Rural hospitals to scrap surcharges
At least a third of the mainland's provinces have launched reforms at county-level public hospitals that will scrap drug surcharges in an effort to bring down skyrocketing medical bills.
The reforms are seen as pilot schemes for an overhaul of much bigger city-level hospitals, which rely on drug prescriptions for as much as half their income.
Health Minister Chen Zhu announced last month that 300 selected county-level hospitals would abandon drug surcharges this year, with the other 1,900 county-level hospitals to follow suit next year.
No mainland public hospitals should be marking up medicine prices by 2015.
Hunan, Guangdong, Shandong, Qinghai, Hebei, Shanxi, Anhui, Zhejiang, Heilongjiang, Fujian and Jiangsu have ushered in reforms at dozens of county-level hospitals since last month. Shaanxi has been more ambitious, announcing last week the start of 'comprehensive reform' at all public hospitals in its 107 counties.
The reform guideline says local governments should guarantee public hospitals' staff salaries, daily expenses and infrastructure, including the purchase of major equipment. Their debts will be covered by county governments, the Ministry of Health's Health Daily reported.
Provincial, city-level and county-level governments will compensate them for their losses from the removal of drug surcharges, with alternative means to bolster their balance sheets including raising fees for medical services, but with caps set.
Hospitals' management systems will also be revamped, with hospital heads recruited on the open market and staff paid according to their performance. There should be enough doctors and nurses, and senior doctors will be encouraged to work in county-level hospitals.
Mainland public hospitals, which have had to get by on as little as 10 per cent government funding for decades, have been left to 'feed themselves', mostly through marking up medicine prices and prescribing unnecessary drugs.
The high cost of medical care has sparked an overwhelming public outcry.
Professor Hu Shanlian, a public-health expert at Shanghai's Fudan University, said the county-level hospital reform could build up experience for future reform of city-level hospitals.
'Drugs in cities' health centres are usually more sophisticated and of higher cost compared with the county-level institutions, and drug consumption in city-level hospitals is much higher than in rural areas,' Hu said. 'Therefore, it's more difficult to seize this sweet cake - the astronomical profits from selling drugs - from cities' hospitals.'
He said the authorities also wanted to strengthen county-level hospitals, hoping they could retain rural patients and stop them flocking to major health centres in cities, where Class-A hospitals are overcrowded.
Dr Zhu Hengpeng, from the Chinese Academy of Social Sciences, told sohu.com that drug prices would not fall much after this round of reform, because drug companies still needed to pay bribes to health officials and hospital chiefs so their products would be bought, and those costs were ultimately borne by patients.