Transcript Document

China’s Healthcare
Reform
Ling Li
Peking University
Time line of China’s healthcare reform
Text
Text
2003
2006
2007
2009
2014
Why Need Reform?


Rapid increase in health care
expenditure
Increase share of personal income
spent on health care



Limited access to health care service



Decrease in government spending
Decrease in health insurance coverage
High medical expenses
Poor service qualities
Health Inequality


Regional
Economic
Chinese healthcare system

During the period between 1950 to 1978, China had
many achievements in health field to be proud of
 rapid and large reductions in mortality rate, despite
China’s low income per capita at the time
 create a low cost, wide coverage primary health care
model
Chinese healthcare system

After 30 years of economic reform, China’s healthcare
system has not improved as well as the economy has. Instead,
it has deteriorated in many aspects
 Medical costs are escalating rapidly
 The relationship between patients and doctors are
deteriorating
Healthcare reform in China
The GHE decreased since the late
1980s and has returned to
increase since the early 2000s
( SARS in 2003).
Market reform in health sector:
1985
Source: Chinese Health Statistics Yearbook 2011
SARS, New govt. (NCMS):
2003
10
Life Expectancy and Per Capita GDP in
1980
1980年人均预期寿命与GDP相关性
80
75
70
人
均
预65
期
寿
命60
China
Far Super economic
level
55
50
45
40
0
2000
4000
6000
8000
人均GDP（美元）
数据来源：世界银行
10000
12000
14000
Life Expectancy and Per Capita GDP in
1990
1990年人均预期寿命与GDP相关性
85
80
75
人
均
预
期
寿
命
70
China
65
领先在缩小
60
55
50
45
40
0
5000
数据来源：世界银行
10000
15000
人均GDP（美元）
20000
25000
30000
Life Expectancy and Per Capita GDP in
2000
2000年人均预期寿命与GDP相关性
85
80
75
人
均
预
期
寿
命
China
70
65
60
Normal Country
55
50
45
40
0
5000
10000
15000
20000
人均GDP（美元）
数据来源：世界银行
25000
30000
35000
40000
Life Expectancy and Per Capita GDP in
2009
2009年人均预期寿命与GDP相关性
85
80
75
中国
70
人
均 65
预
期
寿 60
命
55
略好于2000年
50
45
40
0
10000
20000
30000
人均GDP(美元)
数据来源：世界银行
40000
50000
60000
Children Mortality Rate and Per Capita GDP in
1960
1960年婴儿死亡率与人均GDP相关性
200
180
160
中国
140
婴
儿 120
死
亡 100
率
（
‰ 80
）
60
40
20
0
0
200
400
600
800
人均GDP(美元)
数据来源：世界银行
1000
1200
1400
1600
1990年婴儿死亡率与人均GDP相关性
1980年婴儿死亡率与人均GDP相关性
140
120
120
100
婴 100
儿
死 80
亡
率 60
（
%
） 40
婴
儿
死
亡
率
（
%
）
超越经济发展水平
中国
80
60
领先在缩小
40
中国
20
20
0
0
2000
4000
6000
8000
10000
12000
0
14000
0
人均GDP（美元）
5000
10000
15000
20000
人均GDP（美元）
25000
30000
2009年婴儿死亡率与GDP相关性
2000年婴儿死亡率与GDP相关性
100
100
90
90
80
婴70
儿
死60
亡50
率
（40
%30
）
20
80
婴
儿
死
亡
率
（
%
）
回归正常
中国
70
60
50
略好于2000年
40
30
20
中国
10
10
0
0
0
5000
10000
15000
20000
25000
人均GDP（美元）
30000
35000
40000
0
10000
20000
30000
40000
人均GDP（美元）
50000
60000
China’s unbalanced development—
1960-80 vs. 1980-2000
Life Expectancy in Selected Years
80
70
60
50
40
30 30
20
10
0 before 1949
67.9
68.6
71.4
total
male
female
1973-1975
1981
Source: Health Statistic Yearbook, 2006
1990
2000
Life Expectancy under-five mortality Increase
（‰）
（year）
of Life
1980
2003
1980
2003 Expectan
cy
Decrease of
under-five
mortality
China
68
71
42
37
3
-5
Australia
74
79
11
6
5
-5
Hong Kong
74
79
11
3
5
-8
Japan
76
82
8
4
6
-4
Korea
67
76
26
5
9
-21
Malaysia
67
72
30
7
5
-23
New Zealand
73
79
13
6
6
-7
Singapore
71
80
12
3
9
-9
Sri Lanka
68
73
34
15
3
-19
Source: World Bank. World Development Indicators 2005. Washington DC
% of people who should see a doctor
choose not to do so because of the cost
Big
city
Middlesize city
Small
city
Rural 1
Rural 2
Rural 3
Rural 4
inpatient
1993
34.09
33.87
53.47
47.95
63.15
61.14
67.72
1998
53.12
58.43
70.77
63.80
54.12
70.26
69.38
2003
64.4
35.6
74.8
77.6
74.9
75.5
73.6
Outpatient
1993
3.21
2.40
9.58
15.10
21.36
19.55
24.42
1998
36.69
23.48
42.96
30.09
31.67
42.29
38.72
2003
30.8
32.7
47
29.2
33.9
41.2
49.1
Source：The national health service survey, 1993、1998、2003
China’s Healthcare Reform Plan



