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Liu Guoen: What has changed in Chinese medical reform?

6/20/2014 Source: China Pharmaceutical Union

The reason why China launched the new medical reform in 2009 is precisely because the medical and health system formed in the past has been unable to meet the development needs of the new era, and three major system disadvantages are particularly prominent:

Chronic disease has gradually become the main risk of the public's disease spectrum, and the old system lacked an effective risk sharing institutional arrangement. As a result, individual families have assumed an excessive economic burden on the disease. This is a problem of "expensive medical treatment"; the supply of services is subject to the top Under the administrative level planning and resource allocation, the "three-level hospitals have inaccessible water, and the primary-level medical treatment can be difficult". The majority of medical staff have been in the public hospitals for a long time. Conflict is the institutional source of the phenomenon of "big prescriptions" and "red envelope rebates."

In response to the above system issues, what did the Chinese-style medical reform do? What benefits have the masses got? What other issues are the masses dissatisfied with? This should be the basis for objective and rational understanding and evaluation of national medical reform. To sum up, there are two key points in Chinese-style medical reform:

First, establish a universal medical insurance system and form a multi-funding mechanism involving enterprises and families under the leadership of government investment. How does it work? From the perspective of medical insurance coverage, since the full implementation of the medical reform program in 2009, more than 95% of the population insured nationwide.

According to the State Council's Home Residents 'Tracking Survey of Urban Residents' Basic Medical Insurance, the insured population not only received increasingly accessible medical value-added services, but also significantly reduced their own expenses. The fundamental purpose of the universal medical insurance system is to make up for the needs of public finances, and the benefit for the insured people is substantial. From the actual data, medical reform is gradually achieving this goal.

Second, to advance the reform of the medical service system, with the aim of improving medical service supply capacity, efficiency and quality, and better meeting medical service demand.

The reform of the medical service system has been advanced simultaneously along two main lines. On the one hand, vigorously explore the reform of the mechanism and system of public hospitals, including the improvement and innovation of the separation of management and operation, compensation mechanisms, multi-point practice, and hierarchical diagnosis and treatment; on the other hand, actively promoting a fair and orderly market opening policy is conducive to the formation of public and private Effective competition and mutual promotion of medical services.

In fact, the total demand of society is nothing more than two parts, basic and non-basic. Therefore, the fundamental relationship between government-run and society-run doctors is complementary. Therefore, the two main lines of medical service system reform are in line with the requirements of its basic goals. Of course, the reform of the service system is far more challenging than the financing reform, and the institutional barriers involved are deeper and deeper. The reform of the medical service system is a long-term task that requires not only wisdom and courage, but also patience and persistence.

China's medical reform has been going on for 5 years, and it remains a hotly debated public policy issue today. Based on different perspectives, people's perceptions, opinions, and judgments of medical reform policies are different, and even very different. They are not unique to China. In fact, which country does not?

However, differences are divided into differences, and things still have to be done. Major issues of people's livelihood, such as medical reform, will be inadequate no matter how they are changed, but the problem is even greater if they are not changed. Practice in the past few years has shown that the general direction of the new medical reform is correct.

Reform is not afraid of problems, and the best way to deal with them is to continue reforms, not to swing left and right, let alone go back. As long as the general direction is correct, it is the best way to achieve the goal of reform by courageously moving forward and continuously improving and improving during the march.

(The author is a professor of economics at the National Development Research Institute of Peking University and a member of the State Council's National Medical Reform Expert Advisory Committee)

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