Shot in the arm for public hospitals

China is restructuring its healthcare as it considers this the countrys most important strategic investment for the future. PUBLIC hospitals should allocate more of their medical resources to the ordinary people rather than set up special or VIP medical centres for the rich, some policymakers told Chinas parliament session in March. Of course, rich people have the freedom to buy premium service, but they should get it from private hospitals, said Chinese Peoples Political Consultative Conference representative Feng Shiliang. This is fair comment as many provincial and city-level government hospitals offer VIP services where those who can pay are given preference for treatment. Last year, the Chinese Health Ministry introduced a healthcare reform aimed at establishing a medical care system that is affordable and exceptional in service. The restructuring, however, has been hampered by high medical costs and lack of good community hospitals and health insurance coverage. Past reforms over the last two decades had done little to address patients complaints over spiralling costs and mediocre service, as well as that of doctors, who felt they were being made scapegoats by the system. Doctors have earned themselves the reputation of having a poor work attitude and profiting from prescriptions. On the other hand, they complain of low salaries, heavy workload and unrealistic work shifts. Under the restructuring, by 2012, the government would have more than 90% of rural and urban residents covered by basic health insurance. Another 460 billion yuan (RM240bil) will be channelled to subsidies for farmers, rural people and senior citizens and training for medical workers at community hospitals. Over the past one year, we have seen some progress with the reforms, with more citizens able to feel the real benefits, Health Minister Chen Zhu said. He said more than 32 million children aged below 15 had been given free jabs for hepatitis and over 2.5 million women in rural areas had received free checks for vaginal ! and brea st cancer. About six million pregnant women also received subsidies for hospital stay. As for insurance, the governments contribution is 25%, societys 35% and the individuals only 40% (down from 50% in 2000). The premier also mentioned in his work report that subsidies for new farmers will increase by 50%, he said. Currently, such farmers receive an average of 113 yuan, with the highest subsidy amount six times more than that for regular farmers. Since the introduction of a pilot programme that aims to return public hospitals in 16 major cities back to non-profit establishments early this year, Chen said, medicine costs had been slashed by 25% to 50%. However, a 21st Century Economic Daily article questioned whether the 850 billion yuan (RM404bil) budget for healthcare reform would be adequate to sustain the campaign for the whole three years and beyond. The report said that the government would have to compensate public hospitals up to eight billion yuan (RM3.8bil). These hospitals had relied on sales of medicine and premium medical service to keep afloat. Guangdong provincial health department deputy director Liao Xinbo noted that as allocations for the healthcare sector had not been raised, it would affect the success of the reforms. He felt that the central governments funding should be between 5% and 8% of its budget over the next two years. A spokesman from a provincial hospital in Nanjing, Jiangsu province, said that it would be hard for the Health Ministry to offset the losses the hospital would make from the sales of medicine, which made up 46% of its revenue. The mess in the public hospitals was a result of previous reforms. Hospitals were initially fully funded by the government. Since the early 1990s, they only enjoyed some subsidies from the government and had to generate their own income using a business market model. Although there are a few established foreign-owned private medical centres in China, most of the 4,000 set up since 1995 are limited in many aspects, and struggle to attract d! octors f rom the more than 16,000 public hospitals. The Health Minister concurred that the governments investment in the healthcare sector was still too low compared with countries like the United States. He believed the Chinese people would benefit more from the latest reform as the central government had given strong signals that it would double its allocation for the healthcare system. Many local governments have invested hundreds of billions of yuan in economic-related projects, he said. That showed that we were determined to do something, but why not in terms of healthcare? The healthcare profession is not about burning money as it is the countrys most important strategic investment for the future.
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