In November the second Global Symposium on health systems research will take place in Beijing. We are very happy to offer you a guest editorial by some colleagues from the China National Health Development Center, based in the Chinese capital. Dezhi Yu, Xuefei Gu and Yunping Wang describe the Chinese health care reform and current progress.
Enjoy your reading.
David Hercot,Kristof Decoster,Josefien Van Olmen, Basile Keugoung &Wim Van Damme
China’s Health care Reform: Towards “Health Care for All”
Dezhi YU, Xuefei GU, Yunping WANG
(China National Health Development Research Center)
China launched a new round of healthcare reform in 2009 with the overall goal to establish a basic healthcare system for all, and provide the people with safe, efficient, convenient and affordable health care services.
In the past three years, substantial efforts have been made and 850 billion RMB has been committed to invest in the following five priority areas: (1) accelerate the establishment of basic health protection; (2) set up a national essential drugs system; (3) improve the grass-roots health services delivery system; (4) gradually equalize public health services; and (5) pilot test public hospital reforms.
Evidence has shown that significant achievements have already been made in the reform of the urban and rural grass-roots health services delivery system, in terms of both facility construction and capacity building. Meanwhile, people’s financial access to essential health services has improved and the economic burden of disease has been reduced with the rapid development of a basic health protection system, composed of the New Rural Cooperative Medical Scheme (NRCMS), the Basic Medical Insurance scheme for Urban Employees (BMIUE), the Basic Medical Scheme for Urban Residents (BMSUR) and the Medical Assistance Scheme (MA) for urban and rural poor households. MA has helped to improve the equity in health services utilization and enhance the reimbursement level for poor households through subsidizing NRCMS premiums, paying costs below the deductible, cross-reimbursing, and providing immediate financial assistance for catastrophic costs.
By the end of 2011, more than 95% of the Chinese citizens were covered by this system. For the NRCMS enrollees, average financing has increased to 250 RMB per capita, while the out-of-pocket rate has dropped to 49.5%. The percentage of rural households residing within 15 minutes of a health facility increased from 75.6% (in 2008) to 80.8% (in 2011). Out- and in- patient health expenditure now increase by less than 7% in public hospitals annually (i.e. less than economic growth). The infant mortality and maternal mortality rates have declined from 14.9‰ to 12.1‰, and 34.2/100,000 to 26.1/100,000 respectively.
Yet, great challenges remain on the road towards “health services for all”. Typical challenges include: (1) compared with the increasing expectations of beneficiaries, the benefit package of the basic medical security system remains rather narrow and the reimbursement level is considered low; also, the insurance is not portable between provinces. The pooling fund should thus get the best out of every penny spent to ensure access to quality health services and prevent the risk of overspending with proper cost-containing measures and a payment system reform, as well as an appropriate policy on cross-government transfer payments. (2) Deepening the comprehensive reform of the grass-roots health facilities in terms of management mechanism, financing mechanism, drug supply system, personnel management and remuneration mechanism, and information system. A GP system also has to be established. (3) Accelerating the public hospital reform by innovating the management and service delivery pattern, establishing a corporate governance structure, changing the financing mechanism and incentives, encouraging the private sector to invest in the public hospital reform, etc.
In the next five years, the Chinese government is expected to make further progress towards a basic healthcare system for all, by improving the allocation of health resources and ensuring equity, to ultimately enhance the health status of the entire population.
World Bank nomination battle
We just missed the news last week – not all of us are on Twitter – and by now all of you probably already know Obama made an interesting choice when he picked the US nominee for the World Bank presidency. But the debate is just starting. It’s perhaps not “the Hunger Games” (yet), but the battle promises to be rough nevertheless. Kim appears to be the frontrunner, at least for now, but as Laurie Garrett rightly says, it will not be a shoe-in. Global health people seem to favour Kim, unlike most economists (with the exception of Jeffrey Sachs). We wonder what the preference will be in the BRICS, Africa and other developing and emerging countries, and we definitely welcome your opinion on this.
We selected a few pieces that struck us this week, but no doubt there are many more.
