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MedicaldeliverysysteminChina

MaincontentHealthcareSystemEvolutioninChinaTheMedicaldeliverysystemChangesinChinaIssuesandChallengesSomethingaboutthehistoryTheChinesesystemofmedicinehasahistoryextendingbacktoearliestdaysoftheChinesecivilization.Fromtheearly20thcentury,formalhealthcareinstitutionsincludinghospitalsandwesternstylemedicalschoolsbegantoflourishandin1928thefirstMinistryofHealth(MOH)wasformed.Theperiodsince1949hasseenrapidimprovementsinhealthstatusandhealthcareresources.FourguidingprinciplesofhealthdevelopmentServetheworkers,peasantsandsoldiers(concentrateonruralareas)PutpreventionfirstEqualimportancetotraditionalChinesemedicineandWesternmedicineMobilizeallsectorsofpeopleforhealthworkByChairmanMao(During1950to1980)TheEconomicReformTheeconomicreformsofthe1980ssignaledthetransitionfromtheplannedeconomytowardtheSocialist-MarketEconomy(SME).Consistentwiththeprogramofeconomicreformandfiscaldecentralization,MOHpolicydirectionfocusedonholdinghospitalsfiscallyaccountabletoboosttheireconomicefficiency.ChangesaftertheEconomicReformNewpolicies(atthebeginningoftheeconomicreform):allowedforthereintroductionofprivatemedicalpractices(1980);thepricingofservicesbasedonrealcost(1985);theimplementationofaservicecontractsystemandtheallowanceofsidelinecommercialactivitiestocompensateforinadequatebudgetaryfinancing(1989).Bythe1990smosturbanhospitalswerereceivinglessthan10percentoftheretotalrevenuefromthegovernmentbudgetaryallocationwhilegenerating60percentoftheirrevenuebysellingpharmaceuticals.HealthSystemEvolutioninChinaSource:HealthPolicyinandforChinaMedicaldeliverysystemNowtheMedicaldeliverysysteminChinacoveringbothurbanandruralresidentshavebeenputinplace.PublichealthservicesystemMedicalcaresystemMedicalsecuritysystemPharmaceuticalsupplysystemPublichealthservicesystemDiseasepreventionandcontrol,healtheducation,maternityandchildcare,mentalhealth,healthemergencyresponse,bloodcollectionandsupply,healthsupervision,familyplanningandsomeotherspecializedpublichealthservices.Amedicalandhealthcaresystembasedoncommunity-levelhealthcarenetworksthatprovidespublichealthservices.Community-levelhealthcareSixfunctionsMedicalcaresystem-Inurbanareas,thethree-tiernetworkwascomposedofstreetclinics,districthospitals,andcityhospitals.CityhospitalsCommunityhealthservicecenterStreetclinicsProfessionalguidanceProfessionalguidanceTwo-wayreferralTwo-wayreferralMedicalcaresystem-Inruralareas,italsohasathree-tiermedicalservicenetwork:ProfessionalguidanceProfessionalguidanceTwo-wayreferralTwo-wayreferralLeadingroleThebaseMedicalsecuritysystemThissystemcomprisesmainlythebasicmedicalsecuritysupportedbymanyformsofsupplementarymedicalinsuranceandcommercialhealthinsurance.Thebasicmedicalsecuritysystemcovers:BasicmedicalinsuranceforworkingurbanresidentsBasicmedicalinsurancefornon-workingurbanresidentsAnewtypeofruralcooperativemedicalscheme（CMS）

Urban-ruralmedicalaidNewCooperativeMedicalSchemeDuringtheearly1990s,therateofincreaseofruralincomessloweddown,whilehealthcareexpenditureincreasedrapidly.Asaresult,medicalcarebecameunaffordableandinaccessibletoruralresidents.MedicalCareUtilizationStatusforRuralResidents

199319982003Two-weeknon-visitrate%33.733.245.8Annualnon-hospitalizationrate%40.634.530.3Healthsecurityrate%15.611.312.6Source:CenterforHealthStatisticsandInformation2004MedicalsecuritysystemSince2003,thelocalareascarriedouttrialimplementationundertheguidanceoftheabove-mentionedpoliciesandregulations.In2011,therateofnewCMSreached97.5%,about0.8billionpeoplejoinedthenewCMS.In2012,thebasicmedicalsecuritywascoveringover95%ofurban-ruralresidentsinChina.PharmaceuticalsupplysystemThepharmaceuticalsupplysystem,whichcoverstheproduction,circulation,pricecontrol,procurement,dispatchinganduseofpharmaceuticals.Therecentworkisfocusedonestablishinganationalsystemforbasicdrugs.China’sEssentialMedicinesPolicyTheChinesegovernmentwasparticipatingintheWHO’sgeneraldrugactionplanasearlyas1979.TheNationalEssentialMedicinesLists(WesternMedicine)had278entriesfrom28categoriesTheNationalEssentialMedicinesListspublishedin2012have520entries.TotalhealthexpendituresinChinaSource:H

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