The problems of China's Health care system

Hamed, Abdula

The problems of China's Health care system

Zusammenfassung

Inhaltsangabe:Abstract:
A couple of dramatic scenes were seen in China and also after getting more information about the problems of the healthcare system of China the decision were created to learn more about the healthcare system of China for being able to present solutions for the general problems. Trough the change in 1978 from communism to the implementation of the economic reforms by Deng Xiaoping the media all around the world is talking about the incredible increasing of China. The changes to liberalized trade principle waged to decreased poverty levels and determine China on the path to economic sharpness. There is no doubt that China ushered in an era of unprecedented receptivity to foreign leverage. But beside the positive effects of the reform it also showed massive change within the once centralized medical system. Even though many efforts of the government some sections of the population are at a disadvantage. The implementation of the economic reforms have been a blessing for the Chinese as well as the improved reforms concerning to the healthcare system. On the other hand through the higher quality of the healthcare system the access is very difficult due rising costs.
In that research it will be schematize the misbehaviour of many farmers concerning to health and disease and it will be shown that the present health care system that is working in the shadow of the centralized state which is managed by the government, is not the efficient way concerning to the rising costs. Furthermore solution and suggestions for improvement which could lead to an improvement in the health care system in China are introduced. Inhaltsverzeichnis:Inhaltsverzeichnis:
Kurzfassung2
Abstract3
Eidesstattliche Erklärung4
Table of content5
List of abbreviations7
Foreword8
1.Introduction9
2.China's healthcare organisation12
2.1THE DEVELOPMENT PHASE OF THE HEALTHCARE SYSTEM12
2.2CHINA'S HEALTHCARE SYSTEM13
2.3THE HEALTH CARE FINANCING SYSTEM OF CHINA16
2.4THE HEALTHCARE INSURANCE OF CHINA18
2.4.1Basic medical insurance for urban workers18
2.4.2Basic medical insurance for urban residents20
2.4.3The rural cooperative medical care system23
2.4.4The survey of University students' free medical care system27
2.4.5Survey of children's medical insurance28
2.4.6Survey of medical services for foreigners30
2.5REFUND OF COSTS THROUGH THE HEALTHCARE INSURANCE33
2.5.1The doctor choice and hospital choice behaviour in China's New Cooperative Medical […]

Leseprobe

Inhaltsverzeichnis

Abdula Hamed

The problems of China's Health care system

ISBN: 978-3-8366-4336-8

Herstellung: Diplomica® Verlag GmbH, Hamburg, 2010

Zugl. Fachhochschule Furtwangen, Furtwangen, Deutschland, Bachelorarbeit, 2009

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Abdula Hamed

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Kurzfassung

Thema der Bachelor-Thesis:

Die Problematiken des Gesundheitssystem Chinas

Verfasser:

Abdula

Hamed

1. Betreuer:

Herr Prof. Dr. med. Dipl.-Ing. (BA) Gerd Haimerl

2. Betreuer:

Herr Prof. Dr.-Ing. Johannes Ebberink

Semester:

Wintersemester

2009/2010

Hinsichtlich vieler dramatischer Szenen im Gesundheitssektor Chinas und nach

intensiver Recherche über die Problematiken des chinesischen Gesundheitssystems

wuchs das Interesse, mehr über die Problematiken der Gesundheitsversorgung in

China zu erfahren, um hierfür Lösungsansätze zu erörtern. Nach der Einführung der

Reform- und Öffnungspolitik von Deng Xiaoping wird auf der ganzen Welt von

Chinas atemberaubendem Aufstieg berichtet. Der Wandel zum liberalisierten Handel

führte zu einem verminderten Armutslevel und festigt China an die spitze der

weltweiten Wirtschaftsmacht. Es ist nicht zu leugnen, dass sich China in einer Ära,

von noch nie da gewesener Empfänglichkeit hinsichtlich ausländischer Einflüsse,

befindet. Neben den Vorteilen die die neue Reform mit sich gebracht hat, sind

innerhalb des ehemaligen zentralisierten Krankensystems schwere Probleme

aufgetreten. Trotz dem intensiven Engagement der Regierung gibt es zahlreiche

Bevölkerungsgruppen die im Gesundheitssystem benachteiligt werden. Nicht nur die

Einführung der Wirtschaftsreform ist für die Chinesen ein Segen, sondern auch die

