Noisy registration offices, long queues, pained and inpatient people... These are all familiar scenes in Chinese hospitals, its market-oriented health institutions seldom caring about public health. Where is the way of China's public health reform?

Market-oriented hospitals do improve medical facilities and are earning more profits from medicine sales, but also seem to put public interest aside. Imagine that a doctor, sitting in front of a patient and asking questions, does not really care about the patient's health, but is contemplating how to sell their medicines and how to make money.

Medicare, as an essential cog in the social security engine, cannot fully depend on individual resources since it is a kind of social welfare. People complain that medical costs are soaring too quickly and the ratio of individual expense is so high as to be unbearable.

Statistics show that about 70 percent of people in China do not have any medical insurance and even those with insurance still shoulder 30 to 40 percent of the financial burden.

China must invest more in public health. In developed countries, governments often allocate about 8 to 10 percent of their GDP into this field, this figure reaching 14 percent in the US. Last year, China's GDP reached 18 trillion yuan (US$ 2.3 trillion), but only 0.036 percent of it, about 650 billion yuan (US$82.6 billion), was invested to improve public health. If China wants to catch up with the developed countries, it should spend 1.5 to 1.8 trillion yuan (US$190.6 to 228.7 billion).

A large population poses huge challenges to the public health system. The crowds always rush into big hospitals, no matter how far they are and whatever the illnesses are. Presumably the bigger hospitals are, the more excellent doctors there will be, and the better treatment they will receive. This flawed concept echoes in people's mind. On the contrary, most small or moderate-sized community hospitals are struggling for their lives. For doctors, the facilities are not ideal; for patients, they doubt whether these hospitals can provide the best treatments.

A vicious circle forms: the fewer people go, the harder small or moderate-sized hospitals' conditions will be, the less investment they will receive from the state, and the more patients will crowd into big ones.

In China doctors can only work in one hospital. Thus a reallocation of resources is being urged. Zhou Zijun, a professor at Peking University's School of Public Health, advised that the management of medical organs should be reformed. First, local governments should encourage key hospitals to set up more secondary or affiliated ones and to enhance cooperation with neighboring community hospitals. Second, doctors should be allowed to work in several hospitals.

The UK model is impossible

In the UK, with its population of 70 million, the government has created a National Health System (NHS). Completely financed by government funding, a patient benefits from full and complete access to the UK's medical facilities.

China cannot establish a national health service as in the UK because of its No.1 population, 1.3 billion, in the world.

However, this should not be used as an excuse for not founding a basic Medicare system as in the US and neglecting weak groups, according to Zhou. Current systemic insurance is targeted at the working public, failing children and the elderly as well as those who need it most. Unwatched and unchecked, the aging problem is becoming ever more serious. The medical costs of senior citizens are spiraling with costs for the over-65, now 400 percent higher than other age groups.

The UK and US models are hard for China to follow, but a basic Medicare system is available. With the Chinese economy's stupendous forward momentum and the aging population peak yet to come, now it is the time for the government to act, said Zhou.

It has been reported recently that the Ministry of Finance has planned to invest 100 billion yuan (US$12.7 billion) more in improving public health. In Zhou's opinion, this is still too tiny to establish a comprehensive system, but he called for the creation of a medical emergency assistance fund to help those patients who cannot bear the heavy expenses.

Medical service is a public and variable service. Different people have different demands and whatever the government does, not everyone will feel satisfied. As a result, said Zhou, the public health reform should be aimed at establishing a basic medical insurance system that also covers students, pre-school children, the unemployed and the elderly in addition to the working population. Hospital access is not a priority for the rich. As everyone is born equal, even the lowest and poorest should be able to receive universal health care as a birthright. China needs this kind of system, said Zhou.
 (China.org.cn by Wang Ke, November 14, 2006)