The chinese health system

Résumé du document

In the early decades of Communist China, the country used to be praised by the World Health Organization as it had set up as an example for developing countries for its great achievements in its health system, notably in rural areas, where it covered the major party of the population. The system was made of three different features: a government-funded health care (gongfei yiliao) for State employees, a labor insurance healthcare (laobao yiliao) for collectively owned enterprises and a cooperative healthcare system (hezuo yiliao) for rural population. This system allowed the majority of the population to be covered and to get access to cheap or free treatments. For instance in 1975, 90% of the urban population was covered as well as 85% of the rural habitants and had access to basic health provisions. We examine China's success in this sector and the various strategies adopted by the country.

Extraits

[...] It is also worth noticing that because of their high mobility, migrant workers are not covered by the health insurance scheme, neither are the dependants of the workers: the specific needs of some categories of the population are not taken into account enough. [8]As a consequence, more and more sick people can not afford healthcare: a sentence from Shaoguang Wang illustrates the dilemma faced by the poor parts of the population: “when they are sick, they do not dare see a doctor; when they are seriously ill, they do not dare enter the hospital; and when they are in the hospital, they rush out before they are well, afraid of being crushed by the heavy financial burden.”[9]. [...]

[...] The traditional urban/rural divide can also be found in respect to the health service. By opposition to the Mao's era where the emphasis had been placed in reaching rural populations by for instance hiring and training “barefoot doctors” to provide them with basic healthcare, the reforms have led to a switch in this emphasis which is now put on cities: this can be reflected in the repartition of hospital beds: while in of them were located in the countryside, in 2001 this ration had fallen to this reverse in the ratio is relevant to illustrate the switch of emphasis in health care. [...]

[...] However, it is worth noticing that the Chinese government is aware of these difficulties and is willing to take steps to counterbalance them-for instance the introduction of the new CMS and the State financing of it is a sign of good-will from the State: Hu promised to build a universal coverage of medical care, especially in rural areas by 2020: some impressive achievements are already to be noted, for instance insurance coverage have increased in the rural area from in 1998 to in 2003 and have reached the impressive ratio of of people covered by the end of June 2007[37]. Furthermore, in the 11th five- year plan, health has been set up as a priority. [...]

[...] So a universal mandatory health insurance system, partially funded by the government can be necessary, including the dependant of the workers[28]. A health insurance system provided by the government would aim at both promoting care access and making financial contributions related to the ability to pay, which would tackle the two main problems faced by the health insurance system nowadays. Some progress are being made in that sense: in the urban areas, the State is trying to expend the Basic Medical Insurance scheme and in the rural areas, it has promised for instance that it will create a New Cooperative Medical Scheme, to which it will provide 10 Yuan per capita, but this system will be founded on a voluntary basis, and in this case, the poorest part of the rural population-so the part needing the most this kind of coverage- may think they can take the risk not to subscribe[29] to this insurance: in a word, a mandatory insurance scheme would be likely to be far more efficient and of course universal. [...]

[...] The WHO underlines that “China has a complex health financing system decentralized to the lowest administrative level”[19] which has allowed provinces to implement different policies: for instance the repartition of contribution to health insurance between government, enterprises and individuals are different in Shenzhen, Hainan Province and Beijing.[20] . More importantly, as the source of health spending is mostly the local government, the richest provinces have the best infrastructures.[21] For instance, Tibet one of the poorest Chinese provinces counts only 1.99 doctors for 1,000 persons as well as 2,43 hospital beds while Beijing, among the richest cities, counts 4.62 doctors for 1,000persons and 6.28 hospital beds. [...]