The plan, issued on April 6, 2009 by the
State Council, promised to provide a
universal primary health service to the
country's 1.3 billion people.
“The goal is for everyone to enjoy basic health
care services”
Government has responsibility to build a safe,
effective, convenient and inexpensive
health care system covering both urban
and rural residents
Healthcare System
Financing
Drugs &
Equipment
Health
Personnel
Healthcare
Delivery
Management &
Regulation
Health
22
China’s Healthcare Reform Phase I




Speed up the establishment of a universal
healthcare system
Set up an essential drug system
Improve the primary health service
network
Provide equal access to public health care
for urban and rural residents
From 2009-2012

Expand the coverage of health insurance.


Increase the amount of rural and urban
population covered by the basic health
insurance system or the new rural cooperative
medical system to at least 90 percent by 2012
up to now, more than 1.27 billion urban and
rural Chinese have been covered by basic
health insurance, coverage rate is 96%
From 2009-2012

Build an essential drug system that includes a
catalogue of drugs that mostly needed by the
public

Identified 307 essential medicines for common and
frequently-occurring diseases.
 Government guidance on prices of these medicines has
been published.
 The government has included all the essential
medicines into the health insurance reimbursement list.

By the end of 2012, this policy had been implemented in
all urban and rural primary health care institutions
throughout the country
From 2009-2012

Improve health service delivery systems



government increase funding to primary
health care institutes
set up family doctor training system,
emphases on human resources education
government has invested 60 billion yuan to
build 5,169 clinics at the township level,
2,000 hospitals at the county level, 2,400
urban community clinics, and 11,250 village
clinics in remote areas
From 2009-2012



Gradually provide equal public health
services in both rural and urban areas in
the country
Government has offered all the urban and
rural residents 10 types of free public
health services.
Promote health maintenance by setting
up personal health archives for urban and
rural residents
Restructuring the primary
healthcare system

a comprehensive reform of primary care
system





increasing government investment in primary care
centers
Eliminating medicine-subsidized healthcare
Paying for performance
New regulation and incentive for hospitals and doctors
“Two-Envelope” bidding procedure for procurement of
essential medicines
• “Technical Bid” ensures the qualification of pharmaceutical firms;
• “Business Bid” limits drug prices.
改革成效举例
Healthcare and Social
Development




Leading the government’s role and
development pattern towards
emphasizing social development
Experimenting the creative and open
approach for the government’s
policymaking
Learning by doing social experiment
Integrating top-down and bottom up
Challenges of China’s Healthcare
Reform

Li Keqiang called for deepened health
care reform, speeding up the reform of
public hospitals
Health service delivery in
China



1980s reform reduced budget support to
providers
Providers paid fee-for-service
Regulated prices are distorted



Low (or negative) margin on basic care
High margin on high- tech care and drugs
Providers shift demand to high-tech care
and drugs
From 2009-2012

