Reform's Impact on Physicians
Physicians, facing the prospect of losing departmental and pharmaceutical company incentives and likely mandatory service
requirements at community clinics, will also be looking for ways to supplement their paltry government incomes. The MOH continues
to slowly follow through on its promise to allow doctors to practice at multiple locations, with an announcement from the
Beijing Health Bureau that, effective March 1, licensed physicians will be permitted to work simultaneously at a maximum of
three hospitals. Under these circumstances, practitioners, especially those with experience and reputation, will inevitably
establish part-time practices in private settings charging market prices. (This has always occurred at a certain level, with
surgeons operating "weekend clinics" for paying patients, but it has been actively discouraged by the MOH.)
Window for the Private Sector
Coupled with the release last November of a multi-ministerial opinion suggesting that private medical facilities be allowed
to participate in public insurance schemes, enjoy tax benefits, and, at long last, carry 100 percent foreign ownership (versus
the previous 70 percent maximum), it seems that private healthcare may have a chance at a new life. Growth of private pay
has been hampered by the inability of top physicians to leave public practice as well as the privatization of hospitals by
real estate developers and speculators, rather than by experienced hospital management teams. The government has suggested
that it will actively encourage a new round of (well-supervised) creation of private healthcare facilities and is also beginning
to push commercial health insurance. As is the case with OTC medicine, this is a clear attempt to ease the rapidly growing
burden on public health systems by providing alternatives for those who can afford them. The government will move slowly in
this area, with multiple safeguards to prevent a major siphoning of quality to any upper-tier private system. Widespread public
discontent over healthcare disparities is, after all, the prime reason for the healthcare reforms in the first place.
Interest in the private option is just another illustration of how profound the transition is in China's healthcare sector.
It's an appropriate conclusion to this story to cite again the magnitude of what is being attempted: basic, blanket, pay-as-you-go
health coverage for 1.3 billion people, or more than a sixth of the world's population spread out over 3 million square miles
of rural and urban territory, with an aging population subject to vast extremes of income. Other countries with a similar
demographic—most notably India—have not even attempted to make a start in doing this. With a challenge like this, it is no
wonder there are so many avenues being explored to cut costs and distribute the burden of funding such a system. Over time,
the US and other industrialized countries may find that China is the real innovator in health system reform—for better or
worse.
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