CHINA Organization of the Health System in China China People’s Congress Central Committee of Communist Party of China State Council Ministry of Human Resource and Social Security National Development and Reform Commission National Health and Family Planning Commission China Food and Drug Administration Ministry of Finance Ministry of Education Urban Employmentbased Health Insurance and Urban Resident Health Insurance General Administration of Quality Supervision, Inspection, and Quarantine National Universities State Administration of Traditional Chinese Medicine Rural Newly Cooperative Medical Scheme Hospitals Hospitals Provincial Governments Chinese Academy of Medical Science China CDC Bureau of Health Politics and Hospital Administration A similar government structure to that at the national level Department of Health Care Quality Source: Hai Fang, Peking University, 2015. What is being done to promote delivery system integration and care coordination? Medical alliances are regional hospitals groups, often including one tertiary hospital and several secondary hospitals and primary care facilities, that provide access to primary care facilities for patients with minor health issues. The aim is to reduce the need for people to visit tertiary hospitals. At the same time, patients with serious health problems can be referred to tertiary hospitals easily and moved back to primary care facilities after their condition improves. It is hoped that this type of care coordination will meet demand for chronic 36 The Commonwealth Fund
CHINA disease care, improve health care quality, and contain rising costs. Hospitals in the same medical alliance use the same electronic health record system, and results of labs, images, and diagnoses can be shared easily within the alliance. There are three main medical alliance models (Jiang et al., 2014). Hospitals in the Zhenjiang model have only one owner (usually the local bureau of health). Those in the Wuhan model do not belong to the same owner, but administration and finances are all handled by one tertiary hospital. Hospitals in the Shanghai model share management and technical skills only; ownership and financial responsibility are separate. What is the status of electronic health records? Nearly every health care provider has set up its own electronic health record (EHR) system. Within hospitals, EHRs are also linked to the health insurance systems for payment of claims with unique patient identifiers (citizenship ID). However, EHR systems vary significantly by hospital and are usually not integrated or interoperable. Patients often have to bring with them a printed health record if they would like to see doctors in different hospitals. Even if hospitals are owned by the same local bureau of health or universities in the same region, different EHR systems may be used. Patients generally do not use EHR systems for accessing information, appointment scheduling, secure messaging, prescription refills, or accessing doctors’ notes. How are costs contained? Health expenditures have risen significantly in recent decades as a result of health insurance reform, population aging, economic development, and health technology advances. Health expenditures increased from CNY510 (USD139) per capita in 2003 to CNY3,234 (USD884) in 2013 (China National Health and Family Planning Commission, 2014). The key cost-containment strategy is reform of provider payment. Prior to the recent introduction of DRGs, global budgets, and capitation in 2009, fee-for-service was the main provider payment mechanism and consumer- and physician-induced demand increased costs significantly. Global budgets in particular have been used in many regions, since these are relatively easy for authorities to implement. As noted above, government encourages use of community and township hospitals over more expensive care provided in tertiary hospitals. Hospitals compete on the basis of quality, level of technology, and copayment rates. In township, community, and county hospitals, a campaign of “zero markups” for prescription drugs was introduced in 2013 (see below).The National Development and Reform Commission places stringent supply constraints on new hospital buildings and hospital beds, and the National Health and Family Planning Commission controls the purchase of high-tech equipment such as MRI scanners. What major innovations and reforms have been introduced? Sales of prescription drugs have been a major revenue source for hospitals, which are allowed a 15 percent markup, and providers have strong financial incentives to induce demand for more and expensive drugs. Prices for services, on the other hand, are rather low, in accordance with traditional health practice in China. However, as of 2015, 3,077 public county hospitals and 446 public city hospitals were participating in a governmentfinanced pilot program to eliminate markup of prescription drug prices. At the same time, 224 prefectures and cities in 21 provinces adjusted prices of health care services upward to reflect true costs. The zero-markup policy has been found to have significantly reduced total medical spending (Fu and Yang, 2013). Another important health reform was the introduction in 2015 of special health insurance for severe diseases, such as cancers, kidney disease, and acute myocardial infarction (AMI), which supplements the regular publicly financed schemes. Severe-disease health insurance provides reimbursement beyond the rather low reimbursement ceilings. It is also mostly publicly financed, particularly for urban resident basic insurance and the rural new cooperative medical scheme, and administrated by local health authorities. However, private commercial health insurance companies, given their experience in providing complementary insurance, are heavily involved as well. By 2017, severe-disease insurance is expected to be available throughout China. International Profiles of Health Care Systems, 2015 37
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ITALY during hospitalization (Thoms
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ITALY Some regions are promoting ca
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ITALY Organization of the Health Sy
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ITALY although the degree of evolut
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ITALY The author would like to ackn
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JAPAN What is covered? Services: Al
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JAPAN incentives for providers to c
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JAPAN Organization of the Health Sy
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JAPAN The author would like to ackn
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THE NETHERLANDS receive faster acce
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THE NETHERLANDS Hospital payment ra
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THE NETHERLANDS Organization of the
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THE NETHERLANDS References Organisa
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NEW ZEALAND provided in GP clinics.
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NEW ZEALAND largely through efficie
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SINGAPORE Medifund is the governmen
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SWITZERLAND Hospitals: About 70 per
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The COMMONWEALTH FUND Affordable, q