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China implementing public health reforms to reverse privatisation.

In April 2009 the Chinese government announced an ambitious plan to increase the accessibility, equity and quality of health care in China and to reassert government control over the sector. In the 1980s, government support for the health sector dropped and health providers became profit-oriented in order to survive. Rural health insurance schemes fell apart, and by 2000 patients were paying 60% of their medical costs out of pocket. Since 2009, there has been progress in broadening the insurance coverage and in renovating old and building new health facilities. Health care coverage increased from 22% of urban and 13% of rural residents in 2003 to over 90% of people in 2011 with some coverage. However, coverage is often shallow and only 40% of inpatient care is reimbursed.

A major problem are the "perverse incentives" that providers receive. In the 1990s, doctors received much of their income from fees for services, and particularly for drugs, which encouraged doctors to prescribe expensive and sometimes unnecessary treatments. An essential medicines list has now been instituted, which ensures availability of a group of basic medicines, offers high reimbursement rates compared to drugs not on the list, and prohibits providers levying additional charges on drugs. The reforms aimed to compensate doctors through direct government payments, but this has not sufficiently replaced physicians' lost revenue. Hence, the policy has faced fierce resistance. There is ongoing debate over hospital reform although it is clear that hospitals which operate as profit-maximising businesses produce outcomes which are discordant with the public interest. Some progress has been made, but many problems remain. (1)

(1.) Alcom T, Bao B. China: progress with health reform but challenges remain. Lancet 2011;377(7):1557-58.

DOI: 10.1016/S0968-8080(11)38594-1

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Title Annotation:ROUND UP: Health sector policy, financing and privatisation
Publication:Reproductive Health Matters
Article Type:Brief article
Geographic Code:9CHIN
Date:Nov 1, 2011
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