Cut­ting-edge health­care sys­tem is pos­si­ble

China Daily (USA) - - VIEWS -

China’s in­no­va­tions in health and co­op­er­a­tive health­care decades ago showed the world that it was pos­si­ble to im­prove health­care and greatly in­crease life ex­pectancy for hun­dreds of mil­lions of peo­ple. As a re­sult, more peo­ple in China re­ceived ac­cess to qual­ity af­ford­able health­care. Child and ma­ter­nal mor­tal­ity and rates of in­fec­tious dis­ease plunged, and the health and life ex­pectancy of the Chi­nese peo­ple im­proved re­mark­ably.

In 2009, China em­barked on a new phase of health­care re­form. It made ma­jor in­vest­ments in health in­fra­struc­ture, and health in­sur­ance cov­er­age to­day is close to uni­ver­sal. A na­tional es­sen­tial medicine sys­tem is now in place, and outof-pocket health­care ex­penses for pa­tients have come down by al­most half, from 60 per­cent to 32 per­cent.

De­spite this suc­cess, China now faces new chal­lenges, which mirror those in many high-in­come economies. An es­ti­mated 140 mil­lion Chi­nese are above 65, and their num­ber is pro­jected to grow to 230 mil­lion by 2030. Cancer, di­a­betes, heart dis­eases and other non-com­mu­ni­ca­ble and chronic dis­eases ac­count for more than 80 per­cent of the to­tal 10.3 mil­lion deaths ev­ery year.

Chi­nese cit­i­zens are heav­ily de­pen­dent on hos­pi­tals, which ac­count for more than half of health­care spend­ing, in­stead of pri­mary care cen­ters, which em­ploy just one-third of health pro­fes­sion­als. With higher per­sonal in­comes, peo­ple are also de­mand­ing more and bet­ter health­care. These fac­tors have led to rising health­care costs that are grow­ing while the coun­try’s economic growth rate is slow­ing.

Health­care costs have out­paced GDP growth by 5-10 per­cent­age points over the last decade. The World Bank es­ti­mates that, with busi­ness as usual, health­care spend­ing would in­crease to more than 9 per­cent of GDP in 2035, up from 5.6 per­cent in 2015. The Chi­nese govern­ment has re­al­ized it needs to deepen re­form to meet its peo­ple’s grow­ing health needs and ex­pec­ta­tions at an af­ford­able cost.

A new two-year study re­leased by the World Bank Group, the World Health Or­ga­ni­za­tion, and China’s Min­istry of Fi­nance, Na­tional Health and Fam­ily Plan­ning Com­mis­sion, and Min­istry of Hu­man Re­sources and So­cial Se­cu­rity out­lines a blue­print to de­liver high-qual­ity, af­ford­able health­care for all. The study rec­om­mends that China move to­ward a “peo­ple-cen­tered” in­te­grated health­care sys­tem to meet its new chal­lenges. The re­form would shift the health­care sys­tem from the cur­rent hos­pi­tal-cen­tric model that re­wards vol­ume to one that is fo­cused on out­comes, cen­ters on pri­mary care and of­fers bet­ter value.

Eight key changes to the health­care sys­tem have been rec­om­mended. They in­clude cre­at­ing a new model of peo­ple-cen­tered in­te­grated health­care that strength­ens pri­mary care as the core of the health­care sys­tem, making a ma­jor in­vest­ment in health­care qual­ity across the sys­tem, em­pow­er­ing pa­tients with knowl­edge and un­der­stand­ing of health­care ser­vices to in­crease their trust in the sys­tem and ac­tively en­gage pa­tients in making health­care de­ci­sions, and re­form­ing hos­pi­tals so they fo­cus on com­pli­cated cases and del­e­gate rou­tine care to pri­mary care providers.

The health­care work­ers, es­pe­cially the pri­mary care providers, are seen as key to the re­form’s suc­cess and the rec­om­men­da­tion is for them to be bet­ter paid and sup­ported so that they be­come a com­pe­tent work­force aligned with the new de­liv­ery sys­tem. The study also rec­om­mends that the govern­ment de­fine a pol­icy that pro­vides space for the pri­vate sec­tor in those ar­eas where they can de­liver cost-ef­fec­tive so­lu­tions, with the right reg­u­la­tory en­vi­ron­ment and su­per­vi­sion.

Fi­nally, the re­port fo­cuses on pri­or­i­tiz­ing public in­vest­ments ac­cord­ing to the bur­den of dis­ease, and the kind of care peo­ple need on a daily ba­sis. Im­ple­ment­ing these re­forms could save China as much as 3 per­cent of GDP a year by 2035.

I strongly be­lieve that China will once again lead the way with cut­ting-edge health­care re­form that puts the pa­tient first and im­proves the health and well­be­ing of one in ev­ery six peo­ple in the world. The au­thor is pres­i­dent of the World Bank Group.

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