Class: A (Mon.

)
ID: 101001043
Name:
Medicine & Society
For me, I think Perspective 2 is the truest description. Despite the fact that the
Taiwanese health insurance is universal, there are still lots of people over the world
who arent incorporated into the healthcare system. It means that the poor may not be
able to pay such a large amount of money to cover the expense of healthcare.
According to the CDC (Centers for Disease Control and Prevention), even the United
States is a country that heavily relies on the private health insurance. In addition, there
are only 58% of Americans under the coverage of the private insurance. The
government of the United States is still in negotiations with many benefits-related
groups on the sweeping reform. The longer we drag, the more people gonna fall
victim to the twisted system. So what exactly causes this situation? Whos involved? I
think the capitalism plays an important role in the cycle. If we all consider healthcare
to be a part of the industry, then many of us will definitely be in pursuit of the
maximum of the profit. And simultaneously, the poor and the marginal would end up
to be sacrificed. So thats why universe health insurance is so essential to our society.
When the system is set up, the government should take related actions to keep some
situation from happening. Take the medical employees for example, if the health
insurance is being carried out universally, the environment for doctors and nurses
might be more demanding and painstaking. And its more likely for the people in the
society to exploit the precious resources of medicine. Thus the governments effort is
highly significant for the balance between capitalism and socialism. Theres a long
way for Taiwan to go.

United Kingdom[edit]
Main article: National Health Service (England)
The UK's National Health Service (NHS) is a publicly funded healthcare system that
provides coverage to everyone normally resident in the UK. It is not strictly an insurance
system because (a) there are no premiums collected, (b) costs are not charged at the patient
level and (c) costs are not pre-paid from a pool. However, it does achieve the main aim of
insurance which is to spread financial risk arising from ill-health. The costs of running the
NHS (est. 104 billion in 2007-8)
[42]
are met directly from general taxation. The NHS
provides the majority of health care in the UK, including primary care, in-patient care,
long-term health care, ophthalmology, and dentistry.
Private health care has continued parallel to the NHS, paid for largely by private insurance,
but it is used by less than 8% of the population, and generally as a top-up to NHS services.
There are many treatments that the private sector does not provide. For example, health
insurance on pregnancy is generally not covered or covered with restricting clauses.
Typical exclusions for Bupa schemes (and many other insurers) include:
ageing, menopause and puberty; AIDS/HIV; allergies or allergic disorders; birth control,
conception, sexual problems and sex changes; chronic conditions; complications from
excluded or restricted conditions/ treatment; convalescence, rehabilitation and general
nursing care ; cosmetic, reconstructive or weight loss treatment; deafness; dental/oral
treatment (such as fillings, gum disease, jaw shrinkage, etc); dialysis; drugs and dressings
for out-patient or take-home use ; experimental drugs and treatment; eyesight; HRT and
bone densitometry; learning difficulties, behavioural and developmental problems;
overseas treatment and repatriation; physical aids and devices; pre-existing or special
conditions; pregnancy and childbirth; screening and preventive treatment; sleep problems
and disorders; speech disorders; temporary relief of symptoms.
[43]
( = except in
exceptional circumstances)
There are a number of other companies in the United Kingdom which include, among
others, AXA, Aviva, Bupa, Groupama Healthcare, WPA and PruHealth. Similar exclusions
apply, depending on the policy which is purchased.
Recently (2009) the main representative body of British Medical physicians, the British
Medical Association, adopted a policy statement expressing concerns about developments
in the health insurance market in the UK. In its Annual Representative Meeting which had
been agreed earlier by the Consultants Policy Group (i.e. Senior physicians) stating that the
BMA was "extremely concerned that the policies of some private healthcare insurance
companies are preventing or restricting patients exercising choice about (i) the consultants
who treat them; (ii) the hospital at which they are treated; (iii) making top up payments to
cover any gap between the funding provided by their insurance company and the cost of
their chosen private treatment." It went in to "call on the BMA to publicise these concerns
so that patients are fully informed when making choices about private healthcare
insurance."
[44]
The NHS offers patients a choice of hospitals and consultants and does not
charge for its services.
The private sector has been used to increase NHS capacity despite a large proportion of the
British public opposing such involvement.
[45]
According to the World Health Organization,
government funding covered 86% of overall health care expenditures in the UK as of 2004,
with private expenditures covering the remaining 14%.
[23]

