论文部分内容阅读
China’s basic medical insurance program covered more than 95 percent of its population, or about 1.28 billion, by the end of 2011, said Minister of Health Chen Zhu.
“Coverage in rural areas reached 97 percent, exceeding the 89 percent reported for urban areas,” Chen said at a national health work conference on January 5-6. In 2003, 55 percent of urban citizens and 21 percent of rural residents were covered.
In recent years, China has invested heavily in health care and community-level basic medical services. In 2010, spending on health care accounted for 28.6 percent of the national fiscal expenditure, Chen said.
The percentage of total medical costs paid by patients decreased from 60 percent in 2001 to 35.5 percent in 2010, with the government budget and social funds covering the rest.
At present, China’s basic medical insurance is, for the most part, comprised of three separate arrangements: the new rural cooperative medical system, the basic medical insurance scheme for urban residents and the basic medical insurance scheme for urban employees.
Achievements
For more than 30 years after the founding of the People’s Republic of China in 1949, those living in urban areas were entitled to nearly free medical services.
However, when China began its economic restructuring in the early 1980s, the old system was dismantled as the country at- tempted to switch to a market-oriented health care system.
But soaring medical bills plunged many into poverty and made medical services less affordable to ordinary citizens.
The Chinese Government admitted in 2005 that the previous reform was “basically unsuccessful,” and started a new round of reform in 2009.
In April 2009, China unveiled a blueprint for its health care system reform over the next decade.
The plan’s eventual goal is to establish a universal health care system for the country by 2020, giving people access to affordable public hospitals, clinics and other health care facilities as well as extensive coverage from public medical insurance.
“The core principle of the reform is to provide all citizens with basic health care as a public service, and to make the health care system more public-oriented,” said Liu Xinming, an official with the Department of Policies and Regulations of the Ministry of Health (MOH).
The Chinese Government also established a more detailed three-year plan. It committed to investing 850 billion yuan ($124.45 billion) to promote the accessibility, equity and quality of health care services available to the public by the end of 2011. Major reform measures included expanding the health care insurance umbrella, reforming public hospital, establishing an essential drug system and improving the quality of the healthcare provided.
“Lack of government investment has long been the major cause of China’s ailing health care system. The latest reform has changed the situation,” said Xu Guangjian, Deputy Dean of the School of Public Administration at the Renmin University of China.
According to Vice Minister of Finance Wang Jun, the country invested 1.13 trillion yuan ($179 billion) in improving the health care system in 2009-11, 280 billion yuan($44 billion) more than the original budget. It also raised the proportion of health care spending to the national fiscal expenditure to 5.35 percent in 2011, up from 4.57 percent in 2008.
In the past three years China has set up diversified medical insurance systems for urban employees, urban residents who do not work or are self-employed, and rural residents. Meanwhile, annual medical treatment allowances for both urban and rural residents rose to 200 yuan ($31.69) per capita in 2011 from the previous 120 yuan ($19.01).
Rural health care services have been upgraded over the past years as the government allocated more than 40 billion yuan ($6.34 billion) to support the construction of medical institutions in the countryside.
Under the new rural cooperative medical system, China has raised the medical subsidies available to rural residents from 200 yuan to 240 yuan ($35.14) per year per person, according to the MOH.
The new rural cooperative medical system has been on trial since 2003. MOH statistics show that more than 830 million rural residents had joined the new system by the end of 2011.
According to the ministry, the Central Government is planning to provide additional coverage for people suffering severe diseases in rural areas starting this year and raise the medial reimbursement rate to 90 percent.
“The new rural cooperative medical system will cover more diseases by the end of this year, including leukemia, congenital heart diseases and six other conditions,” said Minister Chen. Some regions will also be covered for cancers and vascular diseases.
Experts predict the new system will benefit about 10 million households. Assuming each household has an average of four to five people, about 40 to 50 million people will benefit from it.
“Despite rapid development, the country still has a long way to go to establish a high-standard health care system,” said Yao Lan, a professor at the School of Medicine of Huazhong University of Science and Technology in Zhejiang Province.
“Currently, there is still a big gap between rural and urban health care systems. Even the urban system needs improvements such as raising the reimbursement ratio, covering more drug expenditures and providing more medical services,” he said.
According to the MOH, China will work to reduce household shares of total medical expenditures to less than 30 percent by 2015.
In addition, the ministry has pledged greater efforts to encourage investment in the medical industry, particularly in non-basic health care sectors, in the 12th Five-Year Plan(2011-15) period.
Price curbs
Soaring prices of prescription drugs is a major public complaint in China.
