By Shan Juan (China Daily)
Updated: 2007-10-31 07:27

Debate over the final blueprint for further medical reform continues to rage on, an expert said Tuesday.

The major sticking points are how the country should finance the health system to improve equity among the population and how to better deliver more efficient medical services, Zuo Xuejin, executive vice-president of Shanghai academy of social sciences, told China Daily on the sidelines of the ongoing Global Forum of Health Research in Beijing.

"That's probably why the reform plan is still kept in the closet," Zuo said.

More than a year has passed since the government entrusted eight institutions at home and abroad, including the World Health Organization, McKinsey, the World Bank, the Development Research Center of the State Council and five Chinese universities, to daft a proposal on future reform.

Despite delays, the government is confident of the process moving forward.

Vice-Minister of Health Gao Qiang said during the just-concluded 17th National Congress of the Communist Party of China that by the year 2020, all Chinese citizens in urban and rural areas will have access to basic medical care and health services.

Gao said the reform's framework, drafted on the basis of all eight proposals, would be publicized soon.

Public health, health insurance, hospital management, and basic health services are the major reform points.

"Waking up to the truth that commercial considerations led to the failure of previous reforms, the government realized there needed to be a switch in focus from individual responsibility in medical care to more obligation from the government," Zuo said.

The government is formulating a workable health system structure.

In 2002, the government launched the rural cooperative medical scheme to provide subsidized basic medical care for farmers and promised to include the entire rural population in the scheme by 2008.

However, farmers have complained about the scheme's apparent inability to cover outpatient services, possibly because of budget constraints.

Zuo said funding priorities for outpatient and inpatient services might be made clearer once reform plans are finalized.

Other issues include the best mechanism for financing medical care for individuals, either by paying the hospital providing the service, or to the patient directly.

Some experts, including Zuo, proposed a combination of the two funding methods, citing imbalanced economic development across the country as a factor.

The reform will also reportedly keep the medical and pharmaceutical sector in check, previously accused of "over and unnecessarily" prescribing drugs and health checks to boost profits.

Moreover, the role of public and private hospitals still need to be further defined in the final reform plan, Zuo said.