Verbesserung der Gesundheitsreform hat viel zum höheren Lebensstandard

beigetragen. Anderseits hat der Reformwechsel im Gesundheitssystem Nachteile mit

sich gebracht. Durch die höhere Qualität der medizinischen Versorgung, ist auch der

Zugang aufgrund Preiszuschläge schwerer als je zuvor. In dieser Thesis wird das

Fehlverhalten vieler Bauern hinsichtlich der Gesundheit und Krankheit dargestellt, als

auch die Funktion des zu überteuerten Gesundheitssystems, das im Schatten des

Einheitsstaates von der Regierung geführt wird. Des Weiteren werden Lösungs- und

Verbesserungsvorschläge vorgestellt, die zu einer Verbesserung des

Gesundheitssystems in China führen können.

Abdula Hamed

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Abstract

Title of Bachelor-Thesis:

The problems of China's health care system

Author: Abdula

Hamed

1. Examiner: Herr Prof. Dr. med. Dipl.-Ing. (BA) Gerd Haimerl

2. Examiner:

Herr Prof. Dr.-Ing. Johannes Ebberink

Semester:

Wintersemester

2009/2010

A couple of dramatic scenes were seen in China and also after getting more

information about the problems of the healthcare system of China the decision were

created to learn more about the healthcare system of China for being able to

present solutions for the general problems. Trough the change in 1978 from

communism to the implementation of the economic reforms by Deng Xiaoping the

media all around the world is talking about the incredible increasing of China. The

changes to liberalized trade principle waged to decreased poverty levels and

determine China on the path to economic sharpness. There is no doubt that China

ushered in an era of unprecedented receptivity to foreign leverage. But beside the

positive effects of the reform it also showed massive change within the once

centralized medical system. Even though many efforts of the government some

sections of the population are at a disadvantage. The implementation of the

economic reforms have been a blessing for the Chinese as well as the improved

reforms concerning to the healthcare system. On the other hand through the higher

quality of the healthcare system the access is very difficult due rising costs.

In that research it will be schematize the misbehaviour of many farmers concerning

to health and disease and it will be shown that the present health care system that is

working in the shadow of the centralized state which is managed by the government,

is not the efficient way concerning to the rising costs. Furthermore solution and

suggestions for improvement which could lead to an improvement in the health care

system in China are introduced.

