The Chinese Health Care System - Assignment Example

The Chinese health care system affiliation The Chinese health care system Introduction With reference to the reforms vested in the economy of China, in the 1980s, the Chinese health care system transformed from a communist system where the central government acted as the provider, sponsor, and owner to a system in which the central government had limited roles to play. The mandate to administer and finance the health care division was shifted primarily to the local authorities of various provinces. Consequently, funding the services became reliant on the taxation of the locals hence paving the way for extensive inequities amongst the poor rural provinces and the wealthy coastal provinces. By decreasing the financial support of the public, the health care providers were also allowed and forced to obtain profits on particular types of treatments and the sale of drugs, therefore bringing numerous moral hazard problems, which like in the United States caused a substantial cost inflammation and promoted inequality in accessing the health care services (Giuliano & Droms, 2012). The present health care system is a product of numerous local experiments and health care reforms can be described by a complete structure as shown in the flowchart. The Chinese health care system Essentially, the system plan builds on a separation of the public into three collections referred to as A, B, and C in line with the job functions. The A-collection consists of employees in all levels of research institutions, public health sector, education system, government, the army, public organizations, and Non-governmental like institutions. The Public Health Service Administration Act from the year 1988 governs this A-collection of individuals. The B-collection is comprised of all types of enterprises in the urban regions, and they are governed by the judgments of the state council concerning the structure of an all-inclusive medical care improvement among workers in the urban areas. The C-collection is made up of the rural area population, and any regulation does not cover them. However, a small portion of those individuals in the C-collection is governed by the new rural cooperative health care strategy. These individuals are typically the farmers situated nearby the southeastern part of the seaside area (Hougaard, Østerdal, & Yu, 2011). Furthermore, there lack certified statistics that display the comparative sizes of the three collections. However, according to Hougaard et al., (2011), a rough estimate exists which shows that collection A comprises of 5%, B comprises of 11%, and C comprises of 64% of the entire population. Moreover, we give emphasis to the difference between the A and B-collection due to a number of reasons. First, a separate ministry essentially controls the three collections; the Ministry of Organization and the China National Labor Union control A-collection, the B-collection is governed by the Ministry of Labor and Social Security, and the Ministry of health controls the C-collection. Secondly, on top of the dissimilarity in job role, there are contrasting features in the health benefits received by the industry employees compared to the public sector employees. Thirdly, the real size of the A-collection indicates that they cannot be snubbed as a self-governing body. For A-collection, all their medical care expenses were catered for in accordance with the 1988 rule. Nevertheless, there was an announcement by the government that there will be a measured modification of the conditions of the A-collection to a scheme similar to that of the B-collection. However, these changes have not been effected up to date. The B-collection, which is controlled by the urban comprehensive medical care strategy, is somehow complicated. Essentially, the strategy is planned as an employer-centered insurance scheme entailing both a social pooling and an individual account. It is anticipated that two percent of the individuals gross income is paid to his or her personal account and 6% of the total income of the individual is paid by the enterprise of which 30% is billed to a personal account and 70% is billed to the social pooling (Wang, Rao, Wu, & Liu, 2013). However, the outcome in putting into practice of this scheme differs a lot amongst the rich coastal regions and the rest of the nation as well as amongst enterprises with dissimilar types of ownership. For example, naturally unskilled labors in enterprises that are privately owned are not catered for by this type of scheme despite the fact they are beneath the same rule. This occurs without the sanctions of the local government though the rule seems to be altering it. For the C collection there is no worldwide coverage; however, there are several indigenous initiatives trying to create charitable insurance schemes particularly in the wealthy coastal regions. The primary issue being that individuals are normally too poor to be part of these schemes and those who join, it is due to adverse selection. Three key parties; the individuals, enterprises, and the government provide for the finances of running the Chinese health care system. The charges of the government are a concern to all levels of the government, which are largely catered for by taxation but then also by numerous types of user fees. However, recently, the government has been looking for additional sources of income; for example, the public welfare lottery as well contributes to the financing of Chinese health care services. Moreover, local governments in the rural regions usually make use of several forms of fees when funding their health care services. In China, the proceeds from the tax primarily arise from sales tax, turnover tax, and income tax on enterprises. Enterprises comprise both privately owned, collectively owned, and state-owned enterprises. Straightaway after the restructuring, enterprises that were owned by the state paid their portion of the basic health care system for the B-collection. However, the government lately appears to give emphasis to the sparkling contribution of also the enterprises that are privately owned. Lastly, in the present Chinese health care system, individual payments play a major role. Even though, the individual aid of the public scheme is quite limited; there are a vast extra out-of-pocket cost for the individuals because the public schemes are insufficient to cater for all the essential expenses. The strengths and weaknesses The design of the Chinese health care system presents with a number of strengths that enhance its effectiveness and efficiency. In the Chinese health care system, strategy making is founded on pilot studies. Before the Chinese government develops the strategy on how to affect positively on the health care services, the foundations of the strategy have to be based on studies carried out relating to the issue. Through this, they