China's new medical reform plan re-emphasises
encouragement of private investment in the medical care industry, though
insiders and experts doubt whether the policies can be thoroughly implemented.
The
State Council on April 18 issued China's 2012 medical system reform programme,
which includes policies for domestic and overseas private investors, such as
introducing qualified private clinics into China's public medical insurance
system, allowing doctors to work in more than one medical institution,
increasing charges for medical services and allowing charitable organisations
and commercial insurance businesses to open hospitals.
Private
clinics' entry into the nation's public medical insurance system helps private
ones expand their business and get reliable income from the nation's public
medical insurance pool.
The
policy is convenient for patients, who can get treatment in their
neighbourhoods, and diverts patients from key hospitals, according to Hong Mi,
vice-director of the National Institute of Hospital Administration, which is
affiliated with the Ministry of Health.
Allowing
doctors to work in more than one hospital will facilitate private medical
institutions to share veteran practitioners with big State-owned hospitals.
A lack
of experienced doctors has been a bottleneck for the development of the private
medical sector, as doctors were limited to working in one place and good
doctors wanted to stay in State-owned facilities that offer prestige and
retirement benefits.
The
policy said State-owned hospitals should give up dependence on drug sales. They
will be allowed to increase charges for diagnosis, operations, hospitalisation
and other services, and will have to sell medicines at their purchase prices.
"That
will make our private hospitals compete with the State-owned ones," said
Yan Yubin, founder and president of Xi'an Jiren Hospital, one of the top three
comprehensive hospitals by fixed assets in Shaanxi province.
Private
hospitals generally charge more for operations and services than State-owned
hospitals in China.
Charity
organisations and commercial insurance companies can use their advantages to
operate medical institutions, said Wang Guochang, director of the Tsinghua
Cambridge Investment Management centre. Charity organisations can do better in
the non-profit sector, and the latter can combine their businesses with
healthcare services.
The new
programme also said the nation will further improve the commercial medical
insurance industry, making it a supplement to the public medical insurance
system, and meet the diversified needs of the public.
"The
policies look rather good, but I worry if these can be well implemented or
not," said Xu Liyan, a medical analyst at Samsung Economic Research
Institute.
At
present, State-owned hospitals are categorised as public institutions, which
enjoy government support in terms of finance and personnel administration. They
are under the supervision of the Ministry of Health and some other government
departments.
Private
institutions are regarded as businesses that must make money to support
themselves. They are supervised by the industry and commerce departments.
"Such
a separate system makes many things confusing," Xu said.
"Introducing
private clinics into the public medical insurance system seems good, but who
will supervise those clinics to guarantee medical insurance funds are used
properly and reasonably?"
Since
last March, as a pilot city, the Beijing medical authorities have allowed
doctors to work at up to three hospitals.
But so
far, few doctors from key State-owned hospitals have chosen such arrangements,
according to Zhou Shenglai, vice-president of the Beijing Anzhen Hospital, one
of the key State-owned hospitals.
"The
doctors are very busy and have no energy or time to work in more than one
place," Zhou said.
Xu said
that there are still no detailed policies on how to coordinate among various
medical institutions on issues related to personnel management, salaries and
professional title recognition.
Concerning
planned medical service charge increases, Hong said that is necessary and
urgent, but the question is, how high?
"The
central government asked local governments to formulate their own policies.
Given the various economic conditions in different parts of China, the gaps
might be very large.
"It
will make cross-region medical care very difficult and unfair to some
patients," Hong said.
Reform
is a must, but it faces many challenges and requires detailed policies,
according to Xu and Wang.
Under
the 12th Five-Year Development Plan (2011-15) for the medical industry,
hospital beds of private medical institutions will make up 20 per cent of the
national total by 2015.
At the
same time, non-profit institutions are expected to provide services for 20 per
cent of patients.
So far,
the hospital beds of private medical institutions only make up 8 per cent of
the total beds, and they treat less than 10 per cent of all patients, said the
Chinese Hospital Association.
Liu Jie
China
Daily
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