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Table of content

Kurzfassung... 2

Abstract ... 3

Table of content... 5

List of abbreviations ... 7

Foreword ... 8

1 Introduction... 9

2 China's healthcare organisation... 12

2.1 The development phase of the healthcare system ... 12

2.2 China's healthcare system ... 13

2.3 The health care financing system of China... 16

2.4 The healthcare insurance of China ... 18

2.4.1 Basic medical insurance for urban workers... 18

2.4.2 Basic medical insurance for urban residents... 20

2.4.3 The rural cooperative medical care system... 23

2.4.4 The survey of University students' free medical care system ... 27

2.4.5 Survey of children's medical insurance ... 28

2.4.6 Survey of medical services for foreigners... 30

2.5 Refund of costs through the healthcare insurance ... 33

2.5.1 The doctor choice and hospital choice behaviour in China's New Cooperative Medical

System ... 33

2.5.2 Main medical expenses reimbursement problems of the New Rural Cooperative Medical

System ... 35

2.5.3 Subsidies for severe disabilities... 41

2.6 Reasons for non- participation of farmers in the medical care system... 43

3 Reasons for the increasing poverty in the country-side... 45

3.1 Back into poverty due to illness ... 45

3.2 The generally low cultural quality of the rural labour force ... 46

3.3 The rural economic and social environment ... 46

3.4 The relatively poor natural conditions in rural areas ... 48

4 Problems in the supply of drugs ... 49

4.1 Prevention of the circumvention of law ... 50

4.2 Some Regulations of the Drug Control Law... 52

5 Relation between the doctor and patient ... 53

5.1 Medical corruption... 55

6 Problems during the treatment ... 58

6.1 Bail as a delay of the treatment ... 58

6.2 Lack of Medical Knowledge of the farmers towards the pains... 63

6.3 Problems with the diagnosis of illnesses ... 70

6.4 Hygiene problems ... 74

7 Health and illness ... 81

7.1 Understanding under "health and illness" of the World Health Organization... 81

7.2 Understanding under "health and illness" of the farmers... 83

7.3 Misbehaviour of farmers concerning health and illness... 85

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8 "Market failure" in the health services in the absence of the government intervention ... 86

8.1 Alternative models of government intervention... 89

9 Suggestions for the problem of Chinas health care system ... 91

10 Conclusion ... 93

11 References ... 95

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List of abbreviations

Abkürzung Begriff

NRCMS New Rural Cooperative Medical System

WHO World Health Organisation

e.g. For Example

MRI Magnetic Resonance Imaging

CT Computer Tomography

SARS Severe Acute Respiratory Syndrome

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Foreword

At this point I would like to thank the people who have stood to me during the

treatment of my Bachelor thesis aside:

My heartiest thank-you is valid Mr. Prof. Dr. Med. qualified engineer (BA) Gerd

Haimerl who has supported to me with his engagement and his perpetual help and

has supported me over and over again on with worth-woollen to advice. I thank him

for his patience, and the extraordinary coordination in spite of the distance between

Germany and China. I show his zeal and hard work really very much to estimate.

I thank also rather warmly the staff of the University of Soochow in China which have

stood to me any time aside and have supplied me with enough material and

information. My thanks are also directed to Mr. Prof. Dr. Zhu as well as the dean of

the faculty of mechanical engineering Mr. Prof. Dr. Zailiang Chen. They gave me the

chance to write my dissertation on the Soochow University as well as Mr. Prof. Dr.

Yannian as my supervisor has assigned whose auxiliary readiness I estimate very

much. I would also like to thank Mrs. Suzhen Wu from the foreign affairs office who

has formed the stay to me very pleasantly.

By this work I have learnt not only the methodology of a scientific work in China in

cooperation with Germany, but also things which completely took place off this topic -

in particular human warmth which auxiliary readiness of my surroundings have

deeply impressed me, so that I am really stirred to tears, thank you very much!

Soochow, 31.12.2009

Abdula

Hamed

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1 Introduction

Reasons and motive of the work

In the public media the positive developments of China dominate there to the

industrial state, while the shadow sides of this development, among the rest, the

health system are hardly picked out as a central theme.

A row of dramatic scenes and riots in the town and her surroundings, caused by

varied deficits in the health system, was decisive to write about this complicated

subject and their problems. To learn more about the reasons of the deficits in the

health system was the aim. In spite of many efforts of the government some

population groups seem to have been neglected by this system up to now. Many vital

menaces caused by illnesses ask for an urgent solution. This work wants to pick out

as a central theme the failure of the farmers in the area "Health" and "Illness",

discuss the being in way difficulties and indicate possible improvements in the health

service, the area "doctor's patient" as well as structural areas concerning.

Then as a result of the investigation it should also become possible for population

groups as for example for farmers and for financially weaker groups of town-dwellers

to be able to call away adequate achievements from the health department.

On the one hand with personal experiences, observations and views on the other

hand, the contact with Chinese by birth and beginning doctors could be always called

away the topical references that supply a picture of the current state in China. These

experiences and observations should underpin my criticism of the ruling health care

system.

Indicating of various deficits in the health service should serve for a future

improvement of the same.