can be able to handle situations as they come. One should acknowledge that the financial reforms done by the Chinese government for the public health system have had certain positive effects on the Chinese health system. They improved the economic responsibility of the public health organizations; also, they improved the reasons for the public health organizations to increase their productivity in addition to decreasing the government’s financial weight. Furthermore, by the year 2020, the Chinese government is seeking to ensure all individuals have access to affordable health care services. Additionally, Guarantee of basic services, authorization on grass-root governments and formation of groundbreaking mechanisms are also some major strengths of this system (Yip & Mahal, 2008). The people and the government contribution is another stronghold. This is contrary to the past where only the government played all major roles in the healthcare system, and the financial support was not enough. However, in the recent days, Individuals have now joined hand to help the Chinese health care system in partnership with the government and enterprises. This will ensure the majority of services will be covered by the funds coming from these numerous sources. The problem of insufficient financial support is no longer an issue nowadays because of the multiple participants. By going through the main structure of the health care system in China, it is clear that the system is facing a lot of serious upcoming challenges and numerous severe problems. Though the system is continuously trying to familiarize to the needs of the population and progress its performance, there is formal recognition of fundamental issues like inadequate coverage and the absence of expenses control. Some of the main problems include credibility problems, cost inflation, provider efficiency, limited access, pooling level, and coverage. In the pooling level, even when individuals are protected there might still be issues associated with the real pooling level. Naturally, the social and individual accounts are region or city specific. This means that if a certain individual is shielded in one region or city and for instance moves to another he or she does not have the right to protection in that region or city. In Limited access, when observing whom essentially gets the benefits in the system it looks like there exist huge inequalities. In reality, the majority of individuals who are in need of the health care services are left without the option of receiving assistance even if the official system shields them. This is because it usually needs a large additional out-of-pocket cost to receive health care services. In coverage, the present design of health care system excludes the most vulnerable and poorest groups, particularly a great portion of the rural population. Nevertheless, the system seems to alter towards a rural and urban system but with worldwide coverage including individuals outside the employment market- adding a new scheme to the B-collection, which comprises of the unemployed, children, among others. However, to date there are no details about funding it yet. Additionally, the disintegration of the health system effects to high extent the operational time and cost consuming on reaching consensus building within different stakeholders and ministries. Due to the regulation of price and the absence of a well effective referral system, the patient’s fancy going to hospitals that are ranked on the top producing waiting lists that are lengthy whereas at the same time there is unrestricted capacity in hospitals ranked low. This evidently shows a bad use of the existing capability of the system. Additionally, all levels of governments seem to focus their investment on top-ranked health care providers, hence making the issue worse. Because of regulation of price joined with the absence of public funding, the health care providers are allowable to make a profit on particular high technology drugs and treatment. In addition, there are credibility issues where individuals do not trust the grass-root government insurance trust organization and are nervous that their insurance payments may be averted to other usages. Lastly, the government, health professionals, and the patients do still not fulfill the performance of modifying the health system. Key Issues and Reforms proposed In reaction to the rising social pressures, the central government of China stated a chain of health care reforms. The goals are ambitious, first of all the government wants to form a basic worldwide health system that can provide low-cost, convenient, effective, and safe health services to its inhabitants who are more than 1.3 billion (Ramesh & Wu, 2009). The reforms hence affect most aspects of health care delivery, including public health, medications, hospital management, primary care, and health insurance. To finance the reforms, the Chinese government assured to offer $125 billion in incremental costs by 2011. This was a large increase. While the government is concentrating its efforts on making sure every citizen has access to basic medical care, it is also allowing private providers and payers to play a part in delivering of health care, particularly by addressing the extra requirements of higher-income patients. These reforms will enlarge the health services in China. The majority of them will upsurge the health care quality and inspire the delivery of much more cost-effective care (Yip & Hsiao, 2009). Additionally, the country has achieved a great deal of its greatest determined goals, which is to offer health insurance covers for all its citizens. In 2006, only forty-five percent of its whole population had been covered, however, by 2009, 833 million rural inhabitants and 400 million inhabitants had been covered which is approximately 90% of its overall population had health insurance. This was accomplished by China forming two insurance programs for the citizens who had low incomes, which are the Urban Resident Basic Medical Insurance (URBMI) and the New Rural Cooperative Medical System (NRCMS). Also, Chinese citizens working for enterprises that are state-owned or private are eligible for Urban Employee Basic Medical Insurance (UEBMI), the nation’s most comprehensive and established health insurance strategy. However, for most Chinese, health care still is a major expense. Though the percentage and scope of expenses reimbursed appears to be on the rise, particularly for individuals with UEBMI, it still differs (Porter, 2009). Primary care reforms Until lately, there has been a lack of an effective primary care system in China, and therefore individuals seek health care in especially big hospitals in the large cities. This is because, people believe that these facilities offer the best care and China has no gatekeeper scheme, they are normally harshly overcrowded, an issue that has been