04/07/2009, 00.00
CHINA
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Beijing announces major health reform, but doesn't say how it will be implemented

A clear rejection of the current hospital system, run by companies that must make a profit. The "non-profit nature" of health care is affirmed instead, and the desire to guarantee that it can be used by all. But experts note the lack of specific guidelines for implementation.

Beijing (AsiaNews/Agencies) - Guaranteeing high-quality hospital treatment for all, and lowering the prohibitive costs of health care. Beijing has finally published the guidelines of the reform to guarantee public health care for all. But experts note the many unclear aspects of a reform that has been delayed for too long.

Since the 1990's, most citizens have not enjoyed free medical care, and have had to pay for their own treatments and medicines. Now the government says that over the short term, it intends to provide health care insurance to 90% of residents, to guarantee affordable medication, and to establish a network of hospitals in the cities and rural areas by 2011. Health insurance covering treatment, medication, and hospital stays is not projected until 2020.

The guidelines clearly state that "the government should step up its responsibility in planning, financing, serving and supervising to guarantee the non-profit nature of public health care." But experts note that there is a lack of specific guidelines on how to achieve this, and an absence of a clear statement of citizens' right to treatment.

The focal point of the reform will be the public hospitals, which will administer the health services. After the health reform in 1992, the hospitals have had to finance themselves. For this reason, they are often managed according to the principle of profit, charge high prices for all of their services, and mark up the price of medications. There are also long lines at the best hospitals in the big cities, and patients have to wait for hours. This has led, as Xinhua admitted yesterday, to "a decline in fairness and efficiency." Now the government is promising more financing for hospitals, and incentives based on efficiency and professionalism.

Health insurance is currently based on residency, so migrants, who are not residents of the place where they live and work, are excluded from any health services.

Even those who have health insurance must often pay up front, and public reimbursement is not always quick. Moreover, the state generally covers expenses at hospitals in the place of residency: if the patient wants treatment at a hospital in another city, because it has better services, he must often pay for the treatment himself.

Health experts have commented favorably on the expected reform, but there is also disappointment over the lack of specificity.

Wen Jianmin, director of the orthopedics department of Wangjing Hospital under the China Academy of Chinese Medical Science, tells the South China Morning Post that "the really hard part is to put [the innovations] into practice . . . Until [we read] the supporting documents on the public hospital reform [which will provide the details], I will have reservations about it." The schedule for implementation and the immediate measures have not been clarified either. Meanwhile, the 15% markup for hospitals on the cost of medications has not been abolished.

Zhong Nanshan, director of the Guangzhou Institute of Respiratory Disease and a government consultant, says that "more concrete details as to how the reforms should be implemented will be released" after the national health care conference in April.

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