You can check the profiles and some of the views of the three candidates in the New Yorker (Jim Yong Kim), CGD (Jim Yong Kim and main rival Ngozi Okonjo-Iweala), and the WSJ (José Antonio Ocampo). Some other global health and development commentators wrote pieces on the WB nomination, among others Sarah Boseley, Owen Barder, Julia Robinson, Isobel Coleman, Charles Kenny and Richard Horton.
Let the ‘clash of the titans’ begin!
1. CGD – Healthization of Development
Glassman argues it actually makes sense to give health a somewhat predominant role in development.
2. FT – My call for an open, inclusive World Bank
Before heading for a couple of important capitals, Kim discussed the challenges and opportunities the World Bank faces today in poverty reduction and development assistance for global economic growth in a FT op-ed.
3. Economist – Hats off to Ngozi
As for the noisy opposition, by way of example: the Economist reckons Kim should lead Occupy Wall Street rather than the Bank. Needless to say, the journal strongly supports Okonjo-Iweala. So does Lant Pritchett, who even concocted a five step “game plan” to – in his words – break America’s World Bank hegemony. Wicked.
Humanosphere’s Tom Paulson reckons it’s very unfair to attack Kim for his views on economic growth, as expressed by him in ‘Dying for growth’ (2000). In his FT op-ed, Kim already gave a smart reply to his critics, when he said that economic growth can help alleviate poverty.
No doubt this is just the beginning – we hope to read many more pieces in the coming weeks on this issue, especially from people from the Global South.
BRICS & health
4. BMJ (editorial) – Universal health coverage for India
Ravi Narayan & Thelma Narayan;
UHC is an ethical policy imperative globally, and India is no exception. A high level expert group on UHC was instituted by the Indian Planning Commission in 2010 and it presented its findings and recommendations recently. The challenge now is to get it right, argue Narayan & Narayan: it’s time for action. (but it might be necessary to involve the private sector in this move towards UHC)
Speaking of the private sector in India, Sonia Shah dwells on the danger a form of antibiotic-resistant bacteria presents for the Indian medical sector (in Foreign Affairs) and beyond.
5. GHSi Report – Shifting paradigm: how the BRICS are reshaping global health and development
This Global Health Strategies Initiatives (GHSi) report was released in Delhi, in the run-up to the BRICS summit there. It finds that the BRICS approach foreign assistance differently than traditional donors, largely due to their own domestic experiences, by emphasizing South-South cooperation and technical support that aim to build capacity and self-sufficiency. It also describes important contributions by the BRICS to multilateral health initiatives, and much more. It will be interesting to watch the BRICS’ current and future initiatives and emerging stewardship of global agendas in the near future. (we also wonder who will lead the BRICS bank, when it finally materializes)
A recent IMF paper explores “BRICs’ Philosophies for Development Financing and Their Implications for LICs”.
US Supreme Court & Obama’s health care act
6. Economist – Health-care reform on trial – Full-court press
Obama’s health care law seems in danger. If it’s shooted, chances are he will have a hard time to get re-elected (although we’ve seen another analysis claiming that as long as health care is the central issue, Republicans will lose at the ballot box).
7. Global Health Governance (blog) – The Affordable Care Act and Global Health
Fidler explores what the global health implications could be of the ACA litigation. He thinks the real significance of the ACA controversies for global health is the possibly enormous fiscal impact – if the individual mandate is shot down, “the United States is left with a runaway health-care train and no political consensus or fiscal capability to stop it”. Vital US global health policies will then suffer too.
Health Policy & Financing
8. Global Fund Observer (new issue)
GF boss Jaramillo was interviewed by El Mundo, and there was encouraging news from France and Japan, among others. A new fundraising event is only scheduled for next year, though, it appears. Meanwhile, Chevron was named the first ‘Global Fund Corporate Champion’. (we tend to agree with Laurie Garrett, that the private sector could do a lot more than it does for the moment)
9. Lancet editorial – Tobacco killing in low-income and middle-income countries
The Lancet editorial reports on the pledge by Bloomberg Philantropies, the dire tobacco situation in many LMICs, and the fact that WHO’s MPOWER package of tobacco control policies seems to be working.
