If HSE officials think they have problems catering for the health needs of four million people, then they should consider the challenge facing the Chinese government, writes CLIFFORD COONANin Beijing
A CLINIC in every village, 2,000 new hospitals across the country and health coverage to 200 million uninsured Chinese.
These are the ambitious pledges the Chinese government has made as part of a new €14 billion plan that it says will make universal healthcare services available to all of its citizens by 2020, as it seeks to address a system that is threatening to buckle under the demands of 1.3 billion people.
Underfunding of the public health system is one of the chief causes of social unrest in China and the reform is aimed at “solving pressing problems that have caused strong complaints from the public”, the government report said, referring to long-standing criticism that medical services are difficult to access and increasingly unaffordable.
While the hardware is often there in the shape of hospital buildings and even staff, the software is still seen lacking in the shape of proper administration and decent availability.
Ordinary Chinese people are wary of going to doctors because hospitals are perceived as prescribing too many expensive medicines to help boost doctors’ salaries.
Many turn to traditional Chinese medicine as a cheaper alternative.
As it stands, less than a third of the population is covered by the state scheme and most healthcare is paid for out of a family’s savings.
Chinese people are famous savers, putting aside up to 45 per cent of their income, and a big whack of that goes on providing for healthcare. When you enter a hospital for treatment, you are often required to give cash up-front to ensure attention, and a major illness can wipe out a family’s entire nest-egg for pensions and any other eventualities.
One of the reasons the government is introducing the healthcare reform is to free up some of these savings for domestic consumption, which the Beijing authorities believe will help keep the economy buoyant during the global economic crisis.
Coming up with some way of providing universal insurance coverage has proven a real challenge in funding terms. Currently, insurance is a largely urban phenomenon, with most people getting health coverage from their companies or from government bodies.
The reforms have been approved by China’s cabinet, the State Council, and are aimed at boosting funding and improving oversight to offer “safe, effective, convenient and affordable” health services.
The new reforms allow for improvements in the standards of rural hospitals and clinics, and put a cap on the price of essential medicines, according to a report on the Xinhua news agency.
Disease prevention and control, maternal health, mental health and first aid services will also receive greater attention.
The new health plan calls for limiting the mark-up that hospitals and drug distributors can charge, and tries to regulate the price difference between patent and generic drugs.
“We will gradually cut the profit margin of drugs sold at medical institutions . . . and implement zero profit margin for drugs sold at local public clinics,” said Peng Sen, vice-director of the National Development and Reform Commission, an advisory body to the cabinet.
In the first three years of the plan, the country will build or renovate 3,700 community clinics and 11,000 health service centres in urban areas within three years. The central government will also build 2,400 such centres in underdeveloped urban areas during the same period.
The plan also envisages a greater role for Chinese traditional medicine in disease prevention and control, and in dealing with emergency public health incidents and medical care services.
The government acknowledges that the cities have benefited most from China’s rapid economic rise, and that healthcare services in rural areas have lagged behind because most medical facilities and doctors are in cities.
Under the plan, local governments will be expected to pay 520 billion yuan (€58 billion), or 60 per cent of the cost of the programme, by 2011.
The scheme expands a plan announced in January which involves spending about 850 billion yuan (€95 billion) on the initial stage of the programme up to 2011, though it has yet to spell out how much of that would be new spending or disclose details of the reforms. This is intended to give coverage to up to 90 per cent of the population.
On the streets of Beijing, people were sceptical.
“I don’t know if I believe the government, especially on whether it can do something like this efficiently. I don’t believe in the reform,” said Cui Qunjie, from Shandong province.
Deng Liyun, (25) from Hunan Province said most people his age didn’t care about their health, and knew little about the reform.
However, low living standards meant that healthcare was not good.
In the years after the 1949 revolution, the public health system functioned well and provided free care to most of China’s citizens. China’s state healthcare system suffered badly during the period of economic reform in the 1980s, when many companies were privatised. It became too expensive to see a doctor, and the focus shifted heavily to the cities.