Present and future desirability and options in the development of basic packages in China

Presenter: Yuhua Shi, Australian National University

Abstract

Introduction: Over the past two decades, China has experienced dramatic changes both in its social and economic structures. The market-oriented economic reform successfully sustained an average growth rate of 8.3% in gross domestic product (GDP) between 1980 and 2000, and the per capita GDP reached US$1090 in 2003. These changes have influenced health sector development in the following ways: 1) marketization of health sector focusing on revenue generation at the expense of public health interests, which has caused reduced public financing and increased funding by user fees; 2) collapse of the rural Cooperative Medical System; 3) partial privatization of public or collective sectors has led to fragmentation of public health services. The government of China has admitted that the reform in health sector was unsuccessful and has been revising its basic health care benefit packages. There is increasing need for a rational framework to formulate national benefit packages in China.

Objectuves & Methods: In this paper, we review the major movements in China’s health care reform and the policy focuses by analysing the existing Labor Insurance Schemes (LIS), Government Insurance Schemes (GIS) in cities and the New Rural Cooperative Medical System (NRCMS). We found that policy makers in China tried to focus on balancing between social and economic development including the balance between rural and urban areas, and between regions in terms of 1) financing—collection and allocation of resources for health care services; 2) equity—expanding the social insurance system to protect the vulnerable groups, increasing the inputs in the public health care services towards greater equitability. However, these public health care schemes are generally lack of strategic plans and practical guidelines for implementation, or have very broad guidelines that are difficult for practice, it is unclear that if they will have explicit impact on health care policies. We suggest introducing multi-criteria priority setting in China’s health care decision making, with discrete choice experiment to determine the relative importance of different criteria in identifying priority setting in China; and using other countries’ success and failures as a guide, propose the approaches to meet the criteria and the way to proceed in setting priorities.

Conclusion: Explorative discrete choice experiment is a necessary process to develop a multi-criteria approach to priority setting in health care decision making. Explicity addressing priority setting is expecially important for China to build farier, transparent and efficient public health care system with constrained resources.