Wake up（225）

 

225

 

"Healthy China in 2030", this is a resounding slogan put forward by China. In October 2016, after Xi Jinping, General Secretary of the Central Committee of the Communist Party of China, and Premier Li Keqiang delivered related keynote speeches at the National Health and Health Conference in Beijing, the National Health and Family Planning Commission released the "Healthy China 2030" Planning Outline, which is a An updated comprehensive framework of China's healthcare reform goals and plans.

The strategic theme of "Healthy China 2030" is "co-construction and sharing, health for all". The goal of the strategy is to achieve the following key goals by 2030: continuous improvement of people's health status, increase of life expectancy to 79 years, effective control of major health hazards, substantial improvement of medical and health services, substantial expansion of the medical and health industry, and establishment of inclusive Sexual health-improving regulatory systems. Specific actions include: strengthening health education in schools, promoting healthy lifestyles, encouraging physical activity, improving access to universal health care, improving the quality of services in health care units, paying special attention to the elderly, women, children and people with disabilities, Insurance, drug and medical equipment systems reformed, and so on.

But that's just a slogan. China's health insurance reform has not worked.

Chai Jianhua and Bai Bingqing and other Hong Kong medical friends talked a lot about Chinese medical care. There are big problems in China's medical system and medical education.

Bai Bingqing talked about China's rural cooperative medical system in the 1950s–1980s.

In 1949, the People's Republic of China was established, and the Ministry of Health led China's medical and health system and policies. People's access to health services is led by the central government (rather than local governments). Rural areas have the greatest need for health care reform, so the Rural Cooperative Medical System (RCMS) was established, consisting of a three-tier system, to provide rural health services. The rural cooperative medical system operates under a prepaid fee scheme consisting of individual income contributions, rural collective welfare funds, and higher-level government subsidies.

The first level is made up of barefoot doctors who are trained in basic hygiene and traditional Chinese medicine. Barefoot doctors are the simplest form of medical care, especially in rural areas. Township clinics are the second tier of the rural cooperative medical system and consist of small clinics that are financed by the government and employ medical staff to provide services. Township health clinics plus barefoot doctors treat most common ailments. The third level of the rural cooperative medical system is the county hospital, which is responsible for providing treatment for seriously ill patients. They are mainly funded by the government, but also work with local resource systems (providing equipment, doctors, etc.). In addition, public health campaigns have been promoted, especially in urban areas. The purpose is to improve the environment and health conditions.

The rural cooperative medical system has significantly increased life expectancy while reducing the incidence of certain diseases. For example, life expectancy almost doubled (from 35 to 69 years) and infant mortality decreased from 250 to 40 deaths per 1,000 live births. In addition, the incidence of malaria has dropped from 5.55% of China's total population to 0.3%. The purpose of this system is to do disease prevention and stop various vectors, such as mosquitoes that cause malaria, from spreading diseases. Special emphasis is placed on raising public health awareness.

Under Mao Zedong's auspices, the rural cooperative medical system expanded rapidly during the Cultural Revolution, peaking in 1976 with coverage of 85 percent of the total population. However, due to reforms in the agricultural sector and the end of the People's Commune in the 1980s, the rural cooperative medical system lost its economic and organizational foundation. As a result, the system shrank to a mere 9.6% coverage in 1984.

Bai Bingqing also talked about the reform of Chinese hospitals since 2010.

Bai Bingqing said that public hospitals in China are considered the most important medical units, providing both outpatient and inpatient services. They also have important teaching, training, and research responsibilities. Most hospitals are located in cities.

However, the availability and affordability of hospital services also presents challenges. The first is that the prices of medicines are set too high to make up for the low prices of services. Doctors are also dissatisfied with their income. Secondly, the tense relationship between doctors and patients sometimes leads to conflicts, and even violence against doctors "medical trouble". In addition, patients were not distributed to different levels of hospitals according to the severity of the disease, resulting in excessive consumption of advanced medical resources in the hospital.

The purpose of the hospital reform is to maintain the social welfare essence of public hospitals, and to encourage public hospitals to perform public service functions and provide the people with easily accessible and affordable medical services. The reform was piloted in 16 cities in 2010. In 2015, a new version of the guidelines was released, focusing on county-level hospitals. In 2017, public hospital reforms were expanded with a focus on eliminating drug price differences between hospital pharmacies and wholesalers.

Regarding the results of the reform, different studies have different results. The case study found that the reform of the salary system improved the quantity and quality of services, but led to a sharp decline in management efficiency. Regional evidence shows that out-of-pocket costs have increased despite decreases in inpatient drug use. Although medical staff face higher pressure and overtime, their job satisfaction has improved.

Liu Hanyu, the deputy director of the clinic, told Chai Jianhua about the changes in other healthcare providers. He said: In addition to public hospitals, many grassroots public health institutions and private units also play a unique role in providing medical and health services. The reform of grassroots medical institutions focuses on their cooperation with hospitals, distribution of responsibilities, incentives and remuneration for grassroots medical staff. Private institutions are encouraged to provide health care and to collaborate with the public sector.

Liu Hanyu talked about the reform of the pharmaceutical industry in inland China.

In 2009, the State Council launched the Essential Drug System (EDS for short) and released the first version of the National Essential Drug List (EDL for short) containing 307 drugs. All primary medical institutions are only allowed to prepare, use and sell drugs listed in the catalogue, with few exceptions. Drug prices are determined through negotiation between regional governments and drug manufacturers, and are sold at grassroots institutions at zero profit. Emergency department reimbursement rates are set to be high. The Essential Medicines List is subject to change based on demand and drug development. However, in 2015, the State Council changed the regulations to prevent local governments from expanding the list of essential drugs. The analysis pointed out that if local governments are given the power to add new drugs to the list of essential drugs, it will easily lead to rent-seeking behavior and protectionism for the local pharmaceutical industry. In addition, the new guidelines remove the prohibition on the use of non-listed drugs, as previous restrictions had led to drug shortages in grassroots institutions.

