There are two obvious characters among the 30 provincial-level healthcare reform plans
Comprehensive Review of China’s Local Healthcare Reform Implementation Plans
ChangCe Thinktank
Summary
As the healthcare reform has been implemented all over the nation, every province, autonomous region, municipality, and parts of central metropolis have published their own healthcare plan, on the basis of the spirit of national healthcare reform plan and healthcare reform implementation plan, and their own practical situation. By mid-June, all of China’s 31 provinces, autonomous regions and central municipalities (excluding Taiwan) published their provincial level healthcare reform implementation plans with the exception of Shanghai.
In light of their different level of economic development and medicine and healthcare development, many provincial-level healthcare reform plans have their own local characteristic. Those healthcare reform plans offer the affluent materials to the further research of the development of China's medicine and healthcare, and the reform of China's medicine and healthcare system, and the future road of the China's medicine and healthcare development. Therefore, it is of tremendous significance to collect the materials of local healthcare reform plans, assort and compare them with each other, and then conclude and summarize them. It is not only a precious historic data, but also the index to assess the mid-term efficiency of the healthcare reform policy and process. According to the five main arrangements to further the reform of medicine and healthcare system in the national healthcare reform plan, which includes (1) promote the system construction of basic medical safeguards; (2) set up the basic system of essential drugs; (3) improve the system of medical and health services; (4) promote the equality of public health service; (5) promote the reform of the public hospital, the report has comprehensively evaluated the 30 provincial-level healthcare reform plans except Shanghai.
There are two obvious characters among the 30 provincial-level healthcare reform plans. One is that they all state in detail the construction of health safeguard system, and simplify other aspects. The other is that many provinces make their plans which are identical with the national healthcare reform plan and implementation plan, lacking the countermeasures and arrangements.
The local healthcare reform plans are closely connected with the national healthcare reform plan and implementation plan. In the field of the framework, promotion, and the construction of the basic healthcare safeguard system, the national healthcare reform plan and implementation plan have already offered a comprehensive, explicit, and legible statement. Under the guideline of national plan, it is predictable that local plans also have detailed statement.
However, many provinces only detailedly regulate the national policy objects on the basis of the construction of the basic healthcare safeguard system, but not explore the specific measures to ensure the realization of the policy objects. It is the common failing in almost all the provincial-level healthcare reform plans. For example, on enlarging the coverage of healthcare insurance, each province keeps accordance with the national objects that the coverage rate should reach 90%, or even beyond. Some provinces raise the rate of urban employee healthcare and urban residence healthcare to 95%, and the rate of new rural cooperative medical care scheme almost achieves to 100%. As for the specific difficulties in each province, there are few measures to deal with them. In addition, many provinces are not willing to detailedly publicize their ability of raising money, only offering a general statement and data in national healthcare reform plan, not the government subsidy and individual payment. What's more, each province should set a minimum level for healthcare safeguard, or the package of healthcare safeguard services to ensure all the insured in the whole province could get the minimum level of the health safeguard, which has been ignored by many regions. And as the key point in healthcare reform and the whole healthcare system reform, healthcare payment reform has not gotten basic experimental plan.
The second feature in local healthcare reform plans is more obvious in other field except healthcare insurance plan, especially in the reform and development in healthcare service system. As for the implementation of essential drug system, the improvement of basic level healthcare institutions, equalization of public healthcare service, the reform of public hospital, the development of private-owned healthcare institutions, the provincial-level plans all copy the principles in the national healthcare reform plan, or repeat the non-effective measures which have been implemented for many years.
As a whole, as for the construction of the essential drugs (EDM) system, the provincial healthcare reform plans almost copy the principles in the national healthcare reform plan, lacking the creative measures to implement them. From all the feedback reflected by the practice, the implementation of the EDM system is very difficult.
As for the improvement of basic healthcare service system, whether it involved the nationalization or the diversity of the community healthcare service, or whether it involved the basic healthcare service compensation system or the construction of first treatment and transfer treatment, the provincial healthcare reform plans all show no essential promotion measures.
As for the public health field, the provincial healthcare reform plans are deficient in two points. One is lacking of the promotion of the equality of public health service. The equality of public health service should not be taken as offering the same health service in the province. Actually, the key point of the quality of public health service rests in realizing the equality of public health service through inclining the public resource to the weak region. Obviously, the present public service offered in all regions is not equal. If the allocation of public healthcare resource keeps on, the present imparity will remain unchanged. Secondly, the provincial-level healthcare reform plans keep silence to the system reform of public health service. Actually, there are many problems in immunity program management system, which prove the strengthening of the system of the public healthcare should not only depend on the increasing investment.
As for the reform of the public hospitals, the provincial healthcare reform plans lack the essential substance. Some provincial plans even fall behind the plans which have launched many years. At the same time, many provinces do not ignore the diversity of health service system. But they do not have the specific plans to promote the private-owned hospital, and do not solve the resistance factors which hedge the social capital flows into the health service field.
It must be admitted that the national healthcare reform plan and national healthcare reform implementation plan include two different thoughts in the reform and development of health service. One is administrational management & control oriented; the other is government purchasing-service oriented. China has massive land and huge diversity in the development of society and economy, especially in the development of public service market and the profusion level of social capital. Therefore, there is the co-existence of the thought of administration and market in the national healthcare reform plan and the national healthcare reform implementation plan, which is normal and necessary. On this basis, the central government hopes every province could actively probe and bring forward them in depth, fine, and minute reform measures, according to their practical situation. As for the two thoughts in health service system, each province could identify their own range. For example, they could explore market reform in developed region; and ensure the public could enjoy the basic health service through administration measures in under-developed region. It is a pity that we could not observe the active force, courage, effort, and space to explore in every provincial-level healthcare reform plan.
