China Health Care Reform: Who Gains and Who Loses?

Transcription

1 Speaker Third Plenary Session CHINA HEALTH CARE REFORM: WHO GAINS AND WHO LOSES? Bernhard Schwartländer, PhD World Health Organization Beijing, China China Health Care Reform: Who Gains and Who Loses? Dr. Bernhard Schwartländer Representative, World Health Organization Beijing, China September 9,

2 Part 1 CHINA S PROGRESS ON UNIVERSAL HEALTH COVERAGE Three dimensions of Universal Health Coverage 2

3 China s Progress on UHC China s Progress on UHC Huge Progress to Expand Coverage of Health Insurance to 95% of population 3

4 Part 2 WHO GAINS AND WHO LOSES? Perspective of General Public Trend of healthcare utilization doctor visits per capita Hospitalizations per Source: Chinese Health Statistics

5 Perspective of General Public Trend of healthcare utilization doctor visits per capita Hospitalizations per People are using more health care than before Reimbursement of health costs has risen Source: Chinese Health Statistics 2013 Perspective of General Public % of health expenditure to nonproductive expenditure per capita 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% rural resident 0.0% Source: National Bureau of Statistics of China 5

6 Perspective of General Public % of health expenditure to nonproductive expenditure per capita 12.0% 10.0% 8.0% Rural people pay higher % of expenditure on health care Urban people pay lower % of expenditure on health care 6.0% 4.0% 2.0% rural resident 0.0% Source: National Bureau of Statistics of China Perspective of General Public % of health expenditure to nonproductive expenditure per capita 12.0% 10.0% 8.0% Rural people pay higher % of expenditure on health care Urban people pay lower % of expenditure on health care 6.0% 4.0% 2.0% 0.0% rural resident Constant % of households with catastrophic expenditure (12%) Source: National Bureau of Statistics of China 6

7 Hospitals remain overcrowded Perspective of hospitals and doctors Growth rate of patients visits and public hospital revenue Total Visits Total Inpatient s Revenue (per public hospital) % 13.6% 23.6% % 11.7% 21.9% % 11.3% 23.0% % 16.7% 24.0% Average 8.6% 13.3% 23.1% Source: Chinese Health Statistics

8 Perspective of hospitals and doctors Growth rate of patients visits and public hospital revenue 2008 Total Visits Total Inpatient s Revenue (per public hospital) % 13.6% 23.6% Hospitals are doing good business Increased patient volume % 11.7% 21.9% % 11.3% 23.0% % 16.7% 24.0% Average 8.6% 13.3% 23.1% Source: Chinese Health Statistics 2013 Perspective of hospitals and doctors Growth rate of patients visits and public hospital revenue 2008 Total Visits Total Inpatient s Revenue (per public hospital) % 13.6% 23.6% % 11.7% 21.9% % 11.3% 23.0% % 16.7% 24.0% Average 8.6% 13.3% 23.1% Hospitals are doing good business Increased patient volume Hospital revenue increases almost 25% per year Source: Chinese Health Statistics

9 Perspective of Primary Health Care Providers Market share between hospitals and GRHFs Total visits Inpatients hospitals GRHFs hospitals GRHFs % 63.3% 71.1% 23.3% % 60.5% 64.4% 30.5% % 61.8% 64.0% 31.0% % 61.9% 67.2% 27.9% % 60.7% 70.3% 24.7% % 59.7% 71.3% 23.8% Decreased proportion of total health care visits are at primary care level Source: Chinese Health Statistics % 25% 20% 15% 10% 5% 0% Perspective of pharmaceutical industry Growth rate of Total Value of National Pharmaceutical Industry Pharmaceutical sector continued high annual growth around 20% Source: Bluebook of Chinese Pharmaceutical Market Development 2012,2014 9

10 Perspective of Government 1. Government achieved goal of increasing health insurance coverage to 95% of the population. 2. Government is spending more on health care - from 15.93% of total health expenditure in 2001 to 30.66% in Perspective of Government 1. Government achieved goal of increasing health insurance coverage to 95% of the population. 2. Government is spending more on health care - from 15.93% of total health expenditure in 2001 to 30.66% in Health Care Reforms are delivering higher volume of care but cost is still escalating 4. Health Care Reforms yet to improve efficiency and rebalance service delivery with stronger primary care 10

11 Part 3 REMAINING CHALLENGES Emerging Priorities of Government on Health Fundamental shifts in population and health: NCDs: 80% of BoD in China is from NCDs (cf. 60% globally) Ageing: elderly as % of population will double, from 15% now to 30% by 2050 Urbanization and internal migration: 1 in 2 people live in urban areas now; will increase to 3 in 4 by 2035 Health system reform Regulatory strengthening (food, medicines) to meet int. standards 11

12 Health Reform - Deep Water Phase Re-balancing Health Care Delivery Reforming public hospitals Strengthening primary health care the right staff, in the right place, equipped to do the right work Integrating all in continuum of People Centred Care Institutional, regulatory and policy for public and private sector delivery of services at same cost and quality 12

13 Thank you! 13