Report suggests new national authority to improve health care in China
The government of China should consider establishing a national authority to lead improvements across the health system, according to a new report which highlights the challenges created by the country’s rapidly ageing population.
The report, which has been produced by the World Bank and the World Health Organization, as well as China’s Ministry of Finance, National Health and Family Planning Commission, and Ministry of Human Resources and Social Protection, says China should restructure its delivery model to focus on providing integrated primary care and reform public hospitals so they mainly treat complex and acute cases.
Such a switch to “people-centered, integrated care” could save the east-Asian nation as much as 3% of GDP by 2035, says the report Deepening Health Reform in China.
The savings, according to World Bank estimates, are projected to be in the hundreds of billions of dollars annually.
To oversee improvements, the government should “conduct an in-depth national study of the state of quality of care; develop a national quality improvement strategy; and explore options to cultivate a national authority to lead improvement efforts.”
This agency “would be publicly responsible for coordinating all efforts aimed at quality assurance and improvement, and would actively engage all stakeholders to facilitate the implementation of quality assurance and improvement strategies,” the study says.
If China does not change its current approach, the report warns, health spending would increase by 8.4% a year between 2015 and 2020, faster than the projected GDP growth of 6.5% a year.
World Bank Group president Jim Yong Kim said: “Decades ago, China’s innovations in health such as barefoot doctors and cooperative health care showed the world it was possible to improve the health and greatly increase the life expectancy for hundreds of millions of people.
“Today, China can once again lead the way with cutting-edge primary health care reform that puts the patient first and shifts away from expensive hospital care that often does little to improve the health of people.
“If China institutes these reforms, we believe it will improve the health care system for all Chinese—or one in every six people in the world.”
The report, which was published last week, is based on 20 background studies, more than 30 case studies, visits to 21 provinces in China, and a series of technical workshops with a team of policy makers, practitioners, researchers and academicians from all three partners.
It comes as the Chinese government embarks on health reforms under the 13th Five-Year Development plan, including legislation that would set parameters of the health sector.
Its recommendations are built on China’s success in healthcare over the last two decades: With massive investments in health infrastructure, the country achieved near-universal health insurance coverage at an unprecedented speed, with more than 95% of its population covered by 2011.
This helped reduce child and maternal mortality rates: a child born in China today can expect to live more than 30 years longer than he or she would 50 years ago.
But China’s health costs have been growing because of rising incomes and expansion of health insurance to almost all citizens.
After lifting more than 600 million people out of poverty amid double-digit growth in the last three decades, China now faces slower growth and emerging challenges common to a better-off society.
China faces emerging challenges to meet the healthcare needs of its citizen, due to a rapidly ageing society and the increasing burden of non-communicable diseases, such as cancer and heart disease.
There are now 140 million people older than 65 years in China, and that is expected to increase to 230 million by 2030.
Infectious diseases have been replaced by non-communicable diseases as the greatest health threat, accounting for more than 80% of the 10.3 million deaths every year.
Those diseases are exacerbated by high-risk behaviours such as smoking, sedentary lifestyles and alcohol consumption, as well as environmental factors such as air pollution.
At the same time, with higher economic growth and personal incomes, people are demanding more and better health care.
That has put pressure on the health care system. According to the report, health gains have slowed, but healthcare spending has been growing at a rate of 5 to 10 percentage points higher than GDP growth since 2005.
Out-of-pocket expenditures have eased significantly in recent years, but at 32% of total spending in 2014, the rate is still higher than the average of 21% among high-income economies.
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