ArticleThe key incentive for China's health care system is to protect people's health, not make money
----Li Ling, professor of economics at Peking University
Chinese Premier Wen Jiabao reiterated the medical reform plan in his government report during this year’s NPC opening ceremony. The plan includes an 850 billion Yuan to be budgeted by 2010 to provide universal coverage of basic health care to the country’s total population. The Sate Council passed this long-awaited plan in January 2009. Details of the plan are scheduled for official release after the conclusion of the Two Sessions. How long it will take to implement the new health care plan? How much will the long-waited reform change?
Guest profile
Professor Li Ling is Deputy Director of the China Center for Economics Research at Peking University. She serves as a senior advisor for China’s Ministry of Health and consultant for Health Care Reform, World Bank. She drafted the Peking University health reform proposal among the 10 government solicited from universities and industry players. She is a strong advocate for the government- led health care model.
New healthcare reform proposal
A: A part of the program is to spend, I believe, 800 billion over the next 3 years on 5 specific priorities. Can you talk to us a little bit about those priorities?
L: Health care system, it’s consisted of the financing system, the deliver system and the management and regulation system. So these 5 parts, actually it’s part of the systems. So for example, the first part is the insurance, that’s the finance system. So the government targeted at the next 3 years. They will cover, are expected to cover up to 80% of the population, for both urban and rural population. And the second part is community based health service system that would ensure people can get the basic medical health care. The third part is the equal access to the public health service; the government will invest more to ensure the people can get the public health service. And also for the equal access, both for the rural population and urban population, this is quite a breakthrough, because in China, we never have this kind of target. The government is targeted at next year, will be 50 Yuan per capita for public health.
A: Is that the largest portion of the money going to one area?
L: No, I don’t think this will be the largest portion. We don’t have the detailed plan; we don’t know how they divide this 850 billion Yuan. The forth part is called the basic drug system, or essential drug system. It is to make sure people can get the needed and reliable drug. The fifth one is the pilot reform of the public hospital. Next the key part of the deliver system.
A: Talk to me a little bit about what you think would be the most important area that money should be spent on.
L: Public hospital. Public hospital is the key area in the whole health care system, because in China, public hospital played a leading role in the deliver system, and also we know, in the health care sector, finance and insurance is only paid money. You need people to provide service for you, if the provider has the wrong incentive, people cannot get the service they need.
A: How do you go about providing the right incentive for the providers?
L: For the provider, they should have the same interest as the patient to use the minimum cost to get the best satisfaction for the patients. But right now, obviously, in our system, the incentive is distorted. So people complain, it’s hard to see the doctor, the cost is very expensive to see the doctor. Because currently, our public hospital, they need make money to keep running. So back to your question, to make the right incentive, the doctor should get what they have to be paid decent salary, a nice job, a nice social status. Then they should use the minimum cost to provide service to ensure people’s health.
A: Why has it gone this long without health care being more of an important focus?
L: At each development stage, the target and goal is different. In the past 30 years, obviously, our priority is economic development. So I didn’t think the government put the health at the top priority. The government funding is decreasing, especially the local government. The merit for their job performance is the GDP growth rate. So they really didn’t pay attention to the health sector.
A: Well some economist would argue you can’t have economic growth without health care growth, what do you think?
L: Actually health is the key input for the economic growth; also it’s the key output, because all the environment, the final purpose is people’s happiness. Without health, you don’t have happy life. I think now the government realizes this. I think 2003 SARS is a turning point for China’s health care.