China's top health officials were grilled on Friday over why the ongoing healthcare reform has failed to substantially ease the difficulties facing the public in seeking accessible and affordable medical care.

Given that state-owned hospitals now deliver more than 90 percent of medical services in the country, harsh questions focusing on reform of public hospitals abounded while the Standing Committee of the National People's Congress (NPC) conducted an inquiry into the medical reform.

For instance, an appointment with an expert pediatrician alone costs 1,200 yuan (US$180) at a top public hospital in Beijing and together with a bill for medical treatment could amount to 10,000 yuan for a single day, said Cheng Jinpei, a member of the NPC Standing Committee. And he asked why.

"The problem of difficult access to affordable medical care for people has existed for a long time, particularly at quality public hospitals, and I've also experienced that personally," Vice-Minister of Health Zhang Mao admitted at the inquiry.

Imbalanced distribution of quality medical resources and the current operating mechanism were mainly to blame, according to him.

Currently, about 42 percent of the country's doctors have bachelor or higher degrees, but more than 80 percent work at large public hospitals in cities, official statistics showed.

As a result, patients - including those with minor diseases - swarm into public hospitals for experienced doctors and quality treatment, further straining such hospitals, usually beyond their operating capacity.

In Beijing, for instance, about 70 million patients from other parts of the country visit big local hospitals as they have little confidence in community and rural clinics.

To address that, the central government last year unveiled a three-year plan costing 850 billion yuan for medical reforms, including the reform of public hospitals, which aims to give universal and affordable medical service to all of the country.

"China appears to be determined to use its wealth obtained largely in the past three decades to extend basic healthcare service to all," said Liu Guo'en, an expert in health policy in Beijing.

As part of the public hospital reform now under a trial run at 47 cities selected by the ministry, optimizing the hospital's structure and training more quality doctors for grassroots clinics are high on the agenda, said Zhang.

In 2009, the central government allocated 20 billion yuan to build 5,700 hospitals at the grassroots level.

Meanwhile, 980,000 grassroots doctors were trained by May thanks to the aid program held by large public hospitals.

Health Minister Chen Zhu also conceded on Friday that the reform of public hospitals was the hardest part of the entire medical reform.

"It couldn't be achieved overnight," he said.

Key problems like the widely criticized practice that public hospitals rely on drug sales for income and a lack of a sustainable funding mechanism remain hard to be tackled as they concern interests of many stakeholders, Chen noted.

But he pledged that public hospitals have to return to serving the public good.

Before 1985, public hospitals on the mainland were fully funded by the government. Under the reform and opening-up policies, with huge cutbacks in government support, they shifted to a market orientation and had to earn most of the money needed to stay in operation.

The change enhanced the efficiency of the medical sector but led directly to increasing medical costs in the country, analysts said.

"The current reforms would improve ethics of medical workers and facilitate them to earn honest money," Zhang said.

(China Daily December 25, 2010)