Successful health-care reform in one county in China

[Prometheus Bound]

Sorry, pay to read, so I included about half of the article.

This is a coal county, so relatively rich, though only the 97th richest in China

1 yuan = .146 US$
1 US$ = 6.8 yuan

Health care reform in a Shaanxi county draws nation's attention
Zhuang Pinghui
May 17, 2010
Tragedy hit farmer Liu Huaishan's family twice last year. In November, his wife's hip ached so badly she could not get out of bed. She was diagnosed with a bone disorder and needed immediate surgery. Later, Liu, who makes a living planting sweet corn in Shibantai village in Shenmu county, Shaanxi, was diagnosed with cancer of the oesophagus.

"My family barely earns 10,000 yuan a year; how could I afford to pay for the operations and the chemotherapy?" Liu said.

Eventually the chief of surgery operated on Liu's wife, and a senior surgeon invited from Xian Jiaotong University's No 1 Hospital came to remove his tumour. He stayed in a nice single room for the chemotherapy, and his sister stayed to help care for him.

For Liu, the best part was that he paid less than 5,000 yuan ($730) for the two operations and his chemotherapy.

<snip>

Under the programme, residents, whether urban or rural, need to pay only 400 yuan ($58) per inpatient procedure, and the rest is covered by a government pool that allows each inpatient to enjoy as much as 300,000 yuan ($43,800) a year in medical care.

Since the average mainlander pays 44 per cent of his or her health care bills, Shenmu's measures sounded like utopia.

With much fanfare, the so-called Shenmu model was made known to the whole country amid heated discussions among academics, doctors and policymakers over how to address the country's problematic, expensive and largely inaccessible health care system.

But opinions are divided on whether Shenmu's programme can be introduced to less affluent areas.

<snip>
"Many other places can afford to do this, too. You can build fewer high-rise buildings and all the other things that make your city look nice but don't have much to do with people's everyday lives."

Guo, 55, said the county had earmarked 150 million yuan to upgrade the health care system but used only 120 million yuan the first year.

"That looks like a lot of money, but if you divided that by Shenmu's population, it's around 300 yuan apiece," he said. "Many counties can afford to do that."

The budget for this year's free medical care is 1.8 billion yuan.

The county has established ties with several hospitals in Xian and six of the country's best hospitals in Beijing, including the China PLA General Hospital and the Peking Union Medical College Hospital.

Patients who seek medical care there and stay in hospital must first pay the entire bill themselves and then seek reimbursement from the pool for expenses beyond the first 3,000 yuan.

And if the patient cannot afford to go to Beijing, the local hospital is allowed to invite specialists to Shenmu, and the bill will be covered by the government so that the family can take care of the patient without having to worry about expenses.

After the first year of the programme, figures showed that about 37,000 patients had benefited, and out of an average inpatient bill of 4,319 yuan, the government pool paid 3,632 yuan, or 84 per cent. Only one patient - a 27-year-old man who had a tumour on his liver removed - reached the 300,000 yuan cap. Four were compensated between 200,000 and 300,000 yuan, and 24 others between 100,000 yuan and 200,000 yuan.

"We basically give all the residents in Shenmu the free medical service that was available only to public servants before," Guo said. "These measures were meant to favour the less privileged. We want to make sure those who are struck down by serious illness and those who have long suffered from illness but are intimidated by the possibility of high bills can also afford to seek medical treatment."

Zhang Bo, the county's deputy health department chief who designed the programme, said a series of measures were required to make sure the public's money was not misused, steps that included imposing a cap on the average inpatient fee and limiting the percentage of drug fees in the total medical bill.

<snip>

And financial power is not the only factor to be considered. Even if a local government can afford to cover most health care costs, this does not mean it would place the programme atop its agenda.

"It's questionable whether all local governments would reach a consensus to spend a lot of money on health care," Wang said. "For example, some governments in the southwest might think dealing with drought is the most urgent issue.

"What's more, you have to consider the attitudes of the people involved and the rational basis of the programmes and whether they can be sustained elsewhere."

Because Shenmu uses public money for its programme, it is also subject to abuse of resources, he said. Studies have shown that misuse of public money occurred often when governments paid all health bills, Wang said.

Requiring the patient to pay 20 per cent of the bill would reduce the risk and make the spending acceptable, he said. "It is not a question of whether you have the capability to do it, but whether you think it's worthwhile to do it."

But Guo said the programme has proved itself. The pool for the second year is 180 million yuan, and although he concedes that there is "no obligation to make the programme workable in other parts of China", for his county there is no turning back.

"I'm sure my successors will make the policy a sustainable one, and our rich coal resources can allow that," he said. "And even if they want to change it, do you think our residents will allow that to happen?"
http://www.scmp.com/portal/site/SCMP/menuitem.2af62ecb329d3d7733492d9253a0a0a0/?vgnextoid=59230d44f71a8210VgnVCM100000360a0a0aRCRD&ss=China&s=News