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Improving China's Health Care System


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  • Richard Herd
  • Yu-Wei Hu
  • Vincent Koen


Overall, health outcomes in China have improved tremendously over the past three decades, especially thanks to the reduction in some traditional infectious diseases. However, death rates from chronic diseases have been on the rise, not least owing to changes in life styles and deteriorating environmental conditions. Supply of health care is overwhelmingly provided publicly and hospitals have been absorbing a growing share of the resources. The number of doctors has increased fast but the level of qualification of incumbent doctors is often modest. Demand for care has risen rapidly, in line with incomes, and the relative price of care soared through the early 2000s. Hospital budgets and their doctors’ pay are partly based on the pharmaceuticals they prescribe and sell, whose prices are regulated and involve considerable cross-subsidisation. Faced with these problems, the government has launched a number of reforms. New insurance schemes have been rolled out both in rural and urban areas. As a result, coverage and use of medical facilities has increased a lot, except for migrants. In practice, however, catastrophic but also chronic illnesses continue to push people into poverty, especially in the poorer regions, given limited risk pooling at the national level. A new set of reforms was announced in 2009, aiming at universal, safe, affordable and effective basic health care by 2020. They involve investment in medical infrastructure, generalising coverage, more focus on prevention, a new essential drugs system and far-reaching reorganisation, including hospital reform. It will be important to make sure that primary care plays a greater role and that hospitals are managed more efficiently with less of a hierarchical structure. Progress will also require changes in the relative prices of treatments and higher doctors’ wages and tobacco prices. Améliorer le système de santé chinois Dans l’ensemble, les résultats de la Chine en matière de santé se sont considérablement améliorés au cours des trente dernières années, surtout par suite du recul de certaines maladies infectieuses classiques. Toutefois, les taux de mortalité par maladies chroniques sont en progression, en particulier à cause de l’évolution des modes de vie et de la détérioration de l’environnement. L’offre de soins de santé est essentiellement publique et les hôpitaux absorbent une part grandissante des ressources. Le nombre de médecins a vite augmenté, mais leur niveau de formation est souvent peu élevé. La demande de soins s’est rapidement accrue, parallèlement aux revenus, et leur prix relatif s’est envolé jusqu’au début des années 2000. Les budgets des hôpitaux et la rémunération de leurs médecins dépendent en partie des produits pharmaceutiques qu’ils prescrivent et vendent, dont les prix sont réglementés et donnent lieu à un important financement croisé. Face à ces problèmes, les pouvoirs publics ont lancé des réformes. De nouveaux dispositifs d’assurance ont été mis en place dans les zones rurales et urbaines. Par conséquent, la population couverte et l’utilisation des équipements médicaux se sont beaucoup accrues, sauf dans le cas des migrants. Toutefois, dans les faits, les maladies catastrophiques, mais aussi les affections chroniques, continuent de faire tomber dans la pauvreté ceux qu’elles touchent, surtout dans les régions déshéritées, la mutualisation des risques à l’échelle nationale demeurant limitée. En 2009 a été annoncée la mise en oeuvre d’une nouvelle série de réformes dont le but est d’assurer un accès universel à des soins de santé de base à la fois sûrs, d’un coût abordable et efficaces d’ici à 2020. Ces mesures prévoient des investissements dans les infrastructures médicales, la généralisation de la couverture maladie, une intensification des efforts de prévention, l’instauration d’un nouveau dispositif pour les médicaments essentiels et des restructurations d’envergure, dont une réforme des hôpitaux. Il importera de faire en sorte que le rôle des soins primaires soit renforcé et que les hôpitaux soient gérés de façon plus rationnelle dans le cadre d’un système moins hiérarchisé. Il faudra en outre modifier les prix relatifs des traitements et augmenter la rémunération des médecins, ainsi que le prix du tabac.

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Bibliographic Info

Paper provided by OECD Publishing in its series OECD Economics Department Working Papers with number 751.

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Date of creation: 01 Feb 2010
Date of revision:
Handle: RePEc:oec:ecoaaa:751-en

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Keywords: China; hospital; pharmaceuticals; life expectancy; insurance; diseases; doctors; migrants; tobacco; health; Chine; maladies; médecins; tabac; migrants; médicaments; assurance; espérance de vie; hôpital; santé;

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Cited by:
  1. André Sapir & Jean Pisani-Ferry, 2011. "Global Currencies for Tomorrow: A European Perspective," ULB Institutional Repository 2013/174278, ULB -- Universite Libre de Bruxelles.
  2. Jacky MATHONNAT & Yong HE & Martine AUDIBERT, 2013. "Two-Period Comparison of Healthcare Demand with Income Growth and Population Aging in Rural China: Implications for Adjustment of the Healthcare Supply and Development," Working Papers 201315, CERDI.
  3. Ng, Ying Chu, 2011. "The productive efficiency of Chinese hospitals," China Economic Review, Elsevier, Elsevier, vol. 22(3), pages 428-439, September.


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