China s Health System: Achievements and Challenges

Transcription

1 China s Health System: Achievements and Challenges Qingyue Meng School of Public Health China Center for Health Development Studies Peking University The Asia Health Policy Program at Stanford University Nov 17, 2015

2 WriIen by MENG Qingyue, Peking University YANG Hongwei, Health Development Research Center CHEN Wen, Fudan University SUN Qiang, Shandong University LIU Xiaoyun, Peking University Edited by: Anne Mills, Viroj Tangcharoensathien Topics on: Context Organiza[on and governance Financing Resources Delivery Health reforms Assessment h#p:// asia_pacific_observatory/hits/series/ china_health_systems_review.pdf?ua=1

3 Background High economic growth; More resources available for health; Continuously increasing demand for health and health care by the people; More complicated health challenges from pollutions, popu ageing, NCDs, and food safety

4 Economic indicators Indicators Gross domespc product (GDP, billion US$) GDP at PPP (current internaponal $, billion US$) GDP per capita (US$) GDP per capita at PPP (current internaponal $) Annual GDP growth (%) Public expenditure (% of GDP) Data source: World Bank 2015

5 Health system indicators Indicators ProporPon of total health expenditures in GDP (%) ProporPon of out-of-pocket payment in total health expenditures (%) Number of health professional workers per 1,000 populapon Number of hospital beds per 1,000 populapon Data source: China NaPonal Health and Family Planning 2015

6 Health expenditure as a share (%) of GDP in China and selected countries, % Brazil China Hungary India Malaysia New Zealand Philippines Poland Republic of Korea Romania Russian Federa[on South Africa Thailand From: China HiT 2015

7 GNI per capita U5MR 120 GNI per capita (US$) Child mortality per 1000 live births Year 0 Source: World Bank, World Development Indicators (2014) hip://data.worldbank.org.cn/country/china#cp_wdi

8 Achievements A national goal for universal health coverage; Rising role of health in political and economic agenda; An institutional arrangement in health financial protection; Increased public funding for health; and Capacities in health care delivery.

9 China s health systems reform -One gaol Universal coverage to basic health care -Four systems (si liang) Systems of public health, medical care, health security, and essential medicines -Eight strategies (ba zhu) Concrete strategies and policies, covering areas such as financing, human resources, regulation, and information

10 Coverage of the three health insurance schemes Population coverage (%) Figure 2 Population coverage by the three health insurance schemes, NCMS coverage UEBMI coverage URBMI coverage Year Data source: China health sta[s[cs year book, [12]; China Sta[s[cs [13]; China Labor Sta[s[cs

11 Meng and Xu, WHO Bull, 2014

12 % out-of-pocket payment Percentage of OOP (%) Figure 3 Percentages of out-of-pocket payment (OOP) in total health expenditures, Year Data source: Report on China s Health Account Study, 2012

13 Change in out-of-pocket spending as a share of total expenditure on health, Source: World Health OrganizaPon and OECD, 2014

14 QuanPty of health insptupons in China, InsPtuPon quanpty All hospital General hospital Year Source: Ministry of Health, 2013

15 Changes in total health professionals in China, 1949 to 2012 Source: Ministry of Health, 2013

16 Health care uplizapon Driving forces: -Availability of financial protec[on mechanisms -Income -NCDs -Popu ageing -Others Number of outpatient visit per person and hospitalization rates, 诊 Data source: China Health StaPsPcs Yearbook 2014 and Digest 2015

17 Challenges Inequalities in health; Inequitable coverage of health programs; Hospital-centered health delivery system; Inefficiency in use of health resources; and Low quality of health care.

18 Life expectancy years at birth by province in Gap of life expectance years between the richest and poorest provinces: 9 years old (2010) -Ra[o of IMR (rural/urban): 2.4 (2005)

19 Fragmented health insurance schemes verpcally and horizontally Data source: Meng et al. Lancet, 2015

20 : -% of health professionals of community health facili[es in total health professionals decreased from 32.6% to 29.7% -while increased from 19.9% to 25.3% in 3 rd level hospitals 18.00% 16.00% 14.00% 12.00% 10.00% 8.00% 6.00% 4.00% 2.00% Annual increase rate of health professionals in health facilipes, % 4% 3.75% 0.00% 3rd level hospitals 2nd level hospitals PHC providers Data source: China Health StaPsPcs Yearbook 2014

21 Growth of health facili[es has concentrated in large hospitals (hospital beds >=800, 243 hospitals in 2004 and 1212 in Annual growth rate of number of hospital by number of hospital beds, % 3.20% 3% 4.20% 7.90% 8% >= % -5.00% 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% Data source: China Health StaPsPcs Yearbook 2014

22 Distribution of the inpatient care, DistribuPon of the uplizapon: -Stagnated growth in primary health ins[tu[ons; -The turning point of 3 rd level hospitals and PHC providers in 2011; 总住院人数医院三级医院基层医疗卫生机构 Data source: China Health StaPsPcs Yearbook 2014

23 Impoverishment rates due to diseases Income quintile (I: the poorest; V: the richest) Figure 4 Percentage of households below poverty line due to medical expenditrues (%) All I II III IV V Impoverishment rate (%) Data source: Meng and Xu, PLOS Medicine, 2014

24 Both cost and quality of care are much concerned Top four reasons of papents complaints 45% 40% 35% 30% 25% 20% 15% 40% 16.10% 13.80% 10% 7.10% 5% 0% High medical fees Poor quality of care Bad artudes of providers Unreasonable prices Data source: NaPonal health service survey, 2013

25 The way forward A people- and PHC-centred health care system; Consolidation of the health financing systems; Integration of the health care delivery system; Strengthening of human resources in health; and Improvements in governance and regulation.

26 Thanks for your attentions!