Nearly one in three patients receiving NHS hospital treatment is privately insured and
could have the cost paid for by their insurer. Some private schemes provide cash payments
to patients who opt for NHS treatment, to deter use of private facilities. A report, by
private health analysts Laing and Buisson, in November 2012, estimated that more than
250,000 operations were performed on patients with private medical insurance each year at
a cost of 359 million. In addition, 609 million was spent on emergency medical or
surgical treatment. Private medical insurance does not normally cover emergency treatment
but subsequent recovery could be paid for if the patient were moved into a private patient
unit.
[46]

United States[edit]
Main articles: Health insurance in the United States and Health care in the United States
The United States health care system relies heavily on private health insurance, which is
the primary source of coverage for most Americans. According to the CDC, approximately
58% of Americans have private health insurance.
[47][48]
The Agency for Healthcare Research
and Quality (AHRQ) found that in 2011, private insurance was billed for 12.2 million U.S.
inpatient hospital stays and incurred approximately $112.5 billion in aggregate inpatient
hospital costs (29% of the total national aggregate costs).
[49]
Public programs provide the
primary source of coverage for most senior citizens and for low-income children and
families who meet certain eligibility requirements. The primary public programs are
Medicare, a federal social insurance program for seniors and certain disabled individuals;
and Medicaid, funded jointly by the federal government and states but administered at the
state level, which covers certain very low income children and their families. Together,
Medicare and Medicaid accounted for approximately 63 percent of the national inpatient
hospital costs in 2011.
[49]
SCHIP is a federal-state partnership that serves certain children
and families who do not qualify for Medicaid but who cannot afford private coverage.
Other public programs include military health benefits provided through TRICARE and the
Veterans Health Administration and benefits provided through the Indian Health Service.
Some states have additional programs for low-income individuals.
[50]

In the late 1990s and early 2000s, health advocacy companies began to appear to help
patients deal with the complexities of the healthcare system. The complexity of the
healthcare system has resulted in a variety of problems for the American public. A study
found that 62 percent of persons declaring bankruptcy in 2007 had unpaid medical
expenses of $1000 or more, and in 92% of these cases the medical debts exceeded $5000.
Nearly 80 percent who filed for bankruptcy had health insurance.
[51]
The Medicare and
Medicaid programs were estimated to soon account for 50 percent of all national health
spending.
[52]
These factors and many others fueled interest in an overhaul of the health care
system in the United States. In 2010 President Obama signed into law the Patient
Protection and Affordable Care Act. This Act includes an 'individual mandate' that every
American must have medical insurance (or pay a fine). Health policy experts such as
David Cutler and Jonathan Gruber, as well as the American medical insurance lobby group
America's Health Insurance Plans, argued this provision was required in order to provide
"guaranteed issue" and a "community rating," which address unpopular features of
America's health insurance system such as premium weightings, exclusions for pre-existing
conditions, and the pre-screening of insurance applicants. During March 2628, the
Supreme Court heard arguments regarding the validity of the Act. The Patient Protection
and Affordable Care Act was determined to be constitutional on June 28, 2012. SCOTUS
determined that Congress had the authority to apply the individual mandate within its
taxing powers.
[53]

http://wenthome.pixnet.net/blog/post/26645477-%e5%b0%88%e9%a1%8c%ef%bc%
9a%e7%be%8e%e5%9c%8b%e5%81%a5%e4%bf%9d%e6%94%b9%e9%9d%a9%e
7%b0%a1%e4%bb%8b-%28american-health-care-refo
Healthcare reform in China
From Wikipedia, the free encyclopedia
(Redirected from Healthcare reform in the People's Republic of China)
Jump to: navigation, search
Main article: Health in China
The healthcare system reform in China refers to the healthcare system transition in modern
China. China's government, specifically the Ministry of Health of the State Council
oversees the health services system, which includes a substantial rural collective sector but
little private sector. Nearly all the major medical facilities are run by the government.
China's healthcare reform history has seen an increase in quality after 1949 with the
establishing of the Cooperative Medical System, and a collapse in healthcare with
economic reforms post-1980. Recent reforms include the New al Cooperative Medical
System, health insurance reforms, the World Bank Health VIII project, and the Healthy
China 2020 project, but challenges still exist in providing universal healthcare access to all
of China, most notably the rural sectors.
History of reform[edit]
1940s-1980s[edit]


