China's Ministry of Health (MOH) will realize its promise to
reform the current healthcare system, according to Minister Gao Qiang, who mapped out a reform sketch to
the public for the first time at the national health work
conference on January 8. The four basic systems, namely the basic
healthcare system, basic heath insurance system, basic medicine
system, and public hospitals management, altogether serve the goal
of "basic healthcare covering all urban and rural citizens".
Under the new systems, the government will provide financial
support as well as services and medicine supply. Although the
sketch has been lauded as the right step forward, questions have
been raised over many of the proposed changes, resulting in
continued debate between ministries.
One of the more pressing issues is the amount of money that
needs to be injected into the project. According to the preliminary
calculations of a working team to intensify healthcare reforms, the
government should invest 260 billion yuan in the project to
guarantee access for everyone to free basic medical services.
However, officials from the Ministry of Finance say: "In practice,
the project will require an endless investment."
Speaking at a regular press conference, the Health Ministry's
spokesman said: "In our opinion, it's the right time to carry out
the project," arguing that China's rapid economic development can
provide the financial support needed to fund the new system. Gao
also said that the budget was affordable.
Another question that has been raised is how and who has the
responsibility of defining "basic medical services". The MOH
intends to make a list of basic medical services, medicines and
diseases that come under the general definition of "free medical
services" that is accessible to everyone.
"Primary medical services already include the prevention and
treatment of common and regularly occurring diseases at the
community level. As such, the term 'basic medical services' is
confusing even for medical professionals," said an official from
the Ministry of Labor and Social Security.
When asked why the government plans to offer free treatment as
part of "basic medical services", Mao Qun'an, the MOH spokesman
said: "Early diagnosis should be included in public health." He
added that the costs of diagnosis and treatment at an early stage
of some diseases are reasonably affordable. Overall medical fees
would increase if the disease is not treated in time.
Mao also acknowledged that while there is no clear definition
for "basic medical services", as far as policy is concerned, it
could be defined as medical services available in community and
rural medical centers. Further, defining the term according to
service levels is not only feasible but also acceptable.
But the Ministry of Labor and Social Security disagrees, arguing
that "the definition is too ambiguous". In addition, if "basic
medical services" is defined by the type and service levels of
medical centers, this would result in the medical centers, while
continuing to receive government financial support, making a profit
from medicine sales, a feature of the current healthcare system
that has already been severely criticized.
Then there is the issue who should have the authority to decide
on the definition of "basic medical services”.
"It can't be defined by one single ministry," said the official
from the Ministry of Labor and Social Security, adding that it
would be unreasonable to give the term the status of a system. "If
that happens, there will be widespread buck-passing between medical
centers and hospitals."
Experts from the ministry have also questioned the plan to put
service suppliers in charge of basic medical services. If financial
support corresponds to the number of services provided, the
suppliers might push overpriced and unnecessary services to
patients. On the other hand, there could result in a deficiency of
services if patient numbers become a criterion.
A third issue that is being debated involves the relationship
between finances and service quality.
Under the proposed changes, service suppliers are to distribute
medical services fairly and impartially, ensuring that more people
benefit from healthcare system. However, this could start to go
wrong if suppliers are not motivated to improve their services
because their funding is guaranteed.
There are also concerns that in the event of a funds shortage,
this will directly impact the range of medical services available.
Therefore, Ministry of Labor and Social Security experts maintain
that medical resources will be more effectively utilized under a
scheme of services purchasing, which involves a third party, not
the government, investing directly in medical centers, be they
public or private.
(China.org.cn by Huang Shan, January 24, 2006)