Health social system in China

Lian TongDoctoral student (D3)

Sep 29, 2010

Lab of International Community Care and Lifespan Development

Health sectors/system

Health care system Provision of health services (hospital, health care center…)

Water and sanitationOccupational health Environment hygieneSocial security ……

Healthsystem

Government Health Organization

National level Ministry of Health

Bureau of Health

Department of HealthProvince level

City level

Duty of the Ministry of HealthMake health related policy and strategyPromote medical reformDeal with important public health problems…

Smoking Milk problems

Iodized saltvaccine

Ministry of Health of China

Ministry of Health

Disease control

Rural area health

Women/children health

Emergence issue

Drug managemen

t

Hospital managemen

tMedical policy

Health care Science and education

International bureau

Medicalsupervision

Sub-management bureaus and offices

Chinese center for disease control and prevention (CDC)

Province and city level

National level

CDC in each province and city

Health care system

Central goal of the health sector is the good health of the whole population

Health Services and Medical Security

National health policies Financial Investment Citizens’ utilization of health services

Health Services and Medical Security in China

(1) Health Service Institutions(2)Medical Service Utilization(3)Preventive Care Services(4)Cost of Provision of Health Services(5)Health Insurance Status

(1) Health Service Institutions

Health indicators of China

The number of doctors per thousand citizens is 1.5 (1.5/1000), close to that of Brazil and Egypt, but lower than USA (2.7), Japan (1.9) and UK (2.0).

The number of registered nurses per thousand people is 1.03 (1.03/1000).

Deficiency of medical resource

Health Service Institutions in city and rural area

Health indicators of China

(2) Medical Service Utilization

The total number of visits to medical institutions in 2003 was 2.096 billion, with an average of 1.62 visits per capita.

The distribution of hospitalization in 2003 was 70.0% in comprehensive hospitals, 0.2% in urban community health centers, 24.3% in township hospitals, 4.6% in women and children’s hospitals, and 0.9% in other hospitals.

Recourse waste! Community health centers don’t play the good role of

“guard”!

Medical Service Utilization

(3) Preventive Care Services

Vaccination rate is about 80%-96%

87.8% of pregnant women had at least one pre-natal examination

The rate of delivery in hospitals was comparatively low - averaging only 68.3%, with 92.6% in urban and 62.0% in rural areas.

A clear difference between urban and rural

areas and between geographic

districts

(4) Cost of Provision of Health Services The average outpatient expenditure per visit in 2003 was RMB 108.2, an equivalent of 0.77% of the per capita salary for urban citizens (RMB 14,040), but 4.2% of that of farmers (RMB 2,622).

Average inpatient expenditure per admission in 2003 was RMB 3,911, amounting to 27.9% of the per capita urban salary and 149.1% of per capita farmer income.

Heavy burden of the cost of health

services for farmers

Over cost/ high price for drug

Cold

A patient is looking at the bill

Price of

drug

Getting bigger and

bigger

Business man

Patient

(5) Health Insurance Status

In 2003, 9.5% of rural residents participated in the New Cooperative Medical Scheme (NCMS) and 11.5% in other forms of medical insurance schemes, leaving 80% without any form of medical security.

In urban areas, 30.4% of residents are covered by the basic medical insurance scheme, 24.8% participate in other insurance schemes, leaving 44.8% of urban citizens without any form of medical security. Need a medical

insurance reform urgently!!!

Rural area

City

Background of china society The unbalance in Social Development How to redistribute resources in China???

East West

Workers FarmersGroup/Class

City Rural area

Economy/Hardware

Social Development/

SoftwareField

•Education• Medicine• Social welfare•Culture……

Geography

2004 What the most important motivations to save money? 1. Provide for the aged 2. Medicine3. Education

2006What the most important motivations to save money?4. House5. Education 6. Medicine

What’s people worry about mostly???

Medical insurance and social welfare

reform in 2005

Hospital System Reform

What shall we do???

Medicine Insurance

system

Social Welfare system (Old-age

Insurance System)

New Medicine Insurance system in China

Medical Insurance for Urban Workers

New Rural Cooperative Medical Care

City Rural area

•Local government finance

•National government finance

•Company, enterprise and so on

Individual income

•National government finance

Individual income

From the insurance window, patients can get their money back proportionally depend on the diseases and their cost.

There are 900 million people over 60 years old in rural areas, and the number increase gradually.

There are 39.3% elders living in poverty in rural areas.

Only 1.5% elders in rural areas have endowment insurance.

4. There are 45.3 % elder in rural areas think that their lives are no guarantee.

Situation of elder population in rural China

New Social Endowment Insurance for elders in rural area (2009~2020) •2009, 10% cities and towns as the sample fields.•2020, covering the whole country.

Over 60 years oldThe family pay

the basic insurance fee

Government Compensation

50% fee for east areas100% fee for west areas

Lowest basic endowment cost

Before reform

After reform

75.4 ％ population no medical insurance in 2003, decreased to 65.7% in 2004……No Compensation for general elders in rural area except for handicapped people or elders without child.

Over 90% population in city and rural area were covered with insurance.

Almost 100% elders can get the life compensation from government per month.

Thank you for your attention