Liu Hanyu pointed out that seeing a doctor is expensive, saying that China's "fairness" and "public welfare" have become key words in medical reform. At the beginning of the founding of New China, epidemics were rampant everywhere, especially in rural areas. The number of medical and health practitioners was pitifully small, and medical resources were extremely scarce, and it was almost impossible to solve a large number of health problems of the people. Due to the urgency of the situation, with the development of the patriotic health campaign and the development of medical and health resources, China's public health service system and medical service system have been established. A true portrayal of daring to see a doctor and looking down on a doctor. The public welfare of public health care has not been properly reflected, which has undermined the trust and sense of gain of the masses.

"Everyone enjoys basic medical and health services." This is the goal put forward by the new medical reform in 2009, which marks that the Chinese people will enter the era of "health care".

From "paying out of pocket" for medical treatment to "taking the big head" of the state, from "supporting doctors with medicine" to canceling drug markups, China has comprehensively promoted the comprehensive reform of public hospitals, canceled all drug markups, and further promoted the return of public hospitals to public welfare.

Liu Hanyu said: In the past, I was afraid of illness and traffic. A 75-year-old man told him that when he was a child, a villager suffered from appendicitis and refused to see a doctor until the perforation of the appendix was life-threatening. However, due to inconvenient transportation, he could not go to the county hospital for medical treatment in time. He died before the boat arrived. .

In 2023, a new round of medical insurance reform is rolling out. However, many people believe that their account balance has decreased after the medical insurance reform, and they question the fairness of the new policy. To this end, medical insurance bureaus around the world have issued policy interpretations to respond to doubts and dissatisfaction.

What is the underlying logic of this round of medical insurance policy adjustments? Where will China's medical insurance reform go?

Liu Hanyu explained: The source of the medical insurance reform in various provinces this time is that in April 2022, the General Office of the State Council issued the "Guiding Opinions on Establishing and Improving the Outpatient Mutual Aid Security Mechanism for Basic Medical Insurance for Employees." Subsequently, various places have issued supporting implementation opinions and put them into practice. But I sorted out and found that the two groups that responded strongly to this medical insurance reform are retirees and flexible employees. Most retirees suffer from chronic diseases and often seek medical treatment. They are more sensitive to personal medical insurance accounts, and directly feel problems such as the reduction of personal accounts and the increase in reimbursement thresholds. In some places, flexible employees do not directly open personal accounts, and their psychological gap is relatively large. Relatively speaking, young people pay less attention to the changes brought about by the medical insurance reform due to reasons such as low frequency of medical treatment. In fact, the medical insurance reform in Wuhan is relatively radical. Taking flexible employment as an example, Wuhan simply and rudely canceled the personal accounts of flexible employees. Guangdong Province, on the other hand, retains the personal medical insurance accounts of flexible employees, and the inclusion standards are based on the implementation of current employees.

Liu Hanyu told Chai Jianhua that this is related to the pressure on Wuhan's shared medical insurance funds. In fact, there has been a deficit in shared medical insurance in many places in China.

Bai Bingqing said that a normal feature of seeing a doctor in a Chinese hospital is long queues, which is a sign that the medical system is in crisis. Rapid economic growth over the past 30 years has transformed China from a poor agricultural country into the world's second largest economy. Socialist healthcare from cradle to grave has increased life expectancy and reduced maternal mortality. However, this system is not enough to support China's population of more than 1 billion. Extreme disparity and inequality threaten China's progress, social stability, and fiscal health, and present serious challenges to the Chinese government.

Bai Bingqing told Chai Jianhua that there were many scandals in the Chinese medical field. In July, hundreds of thousands of children were found to have received faulty vaccines. The news has outraged the public, shaken confidence in the government and fueled dissatisfaction with the healthcare system. Although wealthy people can enjoy the best medical services in top hospitals with foreign doctors, most people can only go to overcrowded hospitals. In rural areas, people must rely on village clinics, or travel hundreds of miles to find the nearest medical facility.

China does not have an effective primary health care system that serves as the first line of defense against illness and injury. According to the World Health Organization, China has one general practitioner for every 6,666 people, compared with the international standard of one general practitioner for every 1,500 to 2,000 people.

Instead of seeing a doctor in a doctor's office or a community clinic, the Chinese can't wait to go to a big hospital to see a specialist, even for a minor ailment such as fever and headache. Last winter, flu patients spent the night under blankets in the hallways of several major Beijing hospitals, state media reported.

Hospitals are understaffed and overcrowded. Specialists are overloaded with up to 200 patients a day.

People were annoyed, and some resorted to violence. Attacking doctors is so common in China that it has a name: "medical trouble".

In 2016, Xi Jinping unveiled China's first vision for improving health care since the founding of the country in 1949. The document, called the "Healthy China 2030 Plan," promises to improve medical innovation and allow people to enjoy more equal medical services. The shortage of doctors has become more urgent as the government grapples with mounting health problems for China's vast population. A 2011 World Bank report found that heart disease, stroke, diabetes and chronic lung disease accounted for 80 percent of deaths in China. Hospitals have been unable to meet the needs of the public.

What Bai Bingqing and Liu Hanyu said to Chai Jianhua made the old Chinese doctor Chai Jianhua very confused. He has lived in the mainland for more than 90 years, but he has no way of knowing the real situation of China's medical and health services. The information brought by the doctor in Hong Kong allowed him to see a little-known side of China.