The Chinese Health System in Transition (Research Series on the Chinese Dream and China’s Development Path)

This book provides an overview of the ongoing transition in China’s health system, especially focusing on the new healthcare reform initiated in 2009. First, it reviews the changes in China’s healthcare system from the 1950s to 2008, establishing the situation when the reform was introduced. The book subsequently analyzes the social and economic context in which the health system is embedded. Since the primary focus is on the new healthcare reform, the book introduces the blueprint and the year-for-year development of the new healthcare reform, as well as the specific reforms in health financing, public hospitals, and primary care. Given its central importance in the health system, the book also described major trends in long-term care in the past several years. In addition, it examines the health policy-making process with a case study of the New Cooperative Medical Scheme of China. Lastly, the book assesses the performance of China’s health system and predicts future developmental trends. Series Preface 6 Acknowledgements 8 Contents 10 Introduction 14 Background to China’s Healthcare System Transformation 16 1 Chinese Society in Transition: Impact on the Healthcare System 17 1.1 Economic and Social Background 17 1.1.1 Diverse Social Infrastructures Against the Backdrop of Globalization 17 1.1.2 Tax Sharing and Fiscal Federalism 18 1.1.3 Harmonious Society and Change of Welfare 21 1.2 Demand for Healthcare Services 25 1.2.1 Population Aging and Growing Dependency on Assisted Living Among the Elderly 25 1.2.2 Chinese People’s State of Health and the Country’s Spectrum of Disease 29 1.3 Conclusion: Impact of Economic and Social Transformation on the Healthcare System 33 References 34 2 China’s Healthcare Policy from 1949 to 2008 35 2.1 Healthcare System in the Period of Planned Economy 35 2.1.1 Healthcare Objectives and Strategy 36 2.1.2 Operation of the Healthcare System 37 2.1.3 Results and Comments 40 2.2 Healthcare System Since the Beginning of Reform and Opening Up 41 2.2.1 Economic and Social Environments and Health Needs 42 2.2.2 Healthcare Development Objectives and Strategy 43 2.2.3 Operation of the Healthcare System 44 2.2.4 Results and Comments 48 2.3 Understanding the Change of China’s Healthcare System from the Period of Planning Economy to that of Market Economy 50 References 51 Healthcare System Transformation amid Market-oriented Reform (1980–2008) 52 3 Choice of Health Insurance: Evolution of China’s Health Insurance System Since the Beginning of Reform and Opening Up 53 3.1 Evolution of Urban Health Insurance System (1980–2003) 54 3.1.1 Background 54 3.1.2 How Urban Health Insurance System Evolved 55 3.2 Evolution of Urban Health Insurance System (1980–2003) 59 3.2.1 Background 59 3.2.2 How Rural Health Insurance Systems Evolve Over Time 61 3.3 Development of Health Insurance Systems in Urban and Rural Areas Since the Beginning of the 21st Century 66 3.3.1 Establishment of the New Rural Cooperative Medical Scheme and Medical Assistance System 66 3.3.2 Health Insurance for Urban Residents 67 3.4 Impacts of Changes in Health Insurance on the Use of Health and Medical Services Since the Beginning of Reform and Opening Up 68 3.4.1 Health Insurance Coverage 69 3.4.2 Utilization of Health and Medical Services Among Different Income Groups 70 References 73 4 Medical Institutions Amid China’s Market-Oriented Reform 74 4.1 Changes in Institutional Environment for Public Medical Institutions as a Result of Economic Reform 74 4.2 Public Hospitals Caught Between Government Planning and Market Competition 75 4.3 Township Clinics Amid Market-Oriented Reform 80 4.3.1 History and Role of Township Clinics 80 4.3.2 State of Township Clinics Amid Economic Transformation 82 4.3.3 Impact of the New Rural Cooperative Medical Scheme on Township Clinics 85 4.4 Conclusions and Discussion 86 References 87 5 Health of Migrants and Health Insurance Policy 89 5.1 Health of Rural Migrants and Medical Services 89 5.1.1 Health of Rural Migrants 89 5.1.2 Medical Treatment for Rural Migrants 91 5.1.3 Maternal and Child Healthcare for Rural Migrants 