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Chronology of China's Health-care Reform
2009/04/07
      China on Monday unveiled a blueprint on health-care over the next decade, starting the long-awaited reform to ensure fair and affordable health services for all 1.3 billion citizens.

    The major goal of the reform until 2020 is to build a basic health-care system that can provide "safe, effective, convenient and affordable" health services to urban and rural residents, according to the blueprint, endorsed by the Central Committee of the Communist Party of China and the State Council, or China's Cabinet.

    As the world's most populous country, China has been making continuous efforts over the past 60 years to reinforce its public health network.

    But unbalanced development in urban and rural areas, weak health-care facilities at grassroots level, low government funding and soaring medical bills have caused increasing complaints and made reform an urgent issue.

    Following are some major events in the development and reform of China's health-care system.

    Post 1949 -- After the founding of the People's Republic of China in 1949, governments cover more than 90 percent of medical expenses for urban residents.

    Meanwhile, rural people have access to subsidized health clinics run by "barefoot doctors", who are basically middle-school students trained in first aid. The primitive service, essentially free, plays a role in doubling the country's average life expectancy from 35 years in 1949 to 68 years in 1978.

    But when China begins its economic reforms in the early 1980s, the system is dismantled as the country attempts to switch to a market-oriented health care system.

    1985 -- China launches market-oriented reforms. Public hospitals are encouraged to make their own incomes with the aim of mobilizing medical workers and improving hospital efficiency. Public organizations are also encouraged to run medical institutions in order to make services more accessible. Government investment in public hospitals gradually falls.

    However, less input and supervision from the government result in over-commercialization of hospital practices. Hospitals prescribe drugs aggressively in order to make profits. Soaring fees plunge many rural and urban Chinese back into poverty and make medical services less affordable to ordinary citizens.

    1992 -- Special medical services, including better nursing and more comfortable wards, emerge as market forces increasingly dominate health-care reform.

    1994 -- The State Council launches a pilot scheme in two cities to establish a medical insurance system covering urban employees.

    1997 -- The State Council issues a historic decision, defining medicine as a public welfare sector, changing the previous concept that it was a commercial product.

    1998 -- China begins to establish a medical insurance system. The basic insurance system aims to cover all employers and employees in urban areas, including employees and retirees of all government agencies, public institutions, enterprises, mass organizations and private non-enterprise units.

    2000 -- The reform of the health-care system in urban areas is officially launched to divide hospitals into non-profit public hospitals as the majority and commercial hospitals as supplement.

    2002 -- The government decides to strengthen medical services in rural areas by planning a new rural cooperative medical care system.

    2003 -- The outbreak of severe acute respiratory syndrome (SARS) exposed weaknesses in China's ailing public health system, especially in rural areas.

    China launches the rural cooperative medical care program in 2003, under which rural residents and governments jointly contribute to a cooperative fund. Participants can reclaim some of the costs of hospital care. The rate of reimbursement varies according to the ailment and the actual cost of medical expenses incurred.

    2005 -- A report by the Development Research Center under the State Council harshly criticizes health sector reforms and concludes that reforms over the past decade were "basically unsuccessful".

    Statistics show that only 20 percent of medical fees are covered by the patients themselves in 1978. The percentage rose to52 percent in 2005.

    2006 -- The State Council sets up a joint working team consisting of experts from 16 departments to draft a new health reform plan.

    2007 -- China introduces a comprehensive medical insurance program that will cover all urban citizens, including children and the unemployed.

    The medical insurance system for urban employed covers 180 million Chinese people by 2007.

    February 2008 -- Initial edition of the reform plan is worked out.

    March 2008 -- The rural cooperative medical insurance system covers more than 804 million rural residents, accounting for 91.05percent of the rural population.

    October 2008 -- The reform plan is released for public debate. More than 27,000 comments and suggestions are offered in the month-long debate.

    January 2009 -- The State Council endorses the reform plan in principle, but holds it for further revision.

    April 2009 -- The reform plan is officially published for implementation.

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