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Objective and subject areas

a) The organisation of the health service

Illnesses and disasters accompany the humanity since primeval times. Nevertheless,

the kind, recognition and treatment of illnesses have changed by the social

developments recently rapidly. For the judgement of the topical situation of the health

system the work offers a structural and institutional comparison between the town

and their surroundings. The present draughts and facts are observed under various

aspects and are analysed then.

In this work concrete points are worked on for the first time to bring the grounding of

the health system to the reader. On this occasion, it will be explained for the first time

which organisations in the health system exist in that of the town as well as in the

country. Afterwards general basic principles of the health service as well as the

health insurance sector are described.

b) Doctor's-patient's-respect

In modern China becomes traditional above all on Confucius being based, ethics

more and more by profit striving substituted. Today in the past as a holy called

medicine staff ,,white lion (bailang) "is often called.

Here the setting should be examined by patients and doctors concerning the medical

care and phenomena and selective experiences are shown concerning uses of drugs,

emergency treatment as well as the phenomenon of the Hongbao.

C) Health and illness

The reason why many people do not feel their illness as a personal destiny is

because the numerous tragedies which would be to be prevented by better education

and information easily occur. The traditional rituals play an important role which can

be in way by the production of a clinical picture as well as the prevention measures

and with the health care. These ideological images concerning illness and health

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which are delivered by the traditional are described and will be shown through some

case studies.

Method

This work refers to the general big towns of China like Suzhou as well as the

neighbour towns like Shanghai or also Beijing. Furthermore there are various villages

which have been suggested by informants.

Over and over again big discrepancies appear between official and anonymous

statements to the health system. These differences complicate an exact analysis of

the situation.

Concerning the literature it was very difficult to find topical and true information about

the current situation of China's health care system. Hence, the numerous Chinese

references which have been recommended by doctors and medicine students were

selected beside western references.

Finally, briefly usable strategies are discussed for the solution of the problems

appeared on the basis of hypotheses and proposals namely mainly in such a way

that for an other discussion of the future measures can be led to allow with it the

affected population groups an improvement of the situation.

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2 China's healthcare organisation

Through the last years China's healthcare system was developed through several

concepts which were created by the government. In the following chapter the

proceeding of the healthcare system will be described as well as how the different

structures are working in the urban area and in the countryside.

2.1 The development phase of the healthcare system

The development of the entire health care system is divided into three phases. The

first phase includes the years from 1995 until 1999. There was the lowest safety in

the health insurance for the inhabitants in the town. The inhabitants in the

countryside did not even have any kind of health insurance. The second phase was

from 2000 until 2004. In that time they increased the aid fund for disadvantaged

groups like the unemployed population. According to the opinion other farmers the

unemployed population that got the aid fund would have a higher standard of living

then the poor farmers. But in that phase these poor farmers were ignored by the

program of healthcare. After developing the healthcare system till 2005 the poor

farmers were integrated into the third phase of the program in the healthcare system.

The law will determine that the insurance money should be at least 10 Yuan. For all

whom that have children or a lower standard of living, the communal tax office will

pay the above mentioned amount. The status of the healthcare insurance in China

around the countryside is pre much the same. In 2003 the Chinese State Council

decided to prepare some strategies for the current insurance in terms of the

countryside. They were focused on the health care which were introduced in the

fifties for the employee of the government and nationalised companies.

The aim was to upgrade different fields like accident welfare, maternity protection,

disease welfare, pension insurance and social welfare benefits.

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2.2 China's healthcare system

Chinas healthcare system is divided into two different parts for two different areas.

Since decades most of the money which came from the government went to the town

inhabitants while the rural poor got 63 times less. The town inhabitants were working

for companies which were government properties. During the years the inhabitants

were not afraid or even worried about getting unemployed or shortage of money.

Because of staff reduction in the past through insolvent adventure many people could

not pay for health insurance anymore. So the government decided to establish a

healthcare system in which all the people are divided in different groups like

unemployed persons, children, disabled people, students and pupils. These groups

get financial help for treating diseases, births and emergencies. It is undeniable that

town people have an advantage compared with country people. The government

spent in 1978 for about 170 million town inhabitants 5.1 billion Yuan for healthcare

when 790 million country people got entirely 230 million Yuan. In comparison of both

inhabitants there is a relation of 1:22 to the disadvantage of the country people in

1980. In 1984 until today the relation of them has been 1:63 to the disadvantaged of

the country people.

