Hospitals 'Hardest' Hurdles in Healthcare Reform

The State Council will issue a five-year action plan for China's ongoing healthcare reform soon, aiming for affordable and universal medical care for everyone, a top health official said on Saturday.

Deputy Minister of Health Zhang Mao said this on the sidelines of the Fifth Plenary Session of the 11th Chinese People's Political Consultative Conference National Committee.

"The coming 12th Five-Year Plan for medical reform will show the direction and major tasks in the years to come," he told China Daily. "And public hospital reform is high on the agenda."

In 2009, the central government unveiled an 850 billion yuan (US$135 billion) three-year plan for medical reform, and aimed to make it easier and cheaper for all to seek medical care.

Major targets included establishing health insurance policies for all, enhancing the capacity of grassroots medical institutions, introducing an essential drugs system, the equalization of basic public health services, and public hospital reform.

Asked to assess the achievements of the last three-year plan, Minister of Health Chen Zhu conceded that it was still far from meeting public expectation.

By the end of 2011, 95 percent of the Chinese population was already covered by some form of health insurance, official statistics showed.

Every citizen now enjoys public health services worth 25 yuan a year that may include health profiling and chronic disease intervention. At grassroots level, medication costs had already dropped by about 30 percent.

However, experts are still concerned that at large public hospitals, patients are still finding it hard to see a doctor, and that hospitals are still depending on drug sales to boost their revenue.

Chen, in response, said: "The government is determined to end such practices despite the great difficulty and the barriers expected.

"The current structure of hospitals' revenue stream is skewed partially because the cost of medical services is too cheap. So some cash in on administering unnecessary drugs and medical tests," he said.

"That corrupts our medical workers and burdens the country with rising medical bills," he noted.

To address that, medical workers should be paid respectable remuneration, and the current healthcare insurance payment mechanism must also be fine-tuned, according to Zhang.

Wu Ming, a CPPCC member and director of the health policy and management department of Peking University, recommends the practice of a total prepaid amount, and insurance payment according to the kind of diseases to control overall medical costs.

To date, trials in hospital reform have been based in county-level hospitals which mainly receive rural patients and are under full control of the health administrations, previous reports said.

"But in addition to simple cost control, we have to further explore sustainable funding mechanism for grassroots hospitals, and encourage a more enthusiastic medical work force," Zhang said.

At large urban public hospitals, "the situation is more complex and needs cooperation with other departments like finance, human resources and social security," Wu added.

"The changes in the public hospitals are the hardest part of the medical reforms.

"It may take a long time, perhaps as long as 10 to 20 years," she said.