Expanding Healthcare in China: A systematic perspective Yanfang Su Harvard University November 5th 1
Goal of HC 2020 Reform and The Plan for Getting There Outline Analytical Framework Brief History Stories from Data: doctors and nurses / 1000 people Healthcare reform: guideline (2020) and implementation plan (2009-2011) 2
An Illustration of Instruments, Intermediate and Final Goals Instruments Intermediate outcomes Final outcomes Quality Health Status Financing Payment Organization Regulation Health education Access Equity in Financing Efficiency Public Satisfaction Financial Risk Protection Cost Source: Hsiao
China Healthcare Reform over the Years SARS New cooperative medical system (NCMS) Drop in public investment in public hospitals 1st round Healthcare system reforms :divided hospitals into non-profit public organizations and commercial hospitals The State Council led a joint working team to draft a new health reform plan NCMS covered more than 804 million rural population Post 1949 1985 1994 1997 1998 2000 2002 2003 2005 2006 2007 Jan 2008 Feb 2008 Oct 2008 Jan 2009 Apr 2009 Barefoot doctors LE: increased from 35 years to 68 years (1949-1978) Urban employee health insurance (UEHI) Criticism of health system reform:"basically unsuccessful" urban resident health insurance (URHI): children and the elderly UEHI covered 180 million Released reform draft for public debate The reform plan was officially released for implementation Basic healthcare Service as Public Goods
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Goal of HC 2020 Reform and The Plan for Getting There Goals -2020 Everyone will have access to basic health services Safe, effective, convenient, and affordable health services for urban and rural residents Goals -2011 Improve accessibility to basic health services Reduce financial burden due to healthcare Solve the problem of Kanbingnan and Kanbinggui (inaccessibility and unaffordability of healthcare) 3-year Implementation Plan (2009-2011) Incremental $125 billion investment 5 Reform Programs to address Kanbingnan and Kanbinggui 2020 Guidelines 2011 5 Systematic Reforms 7
5 Key Areas of Focus in the Next 3 Years 2009-2011 5 Pilot Hospital Reform 1 2 3 4 Insurance system Essential Drug System Healthcare delivery System Public Health System 8
If Implemented Successfully, Healthcare Reform May Have Positive Benefits; Opportunities But Some Uncertainties Remain Broadened Coverage Established essential drug list Increased Access to healthcare based on village clinics, community healthcare centers Enhanced Public Health Services Market of medical care and health expands dramatically due to increased health investment in insurance, primary care, and public health Coverage Encouraging commercial insurance programs to meet various needs Essential drugs Emphasizing importance of innovation in pharmaceutical industry Access Acknowledging value of private sector involvement in developing multi-level health care services Public health Special focus on mental health, hypertension, diabetes, HIV,TB & vaccines 9
Initiatives: Analyzing health-system-related policies (content analysis) Summarizing evidence-based evaluation results Conducing laboratory experiments to evaluate the undergoing healthcare reform in China and other countries Conducting small-scale field experiments with collaboration of the professional teams who works in China and other countries Incubating free-lancers who connecting among academic research, policy making, and mass debating Enhancing academic publication with team work Assisting foreign scholars in conducting field research in China 10
Recommended book: Getting Health Reform Right: A Guide to Improving Performance and Equity Roberts, M., Hsiao, W., Berman, P., and M. Reich Oxford, 2003 Contact information Yanfang Su Email: ysu@hsph.harvard.edu 11