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China unveils health-care reform guidelines (04/06/09)

BEIJING, April 6 (Xinhua) -- China Monday unveiled a blueprint for health-care over the next decade, kicking off the much-anticipated reform to fix the ailing medical system and to ensure fair and affordable health services for all 1.3 billion citizens.

The Central Committee of the Communist Party of China and the State Council, or China's Cabinet, jointly endorsed and issued the Guidelines on Deepening the Reform of Health-care System after more than two years of intense debate and repeated revision.

By 2020, China will have a basic health-care system that can provide "safe, effective, convenient and affordable" health services to urban and rural residents, according to the tone-setting document.

This will be supplemented by a more detailed implementation plan for the three years until 2011. The plan has yet to be published, but the State Council announced earlier this year an investment plan of 850 billion yuan (124 billion U.S. dollars) for the reform in three years.

The core principle of the reform is to provide basic health care as a "public service" to the people, which requires much more government funding and supervision.

The document said the government role in "formulating policies and plans, raising funds, providing service, and supervising" must be strengthened in order to ensure the fairness and equity of the service.

"This is the first time that basic medical services in China are clearly defined as a public service for all citizens, which is part of essential rights of the people," said Prof. Li Ling, of Peking University.

The reform is aimed at "solving pressing problems that have caused strong complaints from the public," the document said, referring to long-standing criticism that medical services are difficult to access and increasingly unaffordable.

The blueprint highlights the establishment of a basic health-care system to cover all Chinese citizens to be formed on the basis of systems of public health, medical service, medical insurance and medicine supply.

The government will improve the public health network for disease prevention and control, health education, mother and infant health care, mental health and first aid services, according to the blueprint.

Public, non-profit hospitals will continue to be dominant providers of medical services, while more priority will be given to the development of grassroots-level hospitals and clinics in cities and rural areas.

Patients will be encouraged to use more grassroots-level hospitals and clinics, which can provide more accessible and affordable services, while comprehensive hospitals in big cities will be asked to provide more support to small, local hospitals in terms of personnel, expertise and equipment.

The government plans to set up diversified medical insurance systems in order to have urban employees, urban residents who do not work and rural residents covered by some sort of insurance plan.

The ratio of those covered by the basic medical insurance is expected to surpass 90 percent by 2011.

The reform is also aimed at improving the medicine supply system so that public hospitals and clinics are supplied with essential medicines with prices regulated by the government, according to the blueprint.

Other highlights include:

- The government to enhance the management and supervision of the operation of medical institutions, the planning of health service development, and the basic medical insurance system.

- Public hospitals to receive more government funding and be allowed to charge higher fees for treatment. But they will be eventually banned from making profits through subscribing expensive, sometimes unnecessary medicines and treatment, which isa common practice at present.

- Central and local governments to increase investment in the public health sector, grassroots-level clinics, subsidies for public hospitals, and basic medical insurance systems.

- Governments to increasingly regulate the pricing systems of medical services and medicines, with particular control on the price of basic services at non-profit hospitals and essential medicines those hospitals use.

- Supervision of medical institutions, health insurance providers, and pharmaceutical companies and retailers to be strengthened. Governments will also tighten monitoring of drinking water and food safety, and safety in workplace.



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