1. Health social system in China Lian Tong Doctoral student (D3) Sep 29, 2010 Lab of International Community Care and Lifespan Development

2. Health sectors/system Health care system  Provision of health services (hospital, health care center…)  Water and sanitation  Occupational health  Environment hygiene  Social security  …… Health system

3. Government Health Organization National level Ministry of Health Bureau of Health Department of Health Province level City level

4. Duty of the Ministry of Health  Make health related policy and strategy  Promote medical reform  Deal with important public health problems… SmokingMilk problems Iodized salt vaccine

5. Ministry of Health of China Ministry of Health Disease control Rural area health Women/child ren health Emergence issue Drug management Hospital management Medical policy Health care Science and education International bureau Medical supervision Sub-management bureaus and offices

6. Chinese center for disease control and prevention (CDC) Province and city level National level CDC in each province and city

7. Health care system  Central goal of the health sector is the good health of the whole population Health Services and Medical Security National health policies Financial Investment Citizens’ utilization of health services

8. Health Services and Medical Security in China Health Service Institutions (1) Health Service Institutions (2)Medical Service Utilization (3)Preventive Care Services (4)Cost of Provision of Health Services (5)Health Insurance Status

9. Health Service Institutions (1) Health Service Institutions Health indicators of China  The number of doctors per thousand citizens is 1.5 (1.5/1000), close to that of Brazil and Egypt, but lower than USA (2.7), Japan (1.9) and UK (2.0).  The number of registered nurses per thousand people is 1.03 (1.03/1000). Deficien cy of medical resource

10. Health Service Institutions in city and rural area Health indicators of China

11. (2) Medical Service Utilization  The total number of visits to medical institutions in 2003 was 2.096 billion, with an average of 1.62 visits per capita.  The distribution of hospitalization in 2003 was 70.0% in comprehensive hospitals, 0.2% in urban community health centers, 24.3% in township hospitals, 4.6% in women and children’s hospitals, and 0.9% in other hospitals.  Recourse waste !  Community health centers don ’ t play the good role of “ guard ”!

12. Medical Service Utilization

13. (3) Preventive Care Services  Vaccination rate is about 80%-96%  87.8% of pregnant women had at least one pre-natal examination  The rate of delivery in hospitals was comparatively low - averaging only 68.3%, with 92.6% in urban and 62.0% in rural areas. A clear difference between urban and rural areas and between geographic districts

14. (4) Cost of Provision of Health Services  The average outpatient expenditure per visit in 2003 was RMB 108.2, an equivalent of 0.77% of the per capita salary for urban citizens (RMB 14,040), but 4.2% of that of farmers (RMB 2,622).  Average inpatient expenditure per admission in 2003 was RMB 3,911, amounting to 27.9% of the per capita urban salary and 149.1% of per capita farmer income. Heavy burden of the cost of health services for farmers

15. Over cost/ high price for drug Cold A patient is looking at the bill Price of drug Getting bigger and bigger Business man Patient

16. (5) Health Insurance Status  In 2003, 9.5% of rural residents participated in the New Cooperative Medical Scheme (NCMS) and 11.5% in other forms of medical insurance schemes, leaving 80% without any form of medical security.  In urban areas, 30.4% of residents are covered by the basic medical insurance scheme, 24.8% participate in other insurance schemes, leaving 44.8% of urban citizens without any form of medical security. Need a medical insurance reform urgently !!!

17. Rural area City

18. Background of china society The unbalance in Social Development How to redistribute resources in China??? East West WorkersFarmers Group/Class City Rural area Economy/ Hardware Social Development/ Software Field Education Medicine Social welfare Culture…… Geography

19. 2004 What the most important motivations to save money? 1.Provide for the aged 2.Medicine 3.Education 2006 What the most important motivations to save money? 1.House 2.Education 3.Medicine What’s people worry about mostly??? Medical insurance and social welfare reform in 2005

20. Hospital System Reform What shall we do??? Medicine Insurance system Social Welfare system (Old-age Insurance System)

21. New Medicine Insurance system in China Medical Insurance for Urban Workers New Rural Cooperative Medical Care City Rural area Local government finance National government finance Company, enterprise and so on Individual income National government finance Individual income

22. From the insurance window, patients can get their money back proportionally depend on the diseases and their cost.

23. There are 900 million people over 60 years old in rural areas, and the number increase gradually. There are 39.3% elders living in poverty in rural areas. Only 1.5% elders in rural areas have endowment insurance. 4. There are 45.3 % elder in rural areas think that their lives are no guarantee. Situation of elder population in rural China

24. New Social Endowment Insurance for elders in rural area (2009~2020) 2009, 10% cities and towns as the sample fields. 2020, covering the whole country. Over 60 years old The family pay the basic insurance fee Government Compensation 50% fee for east areas 100% fee for west areas Lowest basic endowment cost

25. Before reform After reform 75.4 ％ population no medical insurance in 2003, decreased to 65.7% in 2004…… No Compensation for general elders in rural area except for handicapped people or elders without child. Over 90% population in city and rural area were covered with insurance. Almost 100% elders can get the life compensation from government per month.

26. Thank you for your attention