Since many years the country people were in disadvantage concerning to the

healthcare compared with the town people because of none existing of pension

insurance and national aids. But in the meantime fewer and fewer people are able to

afford the increasing treating costs in the hospitals. For the sick country inhabitants

there is no way to pay these expensive fees except taking expensive and illegal

credits from private persons. By this time the reason for the latest generation of

poverty is seen by the illegal way for getting money. Most of them are not able to pay

the mostly huge amount back. In the majority of cases it comes to vicious circle.

Without help it is not possible to get out of that vicious circle.

There is a project in the villages called "five guarantees" for the persons in need of

care. This initiative is especially for sick people, orphan children, childless marriages

and widowed people from the village. All these people get financial help for being

able to defray the basic requirements like nourishments, clothes, fuel as well as an

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education for the children. As time passed after the households have been

strengthened they refused to continue paying the healthcare. Therefore the project

"five guarantees" has been stopped and many sanitary stages were closed. The

trained doctors from the university also refused treating in the countryside because of

their financial poorness. They prefer to work in the cities where they have the

possibility to earn more money. Because of that problem the government allowed the

traditional healers known as "bare-foot doctors" and shaman that had been followed

in the past by the government to continue treating people for improving healthcare in

the countryside. Recently, the government established a new rural farmer's insurance

policy. The village doctors in the country region "bare-foot doctors" do not have only

the old-age insurance, but also financial subsidies from the government.

According to Implementation of the village doctors' pension plan provisions, village

doctors' who enjoy the new farmer's insurance are divided into two grades. Firstly,

village doctors' who reach legal and emeritus age, and own more than 20 years

working experience in the village, shall enjoy the new rural social pension insurance.

The participant's insurance premium, the government subsidy pays 60 %, a total of

12,863 Yuan go entirely to the personal accounts, community health service stations

and village doctors' individuals share 40 %. Secondly, the village doctor who have

more than 30 years medicine experience but not working as a village doctor anymore

(over 50 years old and own the license of village doctors at least 15 years), and did

not enjoy other social basic old-age insurance, can participate in the new farmer's

insurance. Village doctors', who reach legal and emeritus age, only have to pay 8575

Yuan at one time in cooperation with the community health service station. Then the

person in line with the conditions of the first category will get 200 Yuan / month, the

person in line with the conditions of the second category will get 140 Yuan / month.

Village doctors formerly known as bare-foot doctors, they Medicare door-to-door in

the village and protect a large number of the peasants' health. The implementation of

the village doctors' pension plan to some extent solve village doctors' pension

problem, give bare-foot doctors a pair of warm shoes and to make them walk

more convenient and comfortable.

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In 2004 the Chinese secretary of health and human services said that the Chinese

government would be ready to establish an emergency plan in some parts of the

country. Because of the bad health environment the government agreed an

investment about 11.4 Billion Yuan. The major investment points were the

improvement of the treatment system, prevention and checking systems of diseases.

The government has also changed its policies concerning medical device imports.

In 2000 the tariffs on medical equipment import fell from 9.9 % to 4.7 %. The medical

device market increases within two years of almost 60 % within 20032005 in

comparison to 70 % in 19972003.

After the modernization of the hospital the prices for the health care services rose up

although the numbers of hospital have been increased during the last years. In 1980

to 2005 the number of hospitals doubled from 9.800 to 18.700. Because of the

permanent state-of-the-art in city regions the hospital need to import the latest and

expensive medicine technology e.g. MRI and CT scans as well as surgical

equipment. Despite the establishment of the free market economy and the rapid

increase of pure competition the prices for the service soar very fast. The problem is

due to the government that was just focused on the accelerated growth. Beside that

they untended many other areas like the health care system. Over the years the

health care sectors were privatized simultaneous they got the power to increase the

price for services. As a protection against epidemic and pandemic the information

system has been enlarged in many parts of China. Finally the system has been

proved several times against SARS, sea quake and the tsunami in India 2003.

