Opinion / Zou Hanru
Health for everyone
By Zou Hanru (China Daily)
Updated: 2005-09-30 06:05
In pluralistic Hong Kong, residents never hesitate to take the government
to task over real or imagined deficiencies in public services. But this
vocal community is rarely heard complaining about the inaccessibility of
healthcare services or exorbitant hospital charges. Even the poorest
group is assured of good health services, thanks to the government's
fundamental philosophy - no one should be denied proper medical care.
Comprehensive Social Security Assistance (CSSA) recipients are exempted
from paying their public healthcare services bills. The government also
has a fee-waiver mechanism for three non-CSSA vulnerable groups - those
with low-incomes, chronically ill patients and senior citizens - to
protect them from undue financial burden.
This patient-first public health approach is in sharp contrast to the
mainland's health system, marked by medical services that are
increasingly being priced beyond the reach of ordinary people, especially
the underprivileged such as rural residents, the urban poor and migrant
workers.
The seething discontent among those that feel hard done by and resent the
profit-driven medical system has led even the Ministry of Health itself
to acknowledge the mainland's medical reform programme has been
"unsuccessful."
Just three decades ago, the World Health Organization hailed China's
public health system as a model for the world. The goal of the health
programme then was to provide medical care for every member of society.
The quality of services may have varied between rural and urban areas but
no one was plagued by the fear of being left unattended.
Today, things are starkly different. It is true that from 1990 to 2000
the average income rose five-fold in urban areas and three-fold in rural
regions. But it is also true that increases in medical costs have far
outpaced those rates - to be precise, they have increased by a factor of
nine.
The poor, low-income earners and even a large percentage of the
middle-class just cannot take care of their ailing or chronically ill
relatives. Rural areas on the whole have very poor environmental and
sanitary conditions - a breeding ground for disease.
Primary healthcare has come to mean low quality healthcare services for
the poor. Profit-hungry hospitals have built barriers that only the
affluent can cross.
Even State-run medical facilities, supposed to provide "safe, reliable
and inexpensive" services, rely on income from patients for further
development. That statement came from none other than Minister of Health
Gao Qiang. He said hospitals motivated by profit, instead of caring for
the sick, were to blame for some of the problems plaguing the country's
health system.
"Patients' medical bills are being used to cover almost everything, from
the cost of medicines and wages and subsidies for doctors and nurses to
new medical apparatus and hospital facilities."
But Gao held out hope, too, when he said the "next step of medical reform
will focus more on public interest and affordability of medical services
for all."
But how will that be done? We can make medical services more affordable
in three ways - by increasing citizens' income, by increasing insurance
cover or by controlling medical costs. The government has been trying on
all three fronts. But success has come more on the income front than on
insurance and cost-control.
Investment in healthcare must not be seen as an unnecessary burden.
Government funding is just as important as cash pumped into roads,
buildings and bridges, or national security and a sound legal system.
A healthy population means a healthy workforce. Only a healthy workforce
will be able to continue to keep up the pace of China's economic
development.
To achieve that goal, the government must not leave healthcare at the
mercy of market forces. It has to provide basic medical services for the
population in areas where the market fails to deliver.
An estimated 50 per cent of the population will be living in cities in 15
years' time. We must urgently begin to plan for meeting the disparate
needs of the rural and urban floating populations.
To build a better health system, we not only need sound policies, but
also a critical mass of well-informed, open-minded and highly-responsible
officials at all levels that will be able to effectively implement the
directives.
For that we need not look further than Hong Kong. It is the best possible
model that will help us provide, as Gao has said, "health for all."
(China Daily 09/30/2005 page4)
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