worsened by the rising demand of health care and the present expansion of health insurance coverage. Therefore, the health care institutions have been considerably overstretched, and the majority of the patients have not been able to gain access to medication (Yip & Mahal, 2008). For that reason, the Chinese government wants to increase health care at the grassroots levels through the establishment of a primary care structure having two constituents: community health centers (CHCs) in the urban areas and small health centers having high standards in the rural areas. The establishment of 7, 000 CHCs was projected to be established by the government in 2011, to accomplish this, the government developed the essential infrastructure and train general practitioners (GPs) to be employed in the CHCs. To make CHCs look better, the Chinese government is spending seriously to advance this facilities. Additionally, the price of drugs that is dispensed in these CHCs has been subsidized, and compensation rates elevated for care provided there. Nevertheless, numerous factors more especially the absence of well-trained GPs, are delaying the efforts of China to move patients to the CHCs (Yip & Hsiao, 2013). Medical training The total number of doctors in China is 2.3 million and a big percentage is trained in western medicine instead of traditional Chinese medicine. Nevertheless, the medical education they get is extremely variable, in many occasions; doctors go through a three-year postsecondary qualifications program: eight year medical training similar to the training that is being offered in numerous western countries is offered in only two universities. Additionally, in China, medical education mainly concentrates on specialists and not GPs. Also, the Chinese medical students, in disparity to their colleagues in numerous western countries, select a field of specialization to a certain extent early, in their second year of their four-year undergraduate program. Upon completion, these new doctors turn into salaried staffs of the clinics or hospitals where they are working. Since departments structure most health care centers and classes, the majority of these doctors act like specialists all through their professions. Therefore, for China to sufficiently staff the CHCs it needs to re-educate not less than 50,000 doctors as competent GPs. Additionally, the medical education system must be changed if it needs enough GPs to put up with a primary care system. This two processes of building CHCs and training GPs has already been started and is been funded heavily by the majority of its richest cities. To support the concept further, the Chinese government is creating training links in the middle of its class III CHCs and the Hospitals. Additionally, specific pharmaceutical companies are now providing additional training to the GPs in the controlling of common enduring diseases (Guo et al., 2010). Gatekeeping Despite the efforts by China, a comprehensive change in patient’s volumes to the CHCs is yet to happen, and, therefore, it is not clear on how swiftly the CHCs might take on a gatekeeper role. Studies show that CHCs have only experienced a 10-15% increase in the number of patients following the changes from class I or II hospitals. More patients were forced to attend CHCs by a small number of cities; though, these exertions have commonly been unsuccessful. For instance, in January 2010, one grass-root government instigated a rule that required patients with enduring diseases to be treated first at the CHCs before they could seek medical attention at the class III hospitals. Nevertheless, this government withdrew the rule indicating that health care services at the CHCs should be enhanced before they can implement their rule. In addition, the implementation of the Essential Drug List (EDL) restricts CHCs to prescribe quite a number of drugs that are expensive. Due to this CHCs cannot be capable of playing a true gatekeeper role for all segments of the patients in the years to come (Hu et al., 2008). Hospital reforms By distant the greatest difficult challenge the Chinese government has put for itself is reforming how it funds its public hospitals, which account for approximately 80% of all hospitals present in the nation and above 90% of all inpatient hospital beds. The public health care providers get financial aid from different sources. Nevertheless, the direct subsidies from the government to them have been so small and the dues they might charge for health costs have been beneath true costs. For instance, even in large hospitals, the consultation fees for most doctors are below $2. This problem has made health care providers to increase drug prices by up to 15%. Though, the public facilities seem to dominate the health sector in China, the private is set to develop in the next five years since the government has lessened its restraints on where medics can work and how payers can repay for medical care. Therefore, the private health care providers might play a significant role in Chinese health care system through placing pressure on the public healthcare providers to increase care quality and competence (Hu et al., 2008). Conclusion Observing the forthcoming trends, the health care system of the Chinese is likely to face a considerable growth in demand. There are however three key explanations for that. Firstly, the current coverage is very restricted, even the most hopeful estimate is that the present system conceals not more than a quarter of the entire population and government intends to alter the system from the one based on work function to a citizen based function. The alteration alone in the number of individuals covered is expected to upsurge future demands. Secondly, the Chinese one child policy has two critical effects that are an elderly population and a forthcoming incapability of the family to watch out for the elderly. Clearly, an elderly population will need more medical care resources just because the old individuals need more medical care. Furthermore, because the burden of the old will upsurge for the family members, the younger members will not be capable of taking care of the old themselves. Thus, they will be required to outsource this task necessitating the specialized services of the private or public nursing homes. Lastly, with the swiftly rising middle class and good financial conditions in common, the mandate for the quality of health as well as quantity is expected to upsurge significantly. With the present issues of the health care system of the Chinese, it is clear that this demand growth cannot be encountered right away by the public medical care system. This results in extensive inflation in the cost and increased pressure on the top-ranked health providers as well as refined pressure for the institution of private providers (Blumenthal & Hsiao, 2005). 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