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2.3 The health care financing system of China

Before 1980 three different type of health care financing systems were exist in China.

These are the labour insurance medical care scheme, the public service medical care

scheme, and the cooperative medical care scheme. All other inhabitants those are

not covered by the above mentioned schemes have to pay the medical care by

themselves. During the years the labour insurance scheme covered all employees in

state-owned companies and also the workers in collective-owned companies.

The public service medical care scheme has the authority to pay the medical care

consumption of government employees. In rural areas were about 90 % of the

population covered by the cooperative medical scheme. In 1951, the Chinese State

Council stipulated, that all companies with more than one hundred employees should

establish labour insurance. That insurance signifies that the companies should pay

the expenses of their workers. And the employees dependent entitled health to a 50

% refunding of their medical cure costs. In the beginning they budgeted 5.5 % of the

company's total wages for health care costs. Several years later the government

established a new regulation. So the expenditures increased to 15 % since 1980.

17.8 % of the Chinese population were covered through that insurance.

The public service medical care said in 1952 that the government staffs as well as

students are validly to free medical care. The budgeted expenditure until 1980 was

24 Yuan per person and rose in 1984 to 36 Yuan per person. The total expenditure of

the public service medical care scheme was 680 Million Yuan in 1980 and grows up

to 5420 Million in 1990. In 1990, 26.84 Million inhabitants were covered by the public

service medical scheme. It is proofed, that inhabitants covered by the labour

insurance and public service medical schemes have higher medical care utilization,

longer stay at the hospital and higher medical costs per visit as compared with those

who are not covered at all and paying that out of pocket. The expenditure for the

labour insurance coverage in 1980 has a rate of growth about 9.2 % and the

expenditure for the public service coverage has had a rate of growth about 11.1 %.

The other disadvantage of the public service medical scheme and the labour

insurance is their limited ability to spread risk. Because of the huge management of

these insurances at the enterprise or government institution level the enterprise has a

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limited ability to enrage great financial risks. It is for an example not possible to pay

an expensive bill for an employee with disease or cancer. The cooperative medical

scheme released as a result of agricultural collectivization that began in the mid

1950s. In 1970 the cooperative medical scheme had been established in almost 90

% of Chinese villages and became an important position in financing the peasants in

the country sides. In the end of 1970 the Cooperative Medical Scheme collapsed

because of the combination of financial, political and managerial problems. The other

reasons for the weakness were problems in management of the scheme. The

schemes were published without advice from professionals in health planning and

financial management. Some of the cooperative medical schemes are still available

in some parts of China. The provinces have strengthened the schemes by the rural

enterprises and other welfare funds. The increasing heath expenditure has become a

heavy economic problem. The issues of the medical treatment which are paid by the

government and the enterprises are the main source of income for service providers.

Consequently have neither providers of the medical treatment, nor consumer every

stimulus to control consumption of the medical treatment under this insurance

pattern. This is the real reason, why use was higher, more on an average length of

the stay longer and medical costs per visit and admission than those of patients who

pay from the pocket for the medical treatment. Another disadvantage of the working

pattern of the medical treatment of the assurance and civil service is, to some stretch

themselves, her limited ability from to spread out danger. Because the management

pattern mainly in the enterprise or government equipment level, every enterprise of

the equipment has a limited ability to carry big finance dangers like hospital payment

for a cancer patient, for example.

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2.4 The healthcare insurance of China

In China are four important health insurance schemes. The basic medical insurance

system for urban residents, the basic medical insurance system for urban employees,

the new rural cooperative medical service, the urban and rural medical relief and the

commercial health insurance. All these insurance schemes are integrated into the

medical security system. In contrast the children's medical insurance is inaccessible

in most of China. Children who are living in the country-side do not belong to the

Urban Health Care System. According to Chinese scholar studies, due to the various

levels of economic development in each area, there are roughly three forms of

children's medical insurance in China which will be mentioned in that chapter.

