Date and Time
September 26, 2007
1:30 PM - 3:00 PM

Availability
Open to the public
No RSVP required

Speaker
Karen Eggleston - Fellow, Walter H. Shorenstein Asia-Pacific Research Center at Stanford University

Virtually all recent research and commentary on China's healthcare system - in China and abroad - opens with some reference to the ubiquitous lament among PRC patients, "kanbing nan, kanbing gui" (getting medical care is difficult and expensive). Healthcare access and affordability have become key sources of discontent in both urban and rural areas. In fact, in 2005 a research institute under the State Council issued a report stating that China's healthcare reforms were "basically a failure", earning healthcare reforms the dubious distinction of being the only major policy labeled a failure by a government agency.

This paper will explore the institutions and incentives underlying China's healthcare system. A critical literature review sets the stage by identifying recurring themes and gaps in the literature. Drawing on a conceptual framework for China's dual-track "reform without losers" for most sectors of the economy (Lau, Qian, and Roland 2000), I discuss why the distinctive features of the health sector made applying a similar approach to healthcare problematic.

To illustrate the key drivers of policy and institutional changes and their consequence for consumers, patients, providers, insurers, and policymakers, China's experience is viewed through three comparative lenses: the forces driving healthcare reforms globally (e.g. technological change); in developing economies (e.g. epidemiological transition); and transitional economies (such as plan-to-market regulatory reform challenges and soft budget constraints).

I use a series of case studies to illustrate the transformations of China's healthcare system, drawing from local and regional fieldwork and three critical national episodes: the SARS epidemic, which profoundly raised the political profile of healthcare reform; the implementation of New Cooperative Medical Schemes; and the 2006-2007 National Commission on Health System Reform of more than ten government agencies, co-chaired by the Ministry of Health and the National Development and Reform Commission. The Commission took the interesting and somewhat unusual step this year of soliciting about ten reform proposals from independent research organizations (including several Chinese universities, the World Health Organization, the World Bank, and the international consulting firm McKinsey).

It is expected that the Commission will make a recommendation and announcement on the major outlines of reform prior to the autumn 17th Congress of the Chinese Communist Party. The actual reform process will no doubt unfold over years to come. The chapter will close with comments on this process and how the announced reforms hold promise for overcoming the growing pains of China's healthcare system.