91 5.2 Health Insurance for Rural Migrants 92 5.2.1 Health Insurance System Available for Rural Migrants 92 5.2.2 Health Insurance Coverage of Rural Migrants and Their Willing to Enroll 96 5.2.3 Obstacles to Expanding Health Insurance Coverage for Migrants and Solutions 97 5.3 Conclusion and Discussion 99 References 101 China’s New Healthcare Reform (2009–) 103 6 Blueprint for the New Healthcare Reform 104 6.1 Beginning of the New Healthcare Reform 104 6.1.1 Objectives and Approaches of the New Healthcare Reform 104 6.1.2 Getting Healthcare Reform Started 106 6.2 Reform of the Health Insurance System 108 6.3 Essential Medicine System and Medicine-Pricing Reforms 112 6.4 Reform of Primary Healthcare Institutions and the “Multi-tiered System of Diagnosis and Treatment” 114 6.5 Public-Hospital Reform 119 6.6 Conclusions 121 Reference 123 7 Initial Results of the New Healthcare Reform and Policy Trends 124 7.1 Healthcare Resources and Services Since the Implementation of the New Healthcare Reform 124 7.1.1 Health Resources and Services 125 7.1.2 Healthcare Expenditure 129 7.2 Initial Results of the New Healthcare Reform 132 7.2.1 Alleviation of the Problem of Increasing Healthcare Costs for Patients 132 7.2.2 The Problem of the Poor Accessibility of Healthcare Services Remains 133 7.3 Policy Trends with the New Healthcare Reform 134 7.3.1 Emphasis on Fundamental Reform: “Tiered System of Diagnosis and Treatment” and “Public-Hospital Reform” Driven by Administrative Fiat 135 7.3.2 Local Pilots that Transcend the Issue of Fragmentation: Consolidation Under the “Tripartite Healthcare Reform” 137 7.3.3 The “Government-Led” Versus “Market-Driven” Debate: “Government-Led” Currently Favored 138 7.4 Conclusions 141 References 142 8 China’s Experience in Funding Long-Term Care: Case Studies of Three Cities 143 8.1 Changes in China’s Eldercare Service Policies 143 8.1.1 Traditional Eldercare Services Policies in China 144 8.1.2 Moving Towards Policies Focusing on Long-Term Care 146 8.1.3 Resources for Eldercare Services in China 147 8.2 Definition of Long-Term Care and Types of Public Funding 150 8.3 The First Funding Approach for Long-Term Care in China: Capacity-Building for Service Providers 151 8.3.1 Start-Up Subsidies 152 8.3.2 Day-to-Day Operation Subsidies and Incentives 153 8.3.3 Public Eldercare Institutions that Are Funded Under the “Separation of Income and Expenditure” Model 154 8.3.4 Summary of Funding for Eldercare Services Providers 155 8.4 The Second Type of Funding Model for Long-Term Care in China: Assistance-Type Funding on the Demand Side 156 8.4.1 Criteria for Recipients of Assistance 156 8.4.2 Assistance Levels 157 8.4.3 A Simple Summary of the Social-Assistance Model of Funding 158 8.5 The Third Type of Funding for Long-Term Care in China: Extending Health Insurance Coverage 159 8.5.1 A Semi-autonomous “Long-Term Care Insurance” Scheme: The Case of Qingdao 159 8.5.2 Including Medical Care in Health Insurance: The Case of Taicang 161 8.5.3 A Summary of the Health Insurance Funding Method 162 8.6 Policy Evaluation of the Aforementioned Three Types of Funding 162 8.6.1 Accessibility of Services Provided 163 8.6.2 Fairness of Services Provided 165 8.6.3 Funding Use Efficiency 166 8.7 Conclusion and Discussion: Towards a Hybrid Model that Is Fairer and More Accessible 167 References 169 Bibliography 169 Front Matter ....Pages i-xiv Front Matter ....Pages 1-1 Chinese Society in Transition: Impact on the Healthcare System (Lijie Fang)....Pages 3-20 China’s Healthcare Policy from 1949 to 2008 (Lijie Fang)....Pages 21-37 Front Matter ....Pages 39-39 Choice of Health Insurance: Evolution of China’s Health Insurance System Since the Beginning of Reform and Opening Up (Lijie Fang)....Pages 41-61 Medical Institutions Amid China’s Market-Oriented Reform (Lijie Fang)....Pages 63-77 Health of Migrants and Health Insurance Policy (Lijie Fang)....Pages 79-92 Front Matter ....Pages 93-93 Blueprint for the New Healthcare Reform (Lijie Fang)....Pages 95-114 Initial Results of the New Healthcare Reform and Policy Trends (Lijie Fang)....Pages 115-133 China’s Experience in Funding Long-Term Care: Case Studies of Three Cities (Lijie Fang)....Pages 135-161