Healthcare reform in China
The healthcare system reform in China refers to the healthcare system transition in modern China. China’s government, specifically the Ministry of Health of the State Council oversees the health services system, which includes a substantial rural collective sector but little private sector. Nearly all the major medical facilities are run by the government. China’s healthcare reform history has seen an increase in quality after 1949 with the establishing of the Cooperative Medical System, and a collapse in healthcare with economic reforms post-1980. Recent reforms include the New al Cooperative Medical System, health insurance reforms, the World Bank Health VIII project, and the Healthy China 2020 project, but challenges still exist in providing universal healthcare access to all of China, most notably the rural sectors.
History of reform:
After 1949, the Chinese Communist Party took control of China, and the Ministry of Health effectively controlled China’s health care system and policies. Under the Chinese government, the country’s officials, rather than local governments largely determined access to health care. Rural areas saw the biggest need for healthcare reform, and the Rural Cooperative Medical System (RCMS) was established as a three-tier system for rural healthcare access. The RCMS functioned on a pre-payment plan that consisted of individual income contribution, a village Collective Welfare Fund, and subsidies from higher government.
The first tier consisted of barefoot doctors that were trained in basic hygiene and traditional Chinese medicine. This system of barefoot doctors was the easiest form of healthcare access, especially in rural areas. Township health centers were the second tier of the RCMS, consisting of small, outpatient clinics that primarily hired medical professionals that were subsidized by the Chinese government. Together with barefoot doctors, township health centers were utilized for most common illnesses. The third tier of the, county hospitals, was for the most seriously ill patients. These hospitals were primarily funded by the government, but also collaborated with local systems for resources (equipment, physicians, etc.)
Public health campaigns to improve environmental and hygienic conditions were also implemented, especially in urban areas. The RCMS has significantly improved life expectancy and simultaneously decreased the prevalence of certain diseases. For example, life expectancy has almost doubled (from 35 to 69 years), infant mortality has been slashed from 250 deaths to 40 deaths for every 1000 live births. In addition to this, the malaria rate has dropped from 5.55% of the entire Chinese population to 0.3% of the population. This increase in health has been from the efforts of both the Chinese government as a whole and also local, community efforts to increase good health. Campaigns sought to prevent diseases and halt the spread of agents of disease – for example, mosquitoes causing malaria. Attempts to raise public awareness of health were especially emphasized.
The CMS saw great improvements to public health. Infant mortality decreased from 200 to 34 per 1000 live births, and life expectancy almost doubled, increasing from 35 to 68 years. However, the agricultural sector reform slowly ended the original CMS during the 1980s, which had an adverse effect on the poor. The impoverished, especially in rural areas, had no way of paying for medical care. A decentralization of the Chinese government meant a decrease in government involvement in public health services, which in turn made quality healthcare access much more difficult for poorer individuals. In fact, government spending on public health decreased from 32% to 15% as a result of the agricultural sector reform. Recent changes have been implemented in an effort to ensure healthcare for all of China.
New Rural Cooperative Medical Care System
As a result of the agricultural sector reform and the end of the old CMS in the 1980s, many rural areas experienced struggles in affording healthcare fees. The New Rural Cooperative Medical Care System (NRCMCS) is a new initiative that was established in 2003 to overhaul the healthcare system, particularly intended to make it more affordable for the rural poor. The main difference between the NRCMS and original RCMS is that it is a voluntary system. Much of the NRCMS aims to reform both private and public sectors of health. This contrasts with the old RCMS that was almost completely funded by the Chinese government and extended universally across all parts of China. The specifics of the program vary by county, but are funded by individual contributions and government subsidies for the poor. Preliminary studies saw favorable participation of greater than 80%, which was believed to be partially from a push from both the local and national governments to participate.
There are some difficulties that persist in the NRCMCS. The program lacks adequate funding, medical staff, and sufficient equipment that is paid for by the government.One particular issue is that while inpatient costs are covered, the majority of outpatient visits are not, which leaves many people still unable to pay for hospital visits. Additionally, the new CMS, like the old system, is tiered, but this also depends on the specific location. The details of the NRCMCS show that patients benefit most from the NRCMCS at a local level. If patients go to a small hospital or clinic in their local town, the scheme will cover from 70-80% of their bill, while if they go to a county one, the percentage of the cost being covered falls to about 60%, and if they need specialist help in a large modern city hospital, they have to bear most of the cost themselves, where the scheme would cover only about 30% of the bill.
Healthy China 2020
The Chinese government recently declared the pursuit of “Healthy China 2020,” a program to provide universal healthcare access and treatment for all of China by the year 2020, mostly through revised policies in nutrition, agriculture, food, and social marketing. Much of the program centers on chronic disease prevention, and promoting better lifestyle choices and eating habits. The program especially targets public awareness for obesity, physical inactivity, and poor dietary choices. Healthy China 2020 focuses most on urban, populous areas that are heavily influenced by globalization and modernity. Additionally, much of the program is media run and localized, concentrating on change through the community rather than local laws. Many of the aims of Healthy China 2020 are concentrated to more urban areas that are under Western influences. Diet is causing obesity issues, and an influx of modern transportation is negatively affecting urban environments and as a consequence, health.
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