10/15/2008, 00.00
CHINA
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Beijing announces anticipated health system reform

The guidelines have been published after years of study. The objective is to ensure free health care at least for basic and urgent services, and to subsidize the hospitals. But experts warn of the difficulties of applying it, and expect experimentation in just a few hospitals.

Beijing (AsiaNews/Agencies) - After two years of intense debate, the government announced yesterday the guidelines for health system reform. According to the experts, they are interesting ideas, but still very generic.

Three years ago, Beijing acknowledged the "failure" of the current medical system, and announced a complete reform. Today only a minority of citizens enjoy free health care: public employees have it, but the hundreds of millions of rural residents and manual laborers must pay for all of their services. This leads hundreds of millions of people to overlook their health, or forces them to sell everything and go into debt when someone in the family has a serious illness.

Also, the best hospitals are concentrated in the city, and rural inhabitants must often travel hundreds of kilometers to be seen or cared for by good specialists. According to data from the Chinese health ministry, at least 80% of rural residents die without ever seeing a doctor, because of the price of examinations and treatment.

The reform plan is intended to ensure identical access to basic health services in both the city and the countryside, for urgent medical care, checkups and prevention, assistance for mothers and children, and vaccinations. It also aims to guarantee, by 2010, medical insurance for 90% of urban and rural residents, covering at least 80% of clinic visits. It also provides for the sale of essential medicines at limited prices (currently clinics often charge inflated prices for medicines). By 2020, everyone should have equal access to health services.

But experts note that the reform project does not explain how all of this can happen. In particular, it is not explained how the hospitals will be financed, which today receive minimal state subsidies and are forced to finance themselves in order to pay for all of their services (to such an extent that many have been found to encourage unnecessary and expensive treatments). According to unconfirmed information, the reform will be tried at first in only a few hospitals.

Chen Yude, professor of health and administrative policy at the University of Beijing, observes that basic health assistance must first be provided in every community, because "reform for public hospitals is too complicated and difficult and they will be carried out only in a few pilot cases."

A public debate on the project is scheduled to continue until November 14: anyone can view it at the website shs.ndrc.gov.cn/yg and leave ideas and comments.

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