Healthcare System in Rural China - Challenges and Opportunities - - PowerPoint PPT Presentation

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Healthcare System in Rural China - Challenges and Opportunities - - PowerPoint PPT Presentation

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Healthcare System in Rural China - Challenges and Opportunities Hongman Wang, MD. Ph.D. Associate Professor Peking University cde@pku.edu.cn Healthcare System in China Overview Rural versus Urban area: a few comparisons and contrasts

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Healthcare System in Rural China

  • Challenges and Opportunities

Hongman Wang, MD. Ph.D. Associate Professor Peking University cde@pku.edu.cn

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Hongman Wang, MD. Ph.D cde@pku.edu.cn 2

Healthcare System in China Overview

  • Rural versus Urban area: a few comparisons and

contrasts

  • A Brief Historical Review of Rural Healthcare System
  • Case Study: a survey of 12 towns, 96 villages
  • Challenges and Opportunities
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Hongman Wang, MD. Ph.D cde@pku.edu.cn 3

Comparison of Population and Income

$1,300 10,493 RMB 9.6% Growth Rate ~$400 3,200 RMB 6.2% Growth Rate Net Income Per capita 530 millions ~40% 770 millions ~ 60% Population Urban Rural

2005: income data adjusted for inflation

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Hongman Wang, MD. Ph.D cde@pku.edu.cn 4

Challenges :Allocation

Rural vs Urban

40 40 60 60 80 80 20 20

Health Health resource

resource

allocation allocation % %

Urban Urban Rural Rural

the proportion of the proportion of the population the population % %

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Hongman Wang, MD. Ph.D cde@pku.edu.cn 5

Challenges :Health Expenditure

T

  • ta

l H e a l th E xp e n d i tu re (1 0 m i l l i o n yu a n ) fro m1 9 8 0 to 2 4 .0 1 .0 2 .0 3 .0 4 .0 5 .0 6 .0 7 .0 8 .0 1 9 8 0 1 9 9 0 1 9 9 5 2 0 2 2 2 3 2 4 ye a r 1 0 m i l l i o n y T

  • ta

l H e a l th E xp e n d i tu re

Per C api t a H eal t h Expendi t ur e f r om 1990 t o 2004

  • 0. 0
  • 200. 0
  • 400. 0
  • 600. 0
  • 800. 0
  • 1000. 0
  • 1200. 0
  • 1400. 0

1990 1995 2000 2002 2003 2004 year yuan U r ban R ur al

全国卫生总费用构成

2000 4000 6000 8000 1991 1995 1997 1999 2000 2001 2002 2003 2004

年份 费用 政府预算支出（亿元） 社会卫生支出（亿元） 居民卫生支出（亿元）

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Hongman Wang, MD. Ph.D cde@pku.edu.cn 6

Ratio of Medical Doctors and Assistants Per 1000 persons: Rural vs. National Average

  • 1. 55
  • 1. 36 1. 38
  • 1. 56
  • 1. 48
  • 1. 62
  • 1. 44
  • 1. 68
  • 1. 00
  • 1. 50
  • 1. 05
  • 1. 51
  • 0. 2
  • 0. 4
  • 0. 6
  • 0. 8

1

  • 1. 2
  • 1. 4
  • 1. 6
  • 1. 8

1985 1990 1995 2000 2004 2005 r ur al nat i on

  • 1. 55
  • 1. 38
  • 1. 48
  • 1. 44
  • 1. 05

1

  • 1. 56
  • 1. 62
  • 1. 68
  • 1. 5
  • 1. 51
  • 1. 36
  • 0. 2
  • 0. 4
  • 0. 6
  • 0. 8

1

  • 1. 2
  • 1. 4
  • 1. 6
  • 1. 8

1985 1990 1995 2000 2004 2005

r ur al nat i on

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Hongman Wang, MD. Ph.D cde@pku.edu.cn 7

The History of Cooperative Medical System

合作医疗制度的历史沿革 1930s: Prototype of medical Co-Op in the military bases 1955: Early forms of Cooperative Medical System in Henan Province 1968: Chairman Mao’s Approval of CMS experience 1976: 90% of villages established CMS

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Hongman Wang, MD. Ph.D cde@pku.edu.cn 8

Character of 80s 80年代的特征

Collective Economy: Coalition 集体经济：合 the household contract responsibility system: Departure 家庭联产承包责任制：分

Gradual disintegration of CMS 合作医疗逐步解体 By 1989, only 4.8% villages remained in CMS 到1989年全国仅剩4.8%的村维持合作医疗制度

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Hongman Wang, MD. Ph.D cde@pku.edu.cn 9

In the 90s In the 90s 90 90年代 年代

In 1996, National Conference on exchange of work Experience on Cooperative Medical System was held in Kaifeng, Henan Province.

