As an integral part of China's ongoing health care reform, the country has assigned 47 cities so far to spearhead the reform of government-run hospitals to offer more equitable and efficient medical services.

Deputy health minister Ma Xiaowei said 16 of the cities -- including six in central China, six in the east China and four in west China -- were selected by the central government in February this year.

With a population of more than 80 million, or 6.09 percent of the country's total, the 16 cities have nearly 4,000 public hospitals and clinics, ministry figures show.

The other 31 cities were later selected by provincial governments to pilot the reform, Ma said in an interview with Xinhua.

"The reform of public hospitals is the most complicated and difficult part of the entire health care reform," he said. "It cannot be achieved overnight. We have to push forward the reforms step by step."

The Chinese government unveiled a 850-billion-yuan (US$127.7 billion) three-year plan for health care reform last year. The plan aims to provide universal and affordable medical service to the country's 1.3 billion population.

The public hospital reform projects include favorable policies for public hospitals in city planning, social insurance, medical staff training and funding.

Ma admitted that the pilot program has encountered problems such as a "shortage and imbalance in the deployment of good doctors," as well as the "absence of a sound funding system."

Ministry statistics show about 42.4 percent of the country's doctors have bachelor or higher degrees but account for only 19.4 percent of the doctors working in county-level hospitals.

"Doctors disproportionately work at big hospitals in cities," he said.

For example, nearly 70 million patients from other parts of the country attend big hospitals in the Chinese capital, Beijing, every year with the hope of seeing an experienced doctors, because they believe community and rural clinics lack good facilities and skilled doctors.

Many of them fail to see the expert doctors because of the cost and the fact the expert doctors can see only about 1.8 million patients per year.

Ma said a priority for the reforms in the near future is optimizing the layout and structure of public hospitals, and train more talents for grassroots clinics.

"We'll make special efforts to improve medical services in rural and suburban areas, newly-built urban communities and satellite cities where such services have been inadequate," he said.

"Medical services in paediatrics, gynecology and rehabilitation should also be improved," he said.

He said the government will prioritize the construction and development of county-level hospitals in the future.

In 2009, the central government allocated 20 billion yuan for construction of 5,700 hospitals at the grassroots level.

By May this year, about 980,000 grassroots medical staff had been trained, and more than 900 of China's most advanced hospitals had built long-term aid and assistance ties with about 2,000 county hospitals.

Ministry statistics show China had about 14,000 public hospitals in 2009.

Public hospitals were government-funded before 1985. The situation then changed and public hospitals embarked on market-oriented reforms as the reform and opening up policies adopted in 1978 were deepened.

Analysts say market-oriented reforms have improved medical services to some extent but also resulted in higher costs.

Though the government's increased investment can improve the "hardware" of grassroots clinics quickly, talented medical staff and efficient management systems remain a bottleneck for China's health care system development over the long term.

(Xinhua News Agency December 13, 2010)