Addressing inequalities in China's health service

Abstract

Serious inequalities have existed in health-care provision between eastern and western provinces in China and urban and rural areas for some time. The Chinese Government has attempted to address the problem of inequality in health care, and in 2004, a major government initiative—The Myriad Doctors Supporting Rural Health Care Project—involving large hospitals in the urban eastern provinces was launched to provide support for hospitals in rural western provinces through long-term exchange programmes. A government watchdog organisation was set up to monitor progress, and in November, 2013, one of us (TW) toured China, as a member of the organisation, to assess the project in its tenth year of running. Major successes have been achieved as a result of the project: the exchange programme is well established, and hospitals in eastern provinces have brought medical staff , technology, construction projects, and first-class medical treatment to rural areas. The latest available national data, however, clearly suggest that serious inequalities remain (table). We identifi ed three main areas of concern. As government funding for the project is very limited, participating hospitals in eastern provinces are required to meet the shortfall and struggle to pay their seconded medical workers an adequate wage. Human resources are also an issue. Government policy requires the transfer of five senior doctors from each supporting hospital to a partner hospital on 6-month shifts for at least 1 year. These long-term arrangements create a huge burden for hospitals in eastern provinces and can cause personal diffi culties for medical staff . Finally, the deployment of resources is determined by government regulation rather than by market needs. Coordinating this huge project that involves thousands of hospitals and medical workers according to strict policy guidelines is extremely tough, and ineffi ciencies and repetitive allocation of resources inevitably arise. China’s population of 1·3 billion people inhabit vastly diverse geographic areas and live in varying economic conditions. As a result, health-care inequalities remain a serious problem and necessitate support projects for the foreseeable future. Learning how best to integrate medical resources and optimise the allocation of regional resources is undoubtedly key to sustainable development, but the cost required to create a truly eff ective health service is prohibitive. Could market forces succeed by encouraging hospitals in eastern provinces to open public or private amenities in the western provinces? New sources of income might provide sufficient motivation to create effi cient, high-quality services. The fear is that new sources of income might cause new problems, counteracting the government’s attempts to reduce inequality. Nevertheless , the consistent provision of an excellent level of health care in China, particularly in less developed areas, still has a long way to go.