Every Chinese Village To Get Health Clinic

China announced plans Wednesday to build thousands of new hospitals and put a clinic in every village in the next three years, the first steps in a decade-long reform plan to provide universal health care coverage.

Public health care in China has been underfunded for years, and the high cost and poor availability of services are among the biggest complaints of the Chinese public.

China is pumping in 850 billion yuan ($124 billion) to reform the ailing system in the next three years as part of an ambitious - and still only hazily outlined - plan to provide basic medical coverage and insurance to all of China's 1.3 billion people.

"By 2011, we will remarkably improve the accessibility of basic medical care and health care services and alleviate the burden of the general public for medical costs," Vice Health Minister Zhang Mao said at a briefing for reporters.

Health infrastructure in the poor countryside is especially creaky, and a report distributed at the briefing said clinic construction in remote and borders areas would be a key priority.

"Within three years, every village in the country will have a clinic," the report said.

A total of 1.37 million certified health care practitioners will be trained to staff those clinics, it said, alongside about half-a-million more assigned to medical centers at the township and city level. China has nearly 700,000 villages.

The reforms also include plans to build 29,000 new township hospitals, and 2,000 at the county level.

Doctors will also be allowed to work in more than one facility, a change which one public health expert said would dramatically improve the quality of basic health services. Doctors in the public health system are currently constrained to one work unit, like government officials rather than independent professionals.

"Since we do not have good doctors working in the community level because of the policy, people do not stay in the community facilities for primary care," said Gordon G. Liu, chair of the department of health economics and management at Peking University. "This is a fundamental change."

Financial details of the reforms have not been given but Finance Vice Minister Wang Jun, also speaking at Wednesday's briefing, said the central government will pay for 40 percent of the investment while local governments will provide the rest of the funds.

Priority will be given to impoverished central and western parts of China which have fallen behind the prosperous coastal provinces in the east, Wang said.

"The great majority of this amount of investment will be devoted to the primary level public health and medical care services," Wang said. "We will give preference to the central and western parts of China and by doing this we hope to gradually achieve the goal of ensuring equal access for all to basic medical services."

Credited with making huge inroads against infectious diseases and providing basic free care to most citizens, China's soviet-style centralized public health system was largely dismantled in the 1980s amid economic reforms - with little put in its place.

A serious illness can wipe out a family's life savings, while the need to set aside earnings for potential medical costs is considered a major drag on domestic consumption needed to revive the flagging economy.

Though mostly state-owned, public hospitals currently rely on profits from the sale of drugs and expensive treatments and tests to cover their operating expenses. The facilities have been accused of aggressively prescribing expensive and sometimes unnecessary drugs and treatment, creating a heavy burden on patients and a waste of medical resources.

The Health Ministry plans to release a list of essential medicines with controlled prices by the end of the year, raise the salaries of medical workers, and encourage more private investment in health services, said Ma Xiaowei, also vice health minister.

Liu, the expert at Peking University, warned that more government regulation could make joining or staying in the profession less attractive.

"When we move from a planned economy to a market economy, the doctor's time and services should be better appreciated" in political, ethical and economic terms, Liu said.

"In that regard, I don't think we can continue to regulate or price medical doctors' time way below their true value. That will lead to distorted behavior."

Meanwhile, Bill Gates's charitable foundation is teaming with the Chinese government in a $33 million project to test new ways to diagnose drug-resistant tuberculosis, as well as assess new treatments and better ways to track patients.

Gates made the announcement last week in Beijing, where World Health Organization Director-General Margaret Chan warned that emerging, hard-to-treat strains of tuberculosis are set to spiral out of control.


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