Push forward reform trials in public
hospital




70% of Chinese hospitals are publicly owned.
due to low government investment, the public
hospitals are “for profit”
"over treatment" and "doctors make living on
prescribing medicines“ are popular
phenomena
17 pilot cities are reforming the public
hospitals
Structure of Hospital revenue per
patient （general hospitals within health sector ）
Revenue
per
outpatient
（yuan）
Revenue
from
medicine
（%）
Revenue
from
medical
examinati
on （%）
Revenue
per
inpatient
（yuan）
Revenue
from
medicine
（%）
Revenue
from
medical
examinati
on （%）
1990
10.9
67.9
19.3
473.3
55.1
25.7
1995
39.9
64.2
22.8
1667.8
52.8
30.4
1998
68.8
62.1
16.4
2596.8
49.2
28.1
2000
85.8
58.6
19.6
3083.7
46.1
31.7
2002
99.6
55.4
28
3597.7
44.4
36.7
2004
118.0
52.5
29.8
4284.8
43.7
36.6
2005
126.9
52.0
29.8
4661.5
43.9
36.0
2010
173.8
50.7
30.9
6525.6
43.4
25.9
2011
186.1
49.6
31.2
7027.7
41.8
26.7
Source: Health Statistic Yearbook
Sanming (三明）model
Drugs &Equipment
Magt. & Regulation
Availability
+
Affordability
=
accessibility
Delivery
Financing
Health Personnel
36
Restructuring the system
New payment
system
(FFS,DRGs)
Magt. &
Regulation
Public
hospital
New incentive
for doctors
Single Payer by
combining all
the insurances
Drugs &
Equipment
Sanming model
住院总费
用(万元)
检查化验
次均住
同比增 药品收入 同比增
同比增
同比增
费
院费用
长%
（万元） 长%
长%
长
(万元)
（元）
每百门
次均门
次均普
次均普通
急诊住
诊总费
通门诊
门诊费用
院人次
用
同比增
（元）
(住院
（元）
长%
率)
17091.04
-0.58% 5691.14
-29.24% 4975.66
19.32%
6859
-9.49%
129.01
101.89
-1.81%
4.39
三明市第一医院 7332.45
8.46%
2435.63
-10.19% 1976.02
15.59%
8322
-8.09%
138.63
118.33
6.03%
5.40
三明市第二医院 2703.36
-0.18%
911.07
-29.28%
832.53
23.30%
7797
-17.71% 126.04
100.80
-5.81%
495.86
-36.57%
506.15
17.03%
7463
-6.83%
111.26
97.44
-22.46%
4.57
-30.93% 102.24
-59.27%
135.11
3.64%
4736
-24.43% 123.67
97.84
4.58%
3.22
合计
三明市中西医
结合医院
1592.59
三明市第五医院 322.08
-20.82% 4.99
梅列区医院
95.28
12.50%
19.12
-34.93%
24.25
13.66%
3083
-26.82%
90.22
79.02
-52.92% 2.99
永安市立医院
1090.40
-1.63%
360.77
-37.19%
384.60
32.00%
6153
-10.96% 130.82
79.72
-10.74% 3.97
大田县医院
307.90
-25.98% 106.33
-58.66%
83.53
34.39%
5115
6.48%
135.80
100.15
8.37%
三明医改实现了药品收入、总费用、次均费用同时下降
医改主要措施：1. 医生实行年薪制 2. 按照核定任务发放工资 3. 公示
制度等
5.92
Future Directions
•
•
China Dream
Healthy China
•Improve people's health
and happiness
• 12th five-year plan
•HiAP
Future Directions
Integrated Health with Social and
Economic Development
 Health care not Disease care system


With information technology, big
data
• Unified information platform
• Overall process
• Universal population
Future Directions

Great opportunity for information tech
applications



Unified information platform
Integrated public hospital system
Restructure payment system and incentive
system
Health information system in China



A national public health information system
• Direct reporting system of infectious disease
and public health emergency
A regional community health network
• Beijing Dongcheng District Community health
network
An integrated Health Information System
• Shanghai Min Hang District’s Integrated Health
Information System
The administration center
In-time management
Comprehensive health record
Health Management
GPs
Households

Lifetime Seamless Health Maintenance
System
physical examination
Health promotion
maternity
Long-term care
immunization
Birth
palliative
Lifetime
care
Death
Healthy World
Thank You!
H
Thank You!