In response, the National Development and Reform Commission (NDRC), the country’s top price regulator, has managed to lower retail prices of medicines 28 times since 2005.
In March 2011, the NDRC announced cuts in retail prices averaging 21 percent and affecting 162 antibiotics and cardiovascular system drugs. The reduction was expected to help patients save nearly 10 billion yuan($1.58 billion) every year.
Last August, the NDRC announced a reduction in the maximum retail prices of 82 medicines for the hormonal, endocrinal and nervous systems with an average reduction rate of 14 percent.
China also released its National Essential Medicines List in August 2009. Prices of the essential drugs are under government control. The Central Government sets reference prices, based on which provincial governments set the purchase prices of the drugs in their jurisdiction.
Public medical and health facilities at the local levels are required to sell the drugs at the purchase prices. Previous prescriptions included a 15-percent mark-up.
But the efforts have failed to achieve their expected results.
Last November, a survey conducted by national broadcaster CCTV exposed a disturbingly large discrepancy between the cost of producing one particular drug and the prices charged for it in hospitals.
A pharmaceutical Clindamycin Phosphate Injection product that sold for 12.65 yuan($1.85) in several hospitals in Beijing had a gross profit margin as high as 2,000 percent, since its ex-factory price was only 0.60 yuan($0.09), claimed CCTV in its program Weekly Quality Report. The report sparked widespread public outrage.
“In China, most public hospitals are unable to get sufficient funding from the government. Usually, government allocations only account for about 10 percent of the operating cost of a hospital, while the other 90 percent must be self-raised,” said Zhuang Yiqiang, Vice Secretary General of the Chinese Hospital Association.
As a result, doctors at public hospitals have to generate income for the hospitals by prescribing highly profitable, sometimes unnecessary, drugs and treatment, which not only wastes medical resources but also leads to prohibitively expensive medical bills.
At the national health work conference, Minister Chen said that hospitals’ reliance on sales of medicine for revenue, which is blamed for over-medication and over-diagnosis in public hospitals, has severely hampered the medical system reform.
According to a timeframe released by Chen, the separation of medical treatment services and medicine sales in public hospitals will be completed by 2015.
Chen said further reform will be carried out on a trial basis in 300 county-level hospitals this year, and all county-level hospitals will hopefully adopt the diagnosis-related group system by 2013. The practice will be adopted in all public hospitals by the year 2015.
“Coverage in rural areas reached 97 percent, exceeding the 89 percent reported for urban areas,” Chen said at a national health work conference on January 5-6. In 2003, 55 percent of urban citizens and 21 percent of rural residents were covered.
In recent years, China has invested heavily in health care and community-level basic medical services. In 2010, spending on health care accounted for 28.6 percent of the national fiscal expenditure, Chen said.
The percentage of total medical costs paid by patients decreased from 60 percent in 2001 to 35.5 percent in 2010, with the government budget and social funds covering the rest.
At present, China’s basic medical insurance is, for the most part, comprised of three separate arrangements: the new rural cooperative medical system, the basic medical insurance scheme for urban residents and the basic medical insurance scheme for urban employees.
Achievements
For more than 30 years after the founding of the People’s Republic of China in 1949, those living in urban areas were entitled to nearly free medical services.
However, when China began its economic restructuring in the early 1980s, the old system was dismantled as the country at- tempted to switch to a market-oriented health care system.
But soaring medical bills plunged many into poverty and made medical services less affordable to ordinary citizens.
The Chinese Government admitted in 2005 that the previous reform was “basically unsuccessful,” and started a new round of reform in 2009.
In April 2009, China unveiled a blueprint for its health care system reform over the next decade.
The plan’s eventual goal is to establish a universal health care system for the country by 2020, giving people access to affordable public hospitals, clinics and other health care facilities as well as extensive coverage from public medical insurance.
“The core principle of the reform is to provide all citizens with basic health care as a public service, and to make the health care system more public-oriented,” said Liu Xinming, an official with the Department of Policies and Regulations of the Ministry of Health (MOH).
The Chinese Government also established a more detailed three-year plan. It committed to investing 850 billion yuan ($124.45 billion) to promote the accessibility, equity and quality of health care services available to the public by the end of 2011. Major reform measures included expanding the health care insurance umbrella, reforming public hospital, establishing an essential drug system and improving the quality of the healthcare provided.
“Lack of government investment has long been the major cause of China’s ailing health care system. The latest reform has changed the situation,” said Xu Guangjian, Deputy Dean of the School of Public Administration at the Renmin University of China.