A barefoot doctor examines a child.
After 1949, the Chinese Communist Party took control of China, and the Ministry of
Health effectively controlled Chinas health care system and policies.
[1]
Under the
Chinese government, the countrys officials, rather than local governments largely
determined access to health care. Rural areas saw the biggest need for healthcare reform,
and the Rural Cooperative Medical System (RCMS) was established as a three-tier system
for rural healthcare access. The RCMS functioned on a pre-payment plan that consisted of
individual income contribution, a village Collective Welfare Fund, and subsidies from
higher government.
[2]

The first tier consisted of barefoot doctors that were trained in basic hygiene and traditional
Chinese medicine.
[3]
This system of barefoot doctors was the easiest form of healthcare
access, especially in rural areas. Township health centers were the second tier of the
RCMS, consisting of small, outpatient clinics that primarily hired medical professionals
that were subsidized by the Chinese government. Together with barefoot doctors, township
health centers were utilized for most common illnesses. The third tier of the, county
hospitals, was for the most seriously ill patients. These hospitals were primarily funded by
the government, but also collaborated with local systems for resources (equipment,
physicians, etc.)
[2]

Public health campaigns to improve environmental and hygienic conditions were also
implemented, especially in urban areas.
[3]
The RCMS has significantly improved life
expectancy and simultaneously decreased the prevalence of certain diseases. For example,
life expectancy has almost doubled (from 35 to 69 years), infant mortality has been slashed
from 250 deaths to 40 deaths for every 1000 live births. In addition to this, the malaria rate
has dropped from 5.55% of the entire Chinese population to 0.3% of the population. This
increase in health has been from the efforts of both the Chinese government as a whole and
also local, community efforts to increase good health. Campaigns sought to prevent
diseases and halt the spread of agents of disease for example, mosquitoes causing
malaria. Attempts to raise public awareness of health were especially emphasized.
1980s-present[edit]
The CMS saw great improvements to public health. Infant mortality decreased from 200 to
34 per 1000 live births, and life expectancy almost doubled, increasing from 35 to 68
years.
[1]
However, the agricultural sector reform slowly ended the original CMS during the
1980s, which had an adverse effect on the poor.
[2]
The impoverished, especially in rural
areas, had no way of paying for medical care. A decentralization of the Chinese
government meant a decrease in government involvement in public health services, which
in turn made quality healthcare access much more difficult for poorer individuals. In fact,
government spending on public health decreased from 32% to 15% as a result of the
agricultural sector reform.
[1]
Recent changes have been implemented in an effort to ensure
healthcare for all of China.
Recent changes[edit]
New Rural Cooperative Medical Care System[edit]
As a result of the agricultural sector reform and the end of the old CMS in the 1980s, many
rural areas experienced struggles in affording healthcare fees. The New Rural Cooperative
Medical Care System (NRCMCS) is a new initiative that was established in 2003 to
overhaul the healthcare system, particularly intended to make it more affordable for the
rural poor.
[4]
The main difference between the NRCMS and original RCMS is that it is a
voluntary system. Much of the NRCMS aims to reform both private and public sectors of
health.
[2]
This contrasts with the old RCMS that was almost completely funded by the
Chinese government and extended universally across all parts of China. The specifics of
the program vary by county, but are funded by individual contributions and government
subsidies for the poor.
[5]
Preliminary studies saw favorable participation of greater than
80%, which was believed to be partially from a push from both the local and national
governments to participate.
There are some difficulties that persist in the NRCMCS. The program lacks adequate
funding, medical staff, and sufficient equipment that is paid for by the government.
[5]
One
particular issue is that while inpatient costs are covered, the majority of outpatient visits
are not, which leaves many people still unable to pay for hospital visits. Additionally, the
new CMS, like the old system, is tiered, but this also depends on the specific location. The
details of the NRCMCS show that patients benefit most from the NRCMCS at a local level.
If patients go to a small hospital or clinic in their local town, the scheme will cover from
70-80% of their bill, while if they go to a county one, the percentage of the cost being
covered falls to about 60%, and if they need specialist help in a large modern city hospital,
they have to bear most of the cost themselves, where the scheme would cover only about
30% of the bill.
[6]

