Article
Comparison of healthcare systems
For years, authorities have taken measures to reduce the medicine costs. In 2007, prices on 726 different drugs were reduced to a total of 10 billion Yuan. But hospitals’fixed operational costs made it hard to further reduce the price of drugs. Some economists raise the concept of market-led health care system, saying encouraging competition can help hospitals cover their costs and keep patients’bill down. However, Li Ling thinks the government-led model would be most beneficial.
A: We’ve talked a lot about problems that are in the system, is it a good idea maybe to have a third party supervising the system, the doctors, the patients, however the thing is, to put it on a daily basis?
L: Look at the worldwide health care model, the health care system that could provide universal coverage, one is social insurance, or government insurance plan like Germany, like Canada, the other one is like the national health service system, like British, they have this kind of system. I think which system China should adopt, maybe we need to look at the current situation. Currently in China the insurance coverage rate is very low, and to have the social insurance, the government insurance, I think the precondition is, we should have urbanization, industrialization, the population will have the formal job should be the majority. Otherwise, currently China, you have 20% or 30% people to cover the total population, it’s impossible. So now, no matter the CMS, the rural insurance, or the residential, city residents insurance, needs government invest a lot. For many, it’s the government buying insurance for them. But in the long run, we should say, this model is unsustainable. The cost is huge. Then the other is look at China currently, we have a huge public hospital, in terms of beds, 95% of public hospital. We have this system, so I always support we need to use our existing condition, to establish a low cost deliver system they we could provide the service to the people at the cost they can afford. That’s a kind of health security.
A: How will they go about doing that?
L: The information system will play a key role. Because the hospital management and oversight, that’s a very difficult job. But right now, given the information system, we could reinstruct the entire system and make different level of hospital connect together. They could, each part do their own job, which level patient goes to where, and also given the entire system’s incentive is to protect people’s health, not make money. So then they will do more job in the prevention. That’s the key thing could provide the health security for the people. Otherwise, when you get sick, you treat them, you know, now the cancer rate in China is quite high, it’s untreatable and unaffordable.
A: Let’s talk a little bit about the differences between the governments led and market-led systems.
L: In the market, we all should say if everybody interacts with the market, the market will have equilibrium. But some people are below that, it’s a lost, some people will lost in the market because they couldn’t afford health care. So the US government pickup the poor and the elder, but we can see that the Medicare program, they have serious problem, because the government has no ability to regulate hospitals. Every hospital uses Medicare medicated program as a money generator.
A: It’s in terms of market-led.
L: Yes, this is market led. In British, the National Health Service system the government has annual budget, they ensure everybody can get health care service; nobody couldn’t get health service because of financial reason. I think in term of social justice and equity, this system is better. Also they could look at resources more efficiently. Like in the British model, they spend more money in prevent care, in the women child care. They are not like the US model, they spend a lot of resources when people over 65, end of the last 10 months, the last 3 months.
A: What about just the shear population in China, is the government led model going to be so much more expensive, maybe the Chinese government can’t handle it in 10 years?
L: No, I don’t think so. It could have this danger, but if we, the worst case is the government pay the money, but the entire system is market organized like the Medicare Medicate in the US, I don’t think the government can control that cost. But like British model, you have the total budget there, we only have this money. And this is easy to control the cost.
Su Qian, a small city in Jiangsu Province, privatized all the city’s 134 public hospitals. After the move, it was believed the hospitals improved services and reduced check-up and medicine costs for patients. However, a research by Liling and her students found patients there did not end up paying less.
L: In China, there are cities tried this but just look at US model and other countries’model, I don’t think privatized hospital could solve China’s problem. It’s always being a complement for the entire deliver system. But I don’t think you know the private hospital will solve the current, the Chinese people cannot afford health care problems, and on the other hand, the private hospital especially in China now, our regulation system is very week, it’s very hard to regulate them. And most of those private hospitals are full-profit hospital, so they need to make money. In the health care sector, we know there are serious asymmetric information problem, if doctors want to make money, it’s very hard to regulate them. So then you’ll push up the health care cost like what in the US faced.
A: You’ve done quite a bit of travelling in the US and abroad, is there any model you would like to see China follow?
L: I think in the US, the VA hospital model is very good for China to follow. This hospital is a public hospital, and actually 10 years ago, they were facing the same dilemma as the Chinese public hospital. Government didn’t put enough funding and the low cost, low efficiency, poor quality, but after the restructure, I think now the hospital, probably it’s one of the best hospitals worldwide.
A: If you could pick and choose different elements of different health care programs, are there anyone anywhere else that you would say we like the way you do this, we like the way the country does this and let’s take from these suggestions.
L: I think the suggestions China now really learn is the entire system is better than the national health system the British one. But in terms of the management, oversight, and regulation, I think the VA hospital is really good, the future hospital model.
A: Let me get you the overall perception of the plan.
L: It’s a quite good plan. In one hand, we provide universal coverage for the Chinese people for health care. On the other hand, we try to explore the new development pattern. Worldwide, you can see US is the most developed country, but the economy growth itself did not automatically generate the health. Our per capita GDP level is quite low, but maybe we use our system advantage, the traditional Chinese medicine is culture advantage. Probably we can find a way to give people health security.
Changing the healthcare culture in China won't be easy. On top of the challenges the government faces implementing the strategies in the middle of an economic crisis. There are long standing perceptions by patients and doctors which need to be changed. Experts say both sides need to realize the opportunities which could lie in utilizing community based health care.