Dilemmas of Access to Healthcare in China

Abstract

Introduction China's compliance with international standards pertaining to human rights in health warrants particular attention, not only because of the global implications of China's handling of health issues such as SARS, HIV and avian flu, but also because of the effects on the well-being of the Chinese people. China has committed itself to compliance with international human rights standards on the right to the highest attainable standard of physical and mental (1) Yet China's performance conflicted with factors largely unrelated to the normative consensus underlying human rights to health. Instead, questions of Institutional Capacity loom large in assessments of the potential for successful reforms in public access to healthcare. China's public health system has long been presented as a model for developing economies. While the barefoot doctor model of the Maoist period was heavily mythologised, the PRC did succeed in bringing basic levels of healthcare to an unprecedented number of people. However, the modernisation policies of the 1980s and the attendant social and political consequences of income disparities, declining public budgets and official corruption eroded significantly the standards of public healthcare. (2) Obstacles to public access to healthcare continue, born of market policies and accompanying costs of medicines, equipment and treatment. (3) The HIV and SARS crises revealed in stark detail the extent to which policies and practices on public health remain subject to imperatives of political expediency and suggest that the fundamental human right to health remains compromised. (4) Government efforts in the areas of health education and the prevention, reporting and treatment of disease involve individual members of society not merely as passive recipients of the exercise of government authority but as active stewards of their own physical well-being. Yet such involvement--as well as collaboration between public and private sectors--has been obstructed by abuses such as government censorship of information on public health conditions, (5) corruption (6) and popular stigmatisation of disease. (7) These dilemmas reflect the depth of operational challenges facing China's current effort to reform its healthcare delivery systems. China's capacity to remedy these problems will dictate to a significant extent the success of recent health policy reforms. China's New Health Care Reform Plan China's State Council passed a landmark Health Care Reform Plan in January 2009. This was the culmination of a policy process begun in 2006 that included extensive interagency consultation as well as public discussion. (8) The Plan builds on efforts to expand the system of rural cooperative medical service units begun in 2002 and expanded in 2003 following the SARS outbreak. Following a report by the State Council Development Research Centre in 2005 that criticised health sector reforms and noted the increase of patient contributions to medical fees from 20 per cent in 1978 to 52 per cent in 2005, the State Council established a joint working committee to draft a new health reform plan. Statistics from the Ministry of Health show that personal spending on medical services doubled from 21.2 per cent in 1980 to 45.2 per cent in 2007, while government funding dropped to 20.3 per cent from 36.2 per cent in 1980. (9) The healthcare plan is aimed in part at providing state subsidies for personal medical expenses. Comprehensive medical insurance was enacted for urban residents in 2007, and the rural cooperative system was expanded continuously between 2006 and 2008. In the fall of 2008, the draft Health Care Reform Plan was released for public debate. The plan was endorsed by the State Council in January 2009 (10) and taken up in Premier Wen Jiabao's Government Work Report to the Second Session of the 11th NPC in March. (11) The Plan was published for implementation in April. …