Nearly four years after the mainland embarked on comprehensive reform of its health-care system, the health minister says changing public hospitals is the trickiest task he faces in the next three years.
"The hard part is to reform the public hospital system," Dr Chen Zhu said yesterday on the sidelines of the launch of the China-World Health Organisation Country Co-operation Strategy, which outlines a framework to ensure mainlanders in rural and remote areas have access to essential health care.
The mainland began pilot public-hospital reforms in 300 county-level hospitals last year, eliminating a medicine surcharge and introducing a "medical-care service charge". Chen said he hoped the scheme would be expanded to cover 1,000 hospitals this year.
"If we reach the target of covering 1,000 county-level hospitals, then we will be able to achieve the target of carrying out reform at all the county-level hospitals by 2015," he said. "Then the reform of public hospitals will not be a problem, because 70 per cent of patients are treated in county-level hospitals.
"Then it is much easier to tackle the drug-sales commission system in big hospitals."
The medicine surcharge allowed hospitals to bill patients more, taking 15 per cent of the drug price as compensation for government funding shortfalls. It was cited as a major reason for unaffordable health care in April 2009, when the State Council issued a blueprint for medical reform, because it encouraged doctors to prescribe unnecessary drugs or tests for profit.
It was common for hospitals to make half their income from drug sales, and in some cases as much as 70 to 80 per cent.
Several major cities, including Beijing, have scrapped the surcharge, but they increased the basic consultation fee from five yuan to 42 yuan (HK$52) - reimbursable through public medical insurance.
"The experience of big hospitals in the cities has showed that drug prices could drop as much as 30 per cent, because doctors will prescribe drugs more rationally," Chen said.
He said he believed that the government's direct investment in public hospitals should be increased, ideally to 20 per cent. And hospital chiefs who were reluctant to embrace reform should see the big picture, which was that three-quarters of hospital income now came from public medical insurance.
Speaking just a week before the opening of the National People's Congress, where a plan to restructure some ministries will be discussed, Chen said he would like to see his ministry have a "more important role to play in policymaking and supervision".
"The issue is how to regulate the insurance, and who supervises it. In our opinion, the health authority should play a leading role," Chen said, adding that the ministry had done well in managing the New Rural Co-operative Medical Scheme.