainly: through competition and the participation of private economic sectors, the supply capacity of the medical service field was comprehensively improved. The number of medical service institutions, the number of doctors and the number of hospital beds were also increased remarkably compared to the period of the planned economy, the level of technology and equipment was also fundamentally improved. The production and supply capacity of pharmaceuticals were comprehensively increased. The reform on the organizational forms of the medical service organizations noticeably stimulated the enthusiasm of the medical service institutions and the related personnel, and the efficiency of their internal operation was also improved.
It is an undeniable fact, however, that the above-mentioned reform of the medical system also gave rise to some big problems. Of them, the most direct and obvious problems are: the rapid rise of the technological level which is coupled with the excessive pursuit of economic interests by the medical service institutions and enterprises in the fields of pharmaceutical production and circulation, has led to the excessive rise of medical service bills. This rise, along with the overall decline in the coverage of medical guarantee system, has led to the phenomenon that an increasingly number of middle and low income residents are financially unable to seek medical treatment and services. The third medical service survey conducted by the Ministry of Health in 2003 indicated that about 49% of the people surveyed could not see doctors when they were ill, about 29% could not be admitted into the hospitals for treatment when they were ill and should have been admitted into hospitals, and the most direct and decisive factor is that they were unable to pay the medical bills.
At the same time, the market supply-demand relationship has gradually become the major factor in the distribution of medical resources, and medical and health resources gradually shifted from the rural areas to the cities, and from the backward regions to the developed regions, and the priority of medical and health services were also increasingly shifted to serve the top-end customers.
Further consequence caused by these problems is the overall drop in health fairness and input efficiency. According to the overall evaluation results of 191 member countries of the World Health Organization in 2000, China ranked the 188th, and in terms of efficiency of health input, China ranked the 144th. What is noteworthy is that China, at the initial stage of the reform and opening, used about 3% of its GDP as medical input and basically satisfied the demand of basic medical services for almost all of its citizens, and many indexes of its citizens’ health reached the level of medium-developed countries, and China was then cited as a model in terms of medical work for the developing countries by international organizations.
3. It is imperative further improve the medical system
Problems existing in China’s medical field in recent years are undeniable, and consequences so caused are also acute and serious. It not only affects the health of its citizens, but also causes a series of social problems such as poverty, growing dissatisfaction of the public and inequality among the social groups. The pessimistic expectations for medical issues among the majority of residents have become an important factor contributing to the lack of demands of the macro economy. If this problem persists, it would not only affect the economic growth, but also have an impact on social stability and the support of the public for reform. Therefore, it is imperative to further improve the medical system. On this point, it has become a consensus among all the social circles.
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