Healthy China 2020[edit]
The Chinese government recently declared the pursuit of Healthy China 2020, a
program to provide universal healthcare access and treatment for all of China by the year
2020, mostly through revised policies in nutrition, agriculture, food, and social marketing.
[7]

Much of the program centers on chronic disease prevention, and promoting better lifestyle
choices and eating habits. The program especially targets public awareness for obesity,
physical inactivity, and poor dietary choices. Healthy China 2020 focuses most on urban,
populous areas that are heavily influenced by globalization and modernity.
[7]
Additionally,
much of the program is media run and localized, concentrating on change through the
community rather than local laws. Many of the aims of Healthy China 2020 are
concentrated to more urban areas that are under Western influences. Diet is causing obesity
issues, and an influx of modern transportation is negatively affecting urban environments
and as a consequence, health.
World Bank Health VIII project[edit]
An example of a reform model based on an international partnership approach was the
Basic Health Services Project. The project was the 8th World Bank project in China, and
was implemented between 1998 and 2007 by the Government of China in 97 poor rural
counties in which 45 million people live.
[8]
The project aimed to encourage local officials to
test innovative strategies for strengthening their health service to improve access to
competent care and reduce the impact of major illness. Instead of focusing on eradicating a
specific disease, as previous World Bank projects had done, the Health Services Project
was a general attempt to reform healthcare.
[9]
Both the supply (medical facilities,
pharmaceutical companies, professionals) and demand (patients, rural citizens) side of
medicine were targeted.
[9]
In particular, the project supported county implementers to
translate national health policy into strategies and actions meaningful at a local level. The
project saw mixed results While there was an increase in subsidies from the government,
which was able to reduce out-of-pocket spending for residents, there was no statistically
significant improvement in health indicators (reduced illness, etc.)
[9]

Policy implications[edit]
In view of China managing major health system reform against a background of rapid
economic and institutional change, the Institute of Development Studies, an international
research institute, outlines policy implications based on collaborative research around the
Chinese approach to health system development.
[10]
A comparison of China's healthcare to
other nations shows that the organization of healthcare is crucial to its implementation.
There exists some degree of disorganization and inequity in access to healthcare in urban
and rural areas, but the overall quality of healthcare has not been drastically affected.
[11]

Certain incentives, such as adjusting prices of medical equipment and medicine have
helped improve health care to an extent. The largest barrier to improvement in healthcare is
a lack of unity in policies affecting each county. The Institute of Development Studies
suggests testing innovations at local level, encouraging learning from success, and
gradually building institutions that support new ways of doing things. It suggests that
analysts from other countries and officials in organizations that support international health
need to understand this approach if they are to strengthen mutual learning with their
Chinese counterparts.
[12]

Health insurance laws[edit]
Historically, there were two main health insurance systems: the labor insurance schemes
(LIS) and government employee insurance schemes (GIS).
[13]
Under the establishment of
these two health insurance systems, about 700 million rural Chinese citizens were health
uninsured, even with the availability of hospitals and medical professionals. The LIS was a
self-insurance system for all aspects of healthcare (clinic visit, access to medicine, etc.)
while the GIS provided insurance to state employees. After the 1980s reform, the Chinese
government began the transition to a new social insurance system for the entire country to
completely replace LIS and GIS.
[13]
The need for this new insurance system stemmed from
much of the rural Chinese population lacking medical insurance, exacerbated with rising
medical costs. In fact, in 1998, a mere 9.5% of the entire rural Chinese population had
medical insurance.
[14]

Besides only improving health insurance for the rural and insured, the new health
insurance system also improves health insurance standards for those in the lower-middle
income bracket, who now receive subsidies. By the new health insurance laws, citizens in
the middle class can now receive health subsidies of around 20 yuan, which is a contrast
from the past, where neither the central nor local governments provided any subsidies for
health insurance at all. An examination of the health insurance policies saw a need for
more sources funding, since funding from the Chinese government alone was not enough.
[13]

A new health financing policy that matches funds on a local and central government level
may prove to be an improved success.
[14]

Public opinion[edit]
Though life expectancy in China has increased and infant mortality decreased since