10. Lancet (Comment) – Disparities in interventions for child and maternal mortality
Robert L. Goldenberg et al. ;
The Countdown to 2015 movement emphasises the need to address inequities in maternal and child health as a key strategy to improve health and survival (MDGs 4 and 5). Goldenberg et al. comment on a new Lancet study by Barros et al. on child, maternal and neonatal health interventions in 54 countries. They state: “Reductions in within-country disparities in coverage are most likely to be achieved within a functioning health system that uses data to establish goals for both outcomes and coverage, nationally, regionally, and locally”. (More on MDG4 you can find in a few Lancet Letters.)
Still in this week’s Lancet issue, Adele Baleta reports on the start of the testing phase for South Africa’s ambitious National Health Insurance scheme, with pilot projects launching in all provinces.
11. International Journal of Health services – Ecuador’s Silent Health Reform
Pierre De Paepe et al.;
The authors conducted an in-depth review and analysis of published and gray literature on the Ecuadorian health sector from 1990 onward. They found that although neoliberal reform of the health sector was not openly implemented, many of its typical elements are present. President Correa’s progressive government intends to reverse this ‘silent’ neoliberal reform, increasing public budgets for health, but hesitates to introduce needed radical changes.
12. Guardian – Putting the brakes on road injuries is one of development’s greatest tests
With traffic injuries on an upward curve globally, Rio+20 must make traffic safety the centrepiece of a sustainable transport policy.
13. Global Health Check – Debating the World Bank Report on fiscal constraints – a return to the 90s?
A recent World Bank report on the fiscal dimensions of HIV/AIDS in a number of sub-Saharan African countries has stirred significant debate. Here, Brook Baker argues the report is ‘seriously out-of-date’ and ignores important new evidence on treatment-as-prevention. Dr Markus Haacker, co-author of the report, responds. Fascinating exchange of views.
14. CSIS (Report) – The International AIDS Conference Returns to the United States
Katherine E. Bliss;
This new report examines the political history of the international AIDS conferences from 1985 to the present, and draws some lessons for the upcoming conference in Washington.
We would also like to draw your attention to the Equinet newsletter. The latest issue has an interesting editorial stating that making vaccines for pneumonia accessible should be a global good.
15. Science Speaks – Report shows $1.37 billion gap in R&D funding needed to eliminate TB by 2050
Mazzotta explores the second edition of the 2011 Report on TB Research Funding and Trends from 2005 – 2010, released Thursday by Treatment Action Group (TAG) and the Stop TB Partnership.
Development & Aid
16. ODI background note – From high to low aid: a proposal to classify countries by aid receipt
Jonathan Glennie & Annaliza Prizzon;
This Background Note explores how classifying countries according to their aid receipts could contribute to reducing dependence on official development assistance as well as help donors and recipients monitor changes.
Some more news, articles or blog posts related to development:
- There was some bad news on the FTT and the EU this week.
- The ‘Planet under pressure’ conference taking place in London: with articles on the mentioning of planetary boundaries in the zero draft for Rio; on the fact that developing countries want a say in geo-engineering debates, etc.
- Bill Gates is in Africa again, and even invited Geert Wilders to come along and see with his own eyes what aid can achieve in Africa. (if Gates can change Wilders’ view, we’ll buy him a beer)
- A few pieces on the rise of democracy in Africa (in spite of what happened in Mali), in the NYT and the Economist.
- Martin Ravallion adresses some of the common (politically filtered) criticisms of the poverty estimates and the progress made (our assessment: a razor sharp blog post) .
- Forbes has an article on the focal areas of corporate philanthropy.
- Meanwhile, US foundations seem to support mainly Chinese government-supported organisations (GONGOs), not the grassroots organisations.
- There was some debate in the UK this week on the 0.7 % aid norm after a recommendation by the House of Lords economic affairs committee that the UK should abandon the UN target. John Hilary thinks it’s time to move beyond the 0.7 % aid debate (in the Guardian).