China's Health-Care reform plan

The latest edition of The Lancet includes a letter from China's Minister of Health, Zhu Chen. The Chinese government seeks to cover 90% of its people. The Minister of Health outlines 5 elements to the 'action plan':

1. Cover more than 90% of the Chinese people with basic medical insurance
2. Develop a national essential drug sustem
3. Develop the 'three-tier network' at county, town, and village levels.
4. Promote basic public health, including the expanded immunization program.
5. Reform public hospitals.


The letter follows:


The Chinese Government recently approved guidelines
for reform of the health-care system and published an
action plan of targets for reform in 2009–11.1,2 Estimates
suggest that governmental investment (both central
and local) of CNY850 billion (about US$124 billion) will
be injected into the health-care system in the coming
3 years, doubling the average annual governmental
expenditure compared with 2008.
Since China adopted its “Reform and opening up”
policy in 1978,3 the medical care system and health
of residents has developed rapidly. Nevertheless,
because the main orientation of health-care reform
in the 1980s and 1990s was to give autonomy to
hospitals without contribution of public fi nance, the
disparity between urban and rural areas and between
diff erent regions was increased and health-care
expenditure grew too large. Facing these challenges,
the Government decided, in 2006, to prepare new
guidelines for health-care reform. The main aim was to
ensure the basic health-care service works for the good
of the public.4
By absorbing input from ten think-tanks and
integrating experiences from both at home and abroad,
the new guidelines consider reasonable distribution
of health-care resources and core issues of equity and
accessibility. The draft guidelines were available for
public comment from Oct 14, 2008, to Nov 14, 2008,5
and more than 30 000 responses were received. As a
result, major revisions were made and, in particular, the
action plan for tangible targets was developed, which
received strong public support.6
The fi ve major targets in the action plan are
fundamental. First, wide medical insurance cover will
be provided for more than 90% of Chinese people. This
initiative includes basic medical insurance for urban
employees and for residents of cities (elderly people
without previous employment, university students,
children, and migrant workers without a stable labour
contract and their relatives), the new rural cooperative
Medicare scheme for farmers, and the Medicaid system
for urban and rural poor people. The funding level will
also be raised for urban residents and farmers, with
governmental allocation increased to CNY120 per head
in 2010.
Second, a national essential drug system will be
established to meet the basic need for treatment and
prevention of diseases and to ensure safety, quality, and
supply. All drugs on the list will get a high reimbursement
rate by the distinct medical insurance systems.
Third, the medical care and public health service
system will be improved at grassroots level. In rural areas,
emphasis will be on infrastructure and human-resource
development of the three-tier network at county, town,
and village levels. In urban areas, community medicine
centres (stations) will be reinforced. This move will not
only substantially reduce workload in overcrowded
city hospitals but also allow the “health-gatekeeper”
system—ie, family doctors and nurses providing services
at community medicine7 level—to be enhanced for
disease prevention and health promotion.
Fourth is promotion of the basic public health service.
This objective will be realised through: establishment of
health archives for all citizens; provision of screening for
major diseases for elderly people, women, and children;
management of chronic non-communicable diseases;
and health education. Furthermore, major projects
will be launched, including an expanded programme
of immunisation for 15 vaccine-preventable diseases
(eg, against hepatitis B virus for children younger than
15 years), prevention and control for major infectious
diseases (HIV/AIDS and tuberculosis) and geochemical
endemic diseases, and delivery in hospital for all
pregnant women.
The fi nal aim of the action plan is to launch the
pilot reform of public hospitals. This project includes
substantial increases in public investment, restructuring
of the hospital management system, and correction of
the tendency for commercialisation.
In a country with 1·3 billion people, to achieve the goal
of health for all is by no means an easy job, particularly
at a time of global fi nancial crisis and economic
downturn. Our major challenges are to enhance the
working and living conditions of 6 million health-care
workers, to improve the doctor–patient relationship,
and to establish a platform for health records for
all. However, we are determined to transform these
challenges into opportunities. By applying the policy of
prevention fi rst, focusing on rural and grassroots level
service, and paying equal attention to both Western
medicine and traditional Chinese medicine,8 we should
be able to pave a cost-eff ective way for health-care
development.