According to Vice Minister of Finance Wang Jun, the country invested 1.13 trillion yuan ($179 billion) in improving the health care system in 2009-11, 280 billion yuan($44 billion) more than the original budget. It also raised the proportion of health care spending to the national fiscal expenditure to 5.35 percent in 2011, up from 4.57 percent in 2008.
In the past three years China has set up diversified medical insurance systems for urban employees, urban residents who do not work or are self-employed, and rural residents. Meanwhile, annual medical treatment allowances for both urban and rural residents rose to 200 yuan ($31.69) per capita in 2011 from the previous 120 yuan ($19.01).
Rural health care services have been upgraded over the past years as the government allocated more than 40 billion yuan ($6.34 billion) to support the construction of medical institutions in the countryside.
Under the new rural cooperative medical system, China has raised the medical subsidies available to rural residents from 200 yuan to 240 yuan ($35.14) per year per person, according to the MOH.
The new rural cooperative medical system has been on trial since 2003. MOH statistics show that more than 830 million rural residents had joined the new system by the end of 2011.
According to the ministry, the Central Government is planning to provide additional coverage for people suffering severe diseases in rural areas starting this year and raise the medial reimbursement rate to 90 percent.
“The new rural cooperative medical system will cover more diseases by the end of this year, including leukemia, congenital heart diseases and six other conditions,” said Minister Chen. Some regions will also be covered for cancers and vascular diseases.
Experts predict the new system will benefit about 10 million households. Assuming each household has an average of four to five people, about 40 to 50 million people will benefit from it.
“Despite rapid development, the country still has a long way to go to establish a high-standard health care system,” said Yao Lan, a professor at the School of Medicine of Huazhong University of Science and Technology in Zhejiang Province.
“Currently, there is still a big gap between rural and urban health care systems. Even the urban system needs improvements such as raising the reimbursement ratio, covering more drug expenditures and providing more medical services,” he said.
According to the MOH, China will work to reduce household shares of total medical expenditures to less than 30 percent by 2015.
In addition, the ministry has pledged greater efforts to encourage investment in the medical industry, particularly in non-basic health care sectors, in the 12th Five-Year Plan(2011-15) period.
Price curbs
Soaring prices of prescription drugs is a major public complaint in China.
In response, the National Development and Reform Commission (NDRC), the country’s top price regulator, has managed to lower retail prices of medicines 28 times since 2005.
In March 2011, the NDRC announced cuts in retail prices averaging 21 percent and affecting 162 antibiotics and cardiovascular system drugs. The reduction was expected to help patients save nearly 10 billion yuan($1.58 billion) every year.
Last August, the NDRC announced a reduction in the maximum retail prices of 82 medicines for the hormonal, endocrinal and nervous systems with an average reduction rate of 14 percent.
China also released its National Essential Medicines List in August 2009. Prices of the essential drugs are under government control. The Central Government sets reference prices, based on which provincial governments set the purchase prices of the drugs in their jurisdiction.
Public medical and health facilities at the local levels are required to sell the drugs at the purchase prices. Previous prescriptions included a 15-percent mark-up.
But the efforts have failed to achieve their expected results.
Last November, a survey conducted by national broadcaster CCTV exposed a disturbingly large discrepancy between the cost of producing one particular drug and the prices charged for it in hospitals.
A pharmaceutical Clindamycin Phosphate Injection product that sold for 12.65 yuan($1.85) in several hospitals in Beijing had a gross profit margin as high as 2,000 percent, since its ex-factory price was only 0.60 yuan($0.09), claimed CCTV in its program Weekly Quality Report. The report sparked widespread public outrage.
“In China, most public hospitals are unable to get sufficient funding from the government. Usually, government allocations only account for about 10 percent of the operating cost of a hospital, while the other 90 percent must be self-raised,” said Zhuang Yiqiang, Vice Secretary General of the Chinese Hospital Association.
As a result, doctors at public hospitals have to generate income for the hospitals by prescribing highly profitable, sometimes unnecessary, drugs and treatment, which not only wastes medical resources but also leads to prohibitively expensive medical bills.
At the national health work conference, Minister Chen said that hospitals’ reliance on sales of medicine for revenue, which is blamed for over-medication and over-diagnosis in public hospitals, has severely hampered the medical system reform.
According to a timeframe released by Chen, the separation of medical treatment services and medicine sales in public hospitals will be completed by 2015.
Chen said further reform will be carried out on a trial basis in 300 county-level hospitals this year, and all county-level hospitals will hopefully adopt the diagnosis-related group system by 2013. The practice will be adopted in all public hospitals by the year 2015.