Shenmu pilots medical reform plan
0 
Shenmu County in Shaanxi Province has been operating a medicare program since March 2009. As whether or not this pilot scheme is applicable nationwide is a matter of common concern, all eyes have been on this relatively obscure county for the past year.
Free medicare program
Patients poured into the seven designated medicare hospitals in Shenmu during the first month of the county's medicare experiment. Many had been suffering for two or three decades with problems such as gallstones and prostate hyperplasia, but until last March had been unable to afford the high cost of treating them.
"Anyone who is sick, whether farmer or urbanite, can now see a doctor," a rural resident from Hejiachuan Village in Shenmu County said. For a hospitalized case that does not exceed RMB 300,000, the patient needs to pay only RMB 400 from his or her own pocket. Local residents understandably see the program as heaven-sent.
Shenmu's coal reserves in 2007 gave it a number 92 ranking in comprehensive economic strength among China's top 100 counties. The county has since launched 10 projects specifically to benefit its residents. A free medicare program, along with 12-year free compulsory education and support for the disabled and widowed elderly, are among them.
Secretary of the CPC Shenmu County Committee Guo Baocheng, 55, has been a leader of the county for 13 years. "Shenmu has a population of 420,000, one third of whom are wealthy, one third moderately well off and the remaining one third relatively poor," Guo said. He regards free education and medicare as, "financial levers to adjust income distribution."
Guo admits that as funds are prerequisite to bringing these policies into effect, a free medicare program in Shenmu ten years ago, when it was a national impoverished county, would have been out of the question.
These groundbreaking medical reforms were launched as a result of Guo Baocheng's extensive grassroots research. "Most of the poor families were impoverished by heavy medical bills that they had to foot for sick family members or by natural calamities. I thought then that the government should at least cover their hospitalization," Guo recalled.
January 2008 saw the establishment of the Shenmu County Rehabilitation Work Committee with Zhang Bo, chief of Shenmu County Food and Drug Administration Bureau, as director of its general office. "As far as I know, free medicare of a full population coverage had not been adopted by any local government in China at the time; it operated only in certain developed countries," Guo remarked.
The committee conducted investigations to ascertain two basic data. One is the exact size of the population to be covered by medicare; the other is the volume of medical resources needed for the program. Demographic calculations came up with an eligible population of 330,000, after deducting migrant workers that had settled in other parts of the country. Seven of the 12 hospitals in the county, five provincial hospitals in Xi'an and six hospitals in Beijing were accordingly designated as the pilot medicare network.
Hospitalization fees of various hospitals in Shenmu County in 2007 came to a combined total of RMB 80 million, according to statistics. The Rehabilitation Work Committee estimated that RMB 70 million more was needed to support the new program. The county therefore budgeted its 2009 medicare expenditure at RMB 150 million.
Prior to 2007, the combined annual expenditure of the Rural Cooperative Medical System and Basic Medical Insurance for Urban Employees had been RMB 30-40 million.
The pilot medicare program is a reimbursement scheme that covers any registered permanent resident of Shenmu County who has joined the Cooperative Medical System Rural Residents and Basic Medical Insurance for for Urban , or the Basic Medical Insurance for Urban Employees. They receive each year an outpatient medical card that represents RMB 100 worth of treatment and medication. Hospitalized patients need to pay by themselves a tiny part of their hospitalization expenses -- RMB 200 if they go to township hospitals, RMB 400 for county hospitals and RMB 3,000 if they seek hospitalization outside Shenmu County; they get a refund for the amount above the benchmark. Besides regular medical items, the program also covers certain special costs -- for example examinations, treatment and materials needed for an organ transplant operation. The ceiling of medical costs covered by the program is RMB 300,000 per person per year, taking into account that the annual average income of urban Shenmu residents is RMB 16,000, and that of rural inhabitants is RMB 6,000.
Guo Baocheng explained that the RMB 3,000 reimbursement benchmark for hospitals outside Shenmu County is meant to encourage residents to use local medical resources. "We have very good hospitals in our county, and they have close cooperation relations with some of the country's top hospitals; we can invite their medical experts to fly over and help perform complicated surgical procedures," Guo said.
The new program has in fact lowered government employees' preferential treatment. Previously, they only needed to pay RMB 500 if they went to hospitals outside the county. And Guo Baocheng considered it reasonalble that they should pay as much as an everage resident. "At least they have higher incomes," he commented.
Go to Forum >>0 Comments