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China unveiled a three-year action plan on health care reform Tuesday, which it said would lay a solid foundation for equitable and universal access to essential health care for all in China.
Under the 850 billion yuan (124 billion U.S. dollars) plan for 2009 to 2011, the government promised universal access to basic health insurance, introduction of an essential drug system, improved primary health care facilities, equitable access to basic public health services and pilot reform of state-run hospitals.
The document from the State Council, or Cabinet, detailed tasks and goals for the 2009-2011 period as the government explained how it would implement its long-term health care reform plan, which it announced Monday.
The plan did not elaborate how the 850 billion yuan, including 331.8 billion yuan from the central budget, would be used.
But it is widely expected to be spent on subsidizing basic medical insurance programs, supporting grassroots-level health facilities and in underdeveloped western and rural regions.
TARGETING SCARCE, COSTLY CARE
"The three-year reform mainly targets the pressing problem that medical care is too expensive and hard to get, which has drawn many complaints from the people," said the document.
The current system had many problems, the government admitted.
"Some people are not covered by medical insurance, the public health sector has been weak for a long period, and state-run hospitals are too profit-obsessed," said the document.
"These problems must be solved to lay a solid foundation for the long term and for overall health care reform," it said.
China wants to have more than 90 percent of its population covered by some sort of basic medical insurance by 2011.
Three different insurance programs already exist for urban employees, unemployed urban residents and rural residents, into which governments, employers, and individuals contribute.
The health insurance subsidy offered by the government for unemployed urban residents and farmers will rise from 80 yuan per person to 120 yuan per person as of next year, according to the action plan.
The level of reimbursement an inpatient or an outpatient can get from one of the three programs will be gradually raised.
The reformers also intend to have more vulnerable people covered by insurance, such as retirees from bankrupt or financially troubled companies that can no longer pay for insurance, migrant workers and the self-employed.
PROMISING GOOD MANAGEMENT
The broad principles contained in China's new reform "are in line with what the World Health Organization (WHO) is promoting. For example, the principle of equity, the principle of having the poor (covered by) health policies," WHO Director-General Margaret Chan told reporters in Beijing on Tuesday.
The government promised good management and supervision of funds for the insurance programs, and it said it would explore more rational and convenient methods for people to use the programs.
To lower prescription costs, which have drawn much criticism, the government will promote a system of essential medicines for state-run hospitals, clinics and pharmacies. A list of essential drugs will be published this year.
Due to longstanding low government funding for state-run hospitals, which in many places only covers 10 percent of operating costs, doctors often aggressively prescribe expensive, sometimes unnecessary medicines and treatment, in order to make profits for the hospital.
This situation has meant high medical bills and corruption in the medical profession.
The reformers want to designate essential drugs, at controlled prices, to cut the cost of hospital services, while promising to increase funding to non-profit state-run hospitals and clinics that will continue to be dominant service providers.
IMPROVING PRIMARY CARE
To improve primary health care facilities, China will give priority to construction of about 2,000 county-level hospitals so each county would have at least one hospital that was essentially in compliance with national standards.
The central government will fund the construction of 29,000 township hospitals this year and upgrading of 5,000 township hospitals, under the plan.
The central government will also finance the construction of village clinics in remote areas so that every village will have a clinic in the next three years.
It said 3,700 community health centers and 11,000 community health stations would be set up or upgraded in cities.
IMPROVING TRAINING
In the next three years, China will train 1.37 million village doctors and 160,000 community doctors. Also, city-level hospitals, which usually have better expertise and equipment, will each be required to help three county-level hospitals to improve the skills of medics.
Doctors at city hospitals and disease control agencies will be asked to serve in rural hospitals for at least one year before they can be promoted.
Other measures include setting up a universal medical records database, which will be strictly managed, regular exams for those older than 65 or younger than three, and prenatal checkups.
In addition to programs to prevent or control major diseases such as tuberculosis and HIV/AIDS, China will launch new projects to help those below the age of 15 receive Hepatitis B vaccines, eliminate risks from coal-burning fluorine poisoning and improve rural water and sanitation facilities.
It will also provide folic acid to rural women who intend to get pregnant or are in the early stages of pregnancy, to prevent birth defects.
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