China’s citizens are getting fed up with their hospitals. According to a survey published in December 2008 by ChinaCare Group, a health care consultancy, 49.1% of Shanghai residents are dissatisfied with their preferred local hospital. Reasons included poor wait times, poor patient service, a poor physical environment and a tendency to overcharge for services. Many of these problems are due to structural issues.
"Incentives for doctors sometimes encourage excessively expensive medicines or treatments," said David Dollar, country director for China and Mongolia at the World Bank.
Private hospitals exist and often offer a higher level of care than their public counterparts, but their costs put them beyond the means of many Chinese.
Aware of the poor health of the system, Beijing is trying to raise the overall level of care. The government has committed US$123 billion to getting 90% of the population covered by either the country’s basic medical insurance system in urban areas, or the rural cooperative medical insurance system by 2011.
Everyone covered by the system would receive an annual subsidy of approximately US$17 starting in 2010. The quality and services of hospitals and clinics in second-tier cities and rural areas would also be improved. The eventual goal is to establish a universal level of healthcare across the country, but that will not be easily accomplished.
Beijing’s new plan would sharply increase government spending on health care. According to the Ministry of Finance, US$19.3 billion was spent on healthcare in 2006, leaving individuals to spend an additional US$70.9 billion. The expense of medical treatment has discouraged many people from seeking care in the early stages of illness.
It has not always been this way: China once had a fully funded medical system offering guaranteed coverage. Then, in the 1980s, public funding was cut.
"Out-of-pocket payments increased because the funding was insufficient to cover operating costs," said Dr Sarah Barber, team leader for health policy and system development with the World Health Organization’s China office.
Under its new spending plan, Beijing intends to build a drug catalogue into the health care system, Barber said, to include a list of drugs considered necessary for hospitals to carry. These drugs would be covered by the country’s medical insurance system, reducing out-of-pocket costs for patients and encouraging them to seek treatment earlier.
Barber said the government is also planning to launch a pilot program this year to reform hospital management, supervision and operation. It would improve the quality of services and address hospitals’ incentives to over-prescribe drugs.
Exactly how this will be done is unclear. Beijing has not released a detailed plan and public hospitals contacted for this story would not comment on the new funding.
Unlike previous investments in health care, however, this one involves more than money. The government wants to reform the health care system on a primary level to ensure more effective care for patients.
This will benefit people in rural areas, where the quality of health care services remains relatively low, said Amit Ghosh, a project manager for Synovate Healthcare, a health care consultancy.
Others are more skeptical. David Wood, president and senior partner of ChinaCare wonders if Chinese people will get what they want from the reforms. ChinaCare’s survey stated its respondents’ ideal version of a hospital was one with specialized services, private rooms, patient-focused care and superior customer service, as well as personal physicians.
Wood does think that the government spending is a first step, however. "The money would put a safety net under the population," he said.
That may be little comfort for China’s hospital patients. Accustomed to waiting long hours in hospital waiting rooms, they may have to wait a bit longer for quality care.