2.4.1 Basic medical insurance for urban workers

This system is a combination of public health service and labour insurance. It is an

important constitution of national social security system, and also an indispensable in

social insurance. The medical insurance has the properties of social security:

mandatory and mutualisation. So the medical insurance system is usually set up

through states legislation which is carried out by forces. Through fund systems, which

are paid by employer and employee, the government can reduce workers' risk from

illness and working injuries by giving tangible aid. The system of medical insurance

for urban workers has 6 frames. The first is to set up a suitable fare collection

integration scheme. The basic medical insurance is co-paid by the employee units

and individuals, reflecting the compulsory features of state social insurance and the

idea of rights and obligations of unity. The medical insurance premiums are paid by

units and the individuals can expand the source of health insurance funds. More

importantly, that system shows distinct responsibility of the unit and staff and

increases their sense of self-protection. In the recent reform, the government pointed

the state standard contribution rate provided for employers and individuals clearly

out: employers' contribution rate was around 6 % of workers' total wages and

employee contribution rate is generally 2 % of wages.

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The second is to establish general fund and individual account. Basic medical

insurance is constituted of social fund, which is planned by the government as a

whole, and personal accounts, which are used by individuals. All the fees paid by

individuals enter into personal accounts, and about 30 % of the money provided by

enterprises enters also into personal accounts. The rest of the money offered by units

is to establish the social fund. The personal account is especially for each individual,

which also can be inherited. The capital and interest are both possessed by the same

individual. The third is to set a definite system of paying money. Co-ordinate funds

and individual accounts determine the scope of their payment. Co-ordinate fund is to

cover hospital (large) medical treatment costs, personal account pays for the

medical expenses of out-patients' treatment. The co-ordinate fund should have strict

standard of minimum payment and the maximum payment. What else is necessary

than setting up an effective way to manage medical service system? The medical

insurance only pays for medical expenses required in the basic medical insurance

pharmacies directory, clinics items and medical service facilities; which implements

fixed-point management to medical institutions and pharmacies which provide basic

medical insurance services; social insurance institutions and the basic medical

insurance service providers (fixed-point medical institutions and on-site pharmacies)

ought to settle account according to the settlement rules.

At the same time, it is indispensable to establish a unified system of community-

based management services. The basic medical insurance carries out at a certain

level of society to operate. In principle, it is co-ordinated at the level of prefecture-

level cities. The social insurance agencies are responsible for the fund collection, use

and management of the unity, and ensure that the Fund is fully collected, rationally

used and timely paid. Finally it is to establish an improved and effective monitoring

mechanism. The government must guarantee that the basic medical insurance fund

implements a special fiscal account management and the social insurance

institutions establish a sound regulatory system. Moreover, in co-ordinating area the

foundation of the basic medical insurance is consequent and the supervision by

society organizations should be strengthened. These elements are essential for a

Abdula Hamed

MEB 7

new basic medical insurance system for urban workers. The general frame-work is a

foundation for a unified national system and facilitates the formulation of reform

programs, but also leave space for specific provisions.

2.4.2 Basic medical insurance for urban residents

In 1998, China started to build the basic medical insurance system for urban workers,

in order to achieve the objectives that build a basic medical security system covering

the entire population of urban and rural. The State Council decided that from 2007,

the basic medical insurance for urban residents would be carried out in certain

districts. In 2007 the government choose two to three conditional cities to start

experiments. The pilot started 2008 and expands until 2009 up to more than 80 %

nationwide. In 2010, the government will push the process in order to gradually cover

all urban residents in the non-practitioners.

The provisions and management of medical insurance for urban residents

The principle of the pilot

Firstly, the experimental work should begin from a low level, according to various

aspects of economic development and affordability, and set up a reasonable level of

funding and security standards, focusing on the medical needs of the serious illness

of urban residents in the non-practitioner and gradually increasing the protection

level. Secondly, this insurance should adhere to the voluntary principle; fully respect

the wishes of the masses. The third is to clear the responsibility of central and local

governments. The central government sets basic principles and major policies, the

local areas develop specific measures for the administration of insured population.

Lastly, we should stick to the principle of co-ordinating and do well in the

convergence among all kinds of medical insurance system in the basic policies,

standards and management measures.

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The scope of the insured

Primary and secondary school students (including vocational high school, secondary

school, and technical school students), children and other non-practitioners of urban

residents who do not belong to the scope of the basic medical insurance system for

urban employees can voluntarily participate in the basic medical insurance for urban

residents.

Contributions and subsidies

The basic medical insurance for urban residents is paid mainly by family,

accompanied with appropriate government grant subsidies. Residents pay for basic

medical insurance in accordance with the provisions of the insured and enjoy the

corresponding medical insurance. Conditional employers may give the families of the

insured grant. State develops tax incentives rules to encourage subsidies for

individuals and units contributions. The annual per capita subsidy is not less than 40

Yuan for insured residents in pilot cities, of which the central government pay for the

central and western regions by 20 Yuan per capita one year through special transfer

payments from 2007 onwards. On this basis, to families of students and children

belonging to the lowest subsistence security system or severe disabled, the

government gives more than 10 Yuan per capita each year for grant subsidies in

principle, of which the central government gives the central and western regions 5

Yuan per capita for grant. To the rest objects, severe disabilities who lose the ability

to work, and low-income families with 60-year or older people, the government grant

more than 60 Yuan per capita a year, of which the central government grants the

central and western regions 30 Yuan per capita .The finance department of the

central government will provide appropriate subsidies for the eastern region referring

to the granting ways of the new rural cooperative medical care system. The concrete

programs for financial assistance will be determined by the financial department,

labour security department, civil affairs department and other departments. At the

same time, grant funds should be included in the budget of all levels of government.

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Payment

Urban residents' basic medical insurance fund focuses on medical expense used by

the insured population of the inpatients and outpatients severe illnesses. Areas

where conditions permit can gradually try integrating out-patients' medical costs.

The basic medical insurance pays medical expenses for urban residents within the

provisions of the fund. Other costs can be provided by supplementary medical

insurance, commercial health insurance, medical assistance and social charitable

donations and other means.

Management of system

In principle, medical service management and organizational management of the

basic medical insurance for urban residents is carried out referred to the relevant

provisions of the basic medical insurance for workers. And the fund of urban

residents' insurance is brought into special accounts of the social security funds for

unified management of fiscal accounts.

Under the leadership of the State Council, the basic medical insurance for urban

residents Inter-Ministerial Joint Conference of the State Council, (referred to as the

inter-ministerial joint conference afterwards) is responsible for the organization,

coordination and macro-guidance of pilot work, study and formulate relevant policies,

supervise and inspect the implementation of the policy, review the assessment

experimental work, co-ordinate to solve problems occurring in pilot process, and to

submit a report and recommendations on major issues to the State Council. And the

Labour and Social Security department will develop relevant policies and measures

in conjunction with development and reform, finance, health, civil affairs, education,

drug supervision and Chinese medicine and some other departments. Departments

coordinate with each other according to their respective duties, to accelerate the

process of all the supporting reforms.

Details

Seiten
Erscheinungsform: Originalausgabe
Erscheinungsjahr: 2009
ISBN (eBook): 9783836643368
DOI: 10.3239/9783836643368
Dateigröße: 617 KB
Sprache: Englisch
Institution / Hochschule: Hochschule Furtwangen – Maschinenbau und Verfahrenstechnik, Medizintechnik
Erscheinungsdatum: 2010 (März)
Note: 1,7
Schlagworte: china gesundheitssystem bauern medikament medizintechnik
Produktsicherheit: Diplom.de

Autor

Abdula Hamed (Autor:in)

The problems of China's Health care system

Zusammenfassung

Leseprobe

Inhaltsverzeichnis

Details

Autor

Abdula Hamed (Autor:in)