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

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 • A Brief Historical Review of Rural Healthcare System • Case Study: a survey of 12 towns, 96 villages • Challenges and Opportunities Hongman Wang, MD. Ph.D 2 cde@pku.edu.cn

Comparison of Population and Income Rural Urban Population 770 millions 530 millions ~ 60% ~40% Net Income ~$400 $1,300 Per capita 3,200 RMB 10,493 RMB 6.2% 9.6% Growth Rate Growth Rate 2005: income data adjusted for inflation Hongman Wang, MD. Ph.D 3 cde@pku.edu.cn

Challenges :Allocation Rural vs Urban 80 80 Urban Urban 40 40 20 20 60 60 Rural Rural Health resource Health the proportion of the proportion of resource the population % the population % allocation allocation % % Hongman Wang, MD. Ph.D 4 cde@pku.edu.cn

Challenges :Health Expenditure U r ban T o ta l H e a l th n y R ur al E xp e n d i tu re yuan i l l i o 1400. 0 8 0 0 0 .0 0 m 7 0 0 0 .0 1200. 0 6 0 0 0 .0 1000. 0 0 1 5 0 0 0 .0 800. 0 4 0 0 0 .0 600. 0 3 0 0 0 .0 400. 0 2 0 0 0 .0 200. 0 1 0 0 0 .0 0. 0 year 0 .0 ye a r 1 9 8 0 1 9 9 0 1 9 9 5 2 0 0 0 2 0 0 2 2 0 0 3 2 0 0 4 1990 1995 2000 2002 2003 2004 T o ta l H e a l th E xp e n d i tu re (1 0 0 m i l l i o n yu a n ) Per C api t a H eal t h Expendi t ur e f r om 1990 t o 2004 fro m1 9 8 0 to 2 0 0 4 全国卫生总费用构成 8000 费用 6000 4000 2000 0 年份 1991 1995 1997 1999 2000 2001 2002 2003 2004 政府预算支出（亿元） 社会卫生支出（亿元） 居民卫生支出（亿元） Hongman Wang, MD. Ph.D 5 cde@pku.edu.cn

Ratio of Medical Doctors and Assistants Per 1000 persons: Rural vs. National Average 1. 8 1. 68 1. 62 1. 55 1. 56 1. 6 1. 50 1. 51 1. 48 1. 44 1. 36 1. 38 1. 4 1. 2 1. 05 1. 00 1 r ur al 0. 8 nat i on 0. 6 0. 4 0. 2 0 1985 1990 1995 2000 2004 2005 1. 8 1. 62 1. 56 1. 6 1. 68 1. 55 1. 4 1. 51 1. 5 1. 48 1. 44 1. 36 1. 38 1. 2 1 r ur al 1. 05 1 nat i on 0. 8 0. 6 0. 4 0. 2 0 1985 1990 1995 2000 2004 2005 Hongman Wang, MD. Ph.D 6 cde@pku.edu.cn

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

Character of 80s 80 年代的特征 Collective Economy: Coalition the household contract responsibility 集体经济：合 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 Hongman Wang, MD. Ph.D 8 cde@pku.edu.cn

In the 90s 90 年代 In the 90s 90 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 Hongman Wang, MD. Ph.D 9 cde@pku.edu.cn

Coverage rate of CMS 100 90 80 60 40 24 20 10 10 0 58 62 77 92 96 97 98 99 合 作 医 疗 人 口 覆 盖 率 （ % ） Hongman Wang, MD. Ph.D 10 cde@pku.edu.cn

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

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 12

Budgets and Goals in Premier’s NPC Report Central government: RMB20 billion[$2.5B] over the next 5 years [the 11 th 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 Hongman Wang, MD. Ph.D 13 cde@pku.edu.cn

Trend in Mortality Rates Trend in Mortality Rates Mortality Rate of Infant Mortality Rate ( (‰ ‰) ) pregnancy and Child Birth (‰ ‰) ) ( ‰ 1990—2004年孕产妇死亡率变化趋势 1991— 2004年 婴 儿 死 亡 率 变 化 趋 势 ） 120. 0 70 112. 5 ‰ r a t e ‰ 60 100. 0 58 率 ‰ 50 76. 0 41. 6 88. 9 80. 0 mo r t a l i t y 69. 6 50. 2 63. 0 亡 40 死 24. 5 60. 0 30 36. 4 61. 9 53. 0 20 21. 5 48. 3 T h e 40. 0 45. 9 39. 2 10 14. 2 17. 3 28. 9 10. 1 20. 0 0 26. 1 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 0 0 0 2 0 0 3 2 0 0 4 0. 0 年 份 1990 1991 1992 1993 1994 1995 1997 1998 1999 2000 2001 2002 2003 2004 全国 城市 农村 年份 全 国 城 市 农 村 Hongman Wang, MD. Ph.D 14 cde@pku.edu.cn

investigation 2001-2004 2005 12 towns 96 villages 890 households Hongman Wang, MD. Ph.D 15 cde@pku.edu.cn

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

Is it difficult to see doctor? Is it expensive to see doctor? 129, 218, 14. 69% 24. 60% not di f f i cul t di f f i cul t not expensi ve expensi ve 668, 75. 40% 749, 85. 31% C har t 3 t he di st ui but i on of seei ng a C har t 4 t he di st r i but i on of seei ng a doct or doct or di f f i cul t l y or not i n 886 f am i l i es expensi vel y or not i n 878 f am i l i es Hongman Wang, MD. Ph.D 17 cde@pku.edu.cn

Crosstabs analysis of looking for medical care : difficult or expensive in 878 families Expensive Not expensive Total No. Percent No. Percent Difficult 206 27.54 6 4.65 212 Not difficult 542 72.46 123 95.35 665 Total 786 100 145 100 877 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. Hongman Wang, MD. Ph.D 18 cde@pku.edu.cn

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

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