1996年在河南开封召开“全国合作医疗经验交流会”

On National Health Conference on Oct,9th, 1996, formal President Jiang said “The enhancement of rural health work lies in improving and consummating rural Cooperative Medical System ”

1996年12月9日，召开全国卫生会议,江泽民主席讲“加强农村卫生工作， 关键是发展和完善农村合作医疗制度”

Item 11 of the Decision regarding Reform and Development of medical care of CPC Central Committee and State Council : Cooperative Medical System needs to be actively and steadily developed and improved 中共中央、国务院，<关于卫生改革与发展的决定>第11条：积 极稳妥地发展和完善合作医疗制度

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Hongman Wang, MD. Ph.D cde@pku.edu.cn 10

20 40 60 80 100 58 62 77 92 96 97 98 99 合 作 医 疗 人 口 覆 盖 率 （ % ） 24 10 90 10

Coverage rate of CMS

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Hongman Wang, MD. Ph.D cde@pku.edu.cn 11

New Cooperative Medical Scheme

  • The October 2002 document of the Central

Committee and the State Council, “Decision on Further Strengthening Rural Health Work,” provides the foundation for the Government’s efforts to strengthen rural health services.

  • 2003: New cooperate medical scheme (NCMS)

initiatives on the LG level

  • 2005: 671 counties started NCMS pilot program,

covering 177 millions rural residents

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12

Past Budget Allocation in Rural Health

In past three years:

  • RMB 10.5 billion [$1.31 Billion ](CG & LG) to

establish a disease prevention and control system (after SARS outbreak )

  • RMB16.4 billion [$2.05 Billion](CG & LG) on

setting up medical/public health emergency response system

  • RMB 3 billion [$0.375B](CG) to support health

clinics in towns and townships in the less developed central and western regions

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Hongman Wang, MD. Ph.D cde@pku.edu.cn 13

Budgets and Goals in Premier’s NPC Report

Central government: RMB20 billion[$2.5B] over the next 5 years [the

11th 5-year plan]

  • Renovating hospital buildings in towns and townships and in some

counties

  • Upgrading medical equipment

Timeline: medical cooperative scheme will cover

  • By the end 2006: 40% of counties
  • By the end 2008: 100% of all rural areas

Premium distribution:

  • 2003-2005: CG – RMB 10 LG – 10 Farmer – 10 [total $3.75]
  • Currently:

CG – RMB 20 LG – 20 Farmer-10 [total $6.25] Regular medical tours by urban medical professionals to rural areas

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Hongman Wang, MD. Ph.D cde@pku.edu.cn 14

1990—2004年孕产妇死亡率变化趋势

  • 112. 5
  • 48. 3
  • 53. 0
  • 88. 9
  • 61. 9
  • 26. 1
  • 28. 9
  • 45. 9
  • 39. 2
  • 63. 0
  • 69. 6
  • 76. 0
  • 0. 0
  • 20. 0
  • 40. 0
  • 60. 0
  • 80. 0
  • 100. 0
  • 120. 0

1990 1991 1992 1993 1994 1995 1997 1998 1999 2000 2001 2002 2003 2004 年份

T h e mo r t a l i t y r a t e ‰ ‰ ）

全国 城市 农村

‰

Trend in Mortality Rates Trend in Mortality Rates

1991— 2004年 婴 儿 死 亡 率 变 化 趋 势

58

  • 36. 4
  • 50. 2
  • 21. 5
  • 10. 1
  • 14. 2
  • 17. 3
  • 24. 5
  • 41. 6

10 20 30 40 50 60 70

1 9 9 1 1 9 9 2 1 9 9 3 1 9 9 4 1 9 9 5 1 9 9 7 1 9 9 8 1 9 9 9 2 2 3 2 4

年 份 死 亡 率 ‰

全 国 城 市 农 村

Mortality Rate of pregnancy and Child Birth ( (‰ ‰) ) Infant Mortality Rate ( (‰ ‰) )

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Hongman Wang, MD. Ph.D cde@pku.edu.cn 15

investigation

2001-2004

2005

12 towns 96 villages 890 households

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Hongman Wang, MD. Ph.D cde@pku.edu.cn 16

Subjects & Methods

Subjects: Subjects:

﹡ ﹡multi stage stratified clustering: 12 towns and 96 villages multi stage stratified clustering: 12 towns and 96 villages ﹡ ﹡890 households surveyed 890 households surveyed

  • Research Methodology:

Research Methodology:

﹡ ﹡The subjects were questioned by well The subjects were questioned by well-

  • trained

trained investigators door by door. investigators door by door. ﹡ ﹡The content of the questionnaires The content of the questionnaires ： ：general status , general status , knowledge level, behavior and attitude about NCMS knowledge level, behavior and attitude about NCMS

  • Statistic Methods

Statistic Methods: :

﹡ ﹡We used We used Epidate Epidate 3.2 to enter the data double and used SPSS 3.2 to enter the data double and used SPSS 12.0 to analyze them. 12.0 to analyze them.

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Hongman Wang, MD. Ph.D cde@pku.edu.cn 17

Is it difficult to see doctor?

C har t 3 t he di st ui but i on of seei ng a doct or di f f i cul t l y or not i n 886 f am i l i es 668,

  • 75. 40%

218,

  • 24. 60%

not di f f i cul t di f f i cul t

C har t 4 t he di st r i but i on of seei ng a doct or expensi vel y or not i n 878 f am i l i es 129,

  • 14. 69%

749,

  • 85. 31%

not expensi ve expensi ve

Is it expensive to see doctor?

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Hongman Wang, MD. Ph.D cde@pku.edu.cn 18

Crosstabs analysis of looking for medical care : difficult or expensive in 878 families

877 100 145 100 786 Total 665 95.35 123 72.46 542 Not difficult 212 4.65 6 27.54 206 Difficult Percent No. Percent No. Total Not expensive Expensive

From the above table we can see: Generally speaking , most farmers felt it is not difficult to access for medical care ,but considered it to be expensive.

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Hongman Wang, MD. Ph.D cde@pku.edu.cn 19

Our suggestions

  • Provide bottom-line security for farmers

建立农民生活最低保障线

  • Reduce tax and other financial burdens

给农民减负，休养生息

  • Emphasize disease control and prevention
  • Promote health educational program and

enhance the dissemination of information 加强卫生宣传和健康教育

  • Provide multi-level and variety forms of health

care systems 不同卫生保障制度的不同定位

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Hongman Wang, MD. Ph.D cde@pku.edu.cn 20

concentrate on resolving the lack of adequate and affordable medical services.

Chinese Premier Wen Jiabao declared that China would launch a new community-based healthcare programs to address rural healthcare challenges (NPC, March, 2006). *This year, China will completely rescind the agricultural tax , a tax that China has been collecting for 2,600

  • years. This is a change of historic

significance.

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Hongman Wang, MD. Ph.D cde@pku.edu.cn 21

“OUR LIFE IS MUCH BETTER NOW” “GOOD POLICY IS BENEFICIAL TO US ALL”

  • --FAMRER
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Hongman Wang, MD. Ph.D cde@pku.edu.cn 22

NEW COOPERATIVE MEDICAL SYSTEM

Central government decision made in Oct. 2002 Key is for local government to implement the system Shift of emphasis : Re financial resources from supply side to demand side Importance of accountability and performance analysis

  • f health care providers

Challenges and opportunities

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Hongman Wang, MD. Ph.D cde@pku.edu.cn 23

  • The precision and fairness of actuarial calculation (soundness)

The precision and fairness of actuarial calculation (soundness)

  • Balance between coverage of catastrophic and high

Balance between coverage of catastrophic and high-

  • frequency

frequency events events

  • Tension between coverage scope (how many) vs. depth (how

Tension between coverage scope (how many) vs. depth (how much) much)

  • Design of a benefits package commensurate with available

Design of a benefits package commensurate with available funds funds

  • Adverse selection in New Cooperative Medical System

Adverse selection in New Cooperative Medical System

  • Eligibility for Medical Assistance System

Eligibility for Medical Assistance System

There are also challenges to the NCMS and MA programs with respe There are also challenges to the NCMS and MA programs with respect to ct to administrative administrative and and management management arrangements. arrangements.

In part of the challenges are :

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Hongman Wang, MD. Ph.D cde@pku.edu.cn 24