Healthcare system reform in the People's Republic of China

The healthcare system reform in the People's Republic of China refers to the healthcare system transition in modern China.

The Ministry of Health of the State Council oversees the health services system, which includes a substantial rural collective sector but little private sector. Nearly all the major medical facilities are run by the government.

Main organizations involved in the reform
Government: NDRC, Ministry of Health, Ministry of Finance, Ministry of Labour and Social Security, Ministry of Civil Affairs, SFDA

Research institute and universities: Development Research Center of State Council, Ministry of Health Statistics and Information Center, China Health Economics Institute, Peking University, Fudan University, Tsinghua University, Beijing Normal University, Tongji Medical College, Dalian Medical University

Foreign organizations: World Bank, WHO, McKinsey & Co.

History
The Chinese government faced a mammoth task in trying to provide medical and welfare services adequate to meet the basic needs of the immense number of citizens spread over a vast area. Although China's overall affluence has grown dramatically since the mid-1980s — per capita income has increased many times over, and caloric intake has become comparable to that for western Europe — a great many of its people live at socioeconomic levels far below the national average. The medical system, moreover, labours under the tension of whether to stress quality of care or to spread scarce medical resources as widely as possible. In addition, there has been repeated debate over the relative balance that should be struck between the use of Western and traditional Chinese medicine. While the Cultural Revolution pushed the balance toward widespread minimum care with great attention paid to traditional medicine, policy after the late 1970s moved in the other direction on both issues; by the late 1980s the proportion of doctors of Western medicine had exceeded those of traditional practices.

At the same time, the medical establishment also more or less has been affected by this major influence: along with 1980s initial period people's commune disintegration, the original rural cooperatives medical service system rapidly disintegrates in the majority of areas; In the cities scope, the public health services system and the labor insurance medical service system also gradually declines in the varying degree. But the medical service relates to national economy and the people's livelihood and the social stability, and the related problems are extremely complex,the establishment of this new system is slower continuously, compared to other professions.

The health of the Chinese populace has improved considerably since 1949. Average life expectancy has increased by about three decades and now ranks nearly at the level of that in advanced industrial societies. Many communicable diseases, such as plague, smallpox, cholera, and typhus, have either been wiped out or brought under control. In addition, the incidences of malaria and schistosomiasis have declined dramatically since 1949.

As evaluated on a per capita basis, China's health facilities remain unevenly distributed. Only about half of the country's medical and health personnel work in rural areas, where approximately three-fifths of the population resides. The doctors of Western medicine, who constitute about one-fourth of the total medical personnel, are even more concentrated in urban areas. Similarly, about two-thirds of the country's hospital beds are located in the cities.

China has a health insurance system that provides virtually free coverage for people employed in urban state enterprises and relatively inexpensive coverage for their families. The situation for workers in the rural areas or in urban employment outside the state sector is far more varied. There are some cooperative health care programs, but their voluntary nature produced a decline in membership from the late 1970s.

The severest limitation on the availability of health services, however, appears to be an absolute lack of resources, rather than discrimination in access on the basis of the ability of individuals to pay. An extensive system of paramedical care has been fostered as the major medical resource available to most of the rural population, but the care has been of uneven quality. The paramedical system feeds patients into the more sophisticated commune-level and county-level hospitals when they are available.

New Rural Co-operative Medical Care System
The New Rural Co-operative Medical Care System (NRCMCS) is a new 2005 initiative to overhaul the healthcare system, particularly intended to make it more affordable for the rural poor. Nowadays the permanent urban population (except migrants) take out medical insurance. But the poor, many of them in the countryside, go into debt to pay their medical bills or go without treatment. Many in the rural areas struggle to afford with the new burden of healthcare fees, a result of the collapse of the old state-funded health system which existed before China's program of economic reforms in the 1980s.

The annual cost of medical cover under the NRCMCS is 50 yuan (US$7) per person. Of that, 20 yuan is paid in by the central government, 20 yuan by the provincial government and a contribution of 10 yuan is made by the patient. As of September 2007, around 80% of the whole rural population of China had signed up (about 685 million people). The system is tiered, depending on the location. If patients go to a small hospital or clinic in their local town, the scheme will cover from 70-80% of their bill. If they go to a county one, the percentage of the cost being covered falls to about 60%. And if they need specialist help in a large modern city hospital, they have to bear most of the cost themselves, the scheme would cover about 30% of the bill.

Published studies
2006:
 * Meng, Qingyue. Health care pricing and payment reforms in China : The implications for health service delivery and cost containment. PhD Thesis, 2006, Karolinska Institutet. ISBN 91-7140-576-3

2000:
 * Dong, Hengjin. Health financing systems & drug use in rural China. PhD Thesis, 2000, Karolinska Institutet. ISBN 91-628-3982-9

Other related studies:
 * Andrew Green. An Introduction to Health Planning in Developing Countries. New York: Oxford University Press, 1999 (2nd ed). ISBN 0-19-262984-0
 * Willy L. De Geyndt. Managing the Quality of Health Care in Developing Countries. Washington DC : World Bank, 1994. ISBN 0-8213-3092-6

Other systems

 * Welfare, Choice and Solidarity in Transition
 * Medicare (Australia)
 * Medicare (Canada)
 * National Health Service (United Kingdom) - Ranked in the top three in the world
 * Medicare in Italy - Ranked in the top three in the world
 * Medicare in France - Ranked in the top three in the world
 * Medicare (United States)