What should China's health care reform focus on after COVID-19?
Updated 13:34, 29-May-2020
Gu Xuefei

Editor's note: The COVID-19 pandemic in 2020 has changed the lives of everyone on the planet Earth and may even change the global landscape. While Western countries are still struggling with the pandemic, China has started its economic recovery. Here is the ninth piece in our "China In Focus" series during the Two Sessions: China's health care reform. Gu Xuefei is a research professor at the Health Development Research Center in the National Health Commission of China. The article reflects the author's opinions, and not necessarily the views of CGTN.

In combating COVID-19, the State Council of China and the CPC Central Committee have taken emergency measures in the health sector, such as incorporating the novel coronavirus disease into the country's list of statutory infectious diseases, and setting up a national emergency response leading group that led China's health care system in its successful containment of the epidemic.

Specifically, the public health system conducts contact tracing and takes measures to break the circuit of infections; the medical services provider system treated the infected cases and diagnosis to suspected cases by mobilizing medical institutions and health care workers to do their utmost to save lives; and the healthcare security system offers all necessary financial support by adjusting policies in a timely manner based on the needs of the epidemic situation.

In the meantime, we need to take stock of the shortcomings and weaknesses of China's health care system observed during its response to COVID-19. For example, there was the issue of inadequate capacity building for emergency preparedness at "ordinary times", which became evident when budgets and medical supplies were stretched in infectious disease hospitals at all levels.

The inadequate capacity for disease surveillance and detection in the early stages of the epidemic was due to the general weakly capacity, inflexible administration mechanisms and insufficient motivation of disease control institutions at all levels, and even inadequate infrastructure at community levels and alarming brain drain of public health professionals in some areas.

Hospitals at the verge of being overwhelmed in the early stages of COVID-19 spoke volumes about the inadequacy of the patient referral system and the need to strengthen the development of relevant disciplines to deal with "medical surge". A good coordination governance mechanism has yet to be established to closely connect and effectively coordinate the three systems of public health, medical services and healthcare security.

Since the new phase of the health care reform, China has built an institutional framework for the basic health care system, including a patients' referral system, a modern hospital management system, a universal healthcare security system, a drug supply system, a comprehensive supervision system and the development of a public health system, which has played a key role in improving accessibility and reducing costs of healthcare for patients.

Samples of the COVID-19 inactivated vaccine at Sinovac Biotech Ltd., in Beijing, capital of China, March 16, 2020. /Xinhua

Samples of the COVID-19 inactivated vaccine at Sinovac Biotech Ltd., in Beijing, capital of China, March 16, 2020. /Xinhua

However, in deepening the reform and implementing the "Healthy China 2030" strategy, it is necessary to deeply reform the disease prevention and control system, improve the system for treating patients during major epidemics, and improve the medical insurance and assistance system for catastrophic diseases, so as to be better prepared for unknown major public health risks in the future.

Other suggested measures include: 1) strengthening the professionalism and independence of disease control agencies, reforming policies on the training, access, recruitment, remuneration, evaluation and incentive mechanisms for public health professionals, and improving the salary level of disease control professionals; 2) strengthening the monitoring and early detection capacity of the disease control system, and enabling data sharing among disease control agencies and medical institutions to improve the ability to detect, report, warn, respond to and handle major public health risks; and 3) strengthening capacity building of laboratories of disease control agencies and enabling regional resource sharing.

A sound system for dealing with major epidemics requires further public health capacity building of the medical services provider system, including the capacity of general hospitals to deal with infectious diseases and build a pre-hospital emergency system, the comprehensive capacity of infectious diseases hospitals, as well as the public health literacy and supplies of primary medical institutions.

There is also the need to establish an integrated health care system so that municipal- and county-level hospitals can develop together as clusters or professional communities, medical insurance funds and public health funds can be pooled for more efficiently use, and synergizing mechanisms can be created between public health, medical service providers and healthcare security system.

When a model based on the characteristics of medical specialties, is made available both offline and online, there will be greater chances for a successful transition from treatment of diseases to people's health outcome.

Finally, we should improve the health insurance and assistance system for catastrophic diseases. In the event of emergencies such as the activation of the emergency response mechanism for major epidemics, health insurance agencies should allocate part of the health insurance fund in advance to ensure that hospitals provide treatment before charging fees. Barriers should also be removed to real-time reimbursement for patients receiving treatment in hospitals out of their registration region.

There should also be efforts to establish a system of exemptions from medical fees for special groups and specific diseases, with targeted exemptions from restrictive provisions such as drug lists, dosages and payment ceiling.

A government financial guarantee for medical expenses of epidemic-infected patients should also be considered. With lessons learned from COVID-19, the above-mentioned suggestions and practices should be institutionalized over time to further improve our capacity to respond to unknown risks in the future.

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