China Set To Launch Sweeping Health System Reforms, Aimed In Part At Reversing Stratified Access To Medicine, Hospitals, Insurance

BEIJING - China's central government is set to launch sweeping reforms of the country's health system, with the ultimate goal of providing universal health care by the year 2020.

The reforms are aimed at reversing gaps in the level of medical care, health insurance and access to doctors that have expanded over the last three decades, as the country's centrally planned economy and provision of socialized medicine were dismantled.

In drafting the new health system reforms, "The government of China has for the first time set out its strategic vision for universal health care for all Chinese citizens," said Tang Shenglan, a health and poverty advisor at the Beijing office of the World Health Organization. The WHO has been involved in research on crafting China's revamped health system.

As the reforms are implemented, "They should cover 90 percent of the people by 2010," said Tang.

The government of Mao Zedong made gains in providing medical care, controlling some diseases and extending average lifespans after the founding of the People's Republic of China in 1949.

And although some health gains have continued since market-oriented economic reforms were introduced in 1979, the distribution of health services has in many ways followed that of wealth, with populations in the richer cities of eastern China pulling far ahead of rural villagers, especially those in the impoverished western crescent of the country that stretches from Xinjiang and Qinghai to Gansu, Tibet and Yunnan.

The average health status and even life expectancy has stratified along wealth and geographical boundaries, Tang said.

In Shanghai, life expectancy is 78 years, or 13 years higher than in China's poorest provinces. And the poorest rural areas of China have infant mortality rates almost five times higher than in the richest parts of the country.

China's health inequalities are increasing, gains in the overall system are slowing, and public discontent is growing, Tang said. For instance, government financing of total health spending has steadily dropped since the early 1980's, when it paid roughly 40 percent of expenditures. Out-of-pocket payments have risen during the same period from about 20 percent to more than 50 percent.

The Chinese government is now responding with measures to extend health insurance to widening sections of the urban and rural populace and to increase funding for clinics in the countryside, Tang explained (PharmAsia News, Oct. 20, 2008).

"The government is now setting rural health care services as a priority," Tang said.

He explained that since the dismantling of collectivized agriculture and medicine 30 years ago, the proportion of rural residents covered by an insurance scheme plummeted to less than 10 percent.

Local government leaders in the countryside, dependent on taxes from impoverished peasants, have been unable to provide adequate health care facilities.

The central government is now reviewing an array of options to channel more funding to local health facilities and programs, and to provide basic-level insurance to rural residents across the country, Tang said.

To make the reforms work, the central government will have to steadily step up health care financing for the rural hinterland, he added.

At the same time, the central authorities will have to work out a series of incentives to persuade highly trained medical workers to work in the countryside, and in the less developed sections of western China.

"Doctors are now very reluctant to work in the poor western areas of China," Tang said. "And in the western provinces," he added, "many people don't have enough money to buy medicines."

- Kevin Holden ([email protected])

[Editor's note: This is part one in a series on China's wide-ranging plans to reform the country's health system, including its hospitals, insurance schemes and access to medicines.]