Feasibility

Inequality in the distribution of medical resources is one main reason seeing a doctor has become so difficult. Statistics show 80% of China’s overall medical resources are concentrated in urban areas, 1/3 of which are targeted in the tertiary hospitals. Patients’painstaking effort to see a doctor combined with medical doctors’heavy workload often lead to tense patient-doctor relations.

A: Let’s talk about the patient-doctor relationship, lot of tension between the two of them. Is that something that this plan can help solve?

L: Just looking at Wen Jiabao, our Premiere’s report, I think the second sentence said that they need initiate the doctors’incentives. Let doctors satisfy their jobs. Just as I mentioned, right now we have a lot of misleading about the doctors. They always think doctor is making money and they provide the wrong drug, over-provide the drug to the patients. In this plan, public hospital reform, the pilot program, they first need to give the doctor a decent social status. Their salary should be paid well. Maybe the public should realize that the doctor’s job is different from restaurants’servants. Maybe you pay the money, you go to see doctor, but at end you spend the money and the disease is untreatable. It could happen and always happen in the hospital. The tension between doctors and patient, I don’t think it’s the problem between these two players. The problem is rooted at the whole system.

A: Definitely. It’s kind of funny that you said like waiter and restaurant. Realistically, doctors everyday see hundreds of patients. They work tirelessly long hours and unfortunately they take the brunt of the health care system from a lot of patients.

L: As government spends more money in the health care sector, the patients right now pay around 50% of cost. In the long run, this will be adjusted. Maybe at the end, the patients’cost will be 20% or 30%. They would release the burden and could also release the tension between doctor and patient.

A: Talking a little bit more about the number of doctors and the number of patients per capita, is there a way to increase the number of positions in China so that the way isn’t so long, it’s not so expensive, and like you said, some of the tension goes away?

L: Right now, if you are using per 1000 people’s doctor, per 1000 people’s hospital beds, China is on average of world standard, so in this way, the total resource actually is enough, but now the problem is the structure problem. Because like in Shanghai, patients can freely choose the hospital, so no matter serious diseases or just a flu, a cold, they probably go to the best hospital. And the community has center or clinic, no one wants to go there. So maybe in the future, the new system need to have, make sure people can go to the community center then refer to the upper level hospitals. So we can use our resources, use them more efficiently.

A: What needs to be done to change that?

L: I think one thing is you need to improve the quality of community health care center. Second the insurance policy and the pricing policy could guide people to do that. Third I think the information system can help people to rely on this system, because otherwise, people say, if I go to community center and if I have some problem, maybe they get trouble. But with the information system, I think this problem can be solved.

A: Is there any provisions in this new plan to talking about information a little bit more, to follow a patient, because I know right now, a patient can see 5 different doctors, and unless they are keeping their own records, they’ll get lost in the shuffle.

L: In China, in one side, it’s hard to see doctors, on the other side, for one sickness, they may go to 5 hospitals, even more then that and do all the check-ups. That’s the problem because no one take care, there’s no system has responsibility for their health. So they just do this by themselves. I think this is part of reform’s plan is they will have the national wide electronic health record.

A: How long will it take to implement?

L: Given the capability of Chinese government, if they are determined to do that, it could be quick. After SARS, within 1 year, we established CDC system, that’s the best in the world.

A: That’s fast.

The State Council initiated the first heath care reform proposal in 1997. It’s specifically targeted at the problems of rising medical cost, inefficient and inequitable health resource distribution and the low coverage of the "social health security system". But it was not effectively implemented in practice.

A: I’ve heard some of the economics say there’s concern because of the economic slowdown the way it is, that health care could again get lost in the shuffle.

L: It could be, but maybe it’s also an opportunity, because we all know Chinese people saves a lot, one of the reasons is they don’t have security, they have to save money to ensure the future risk, like health, actually they don’t know how much they should save, they just save every penny they have. If you can provide the health security for the people, they can spend the money, and this could increase domestic demand. So, in other hand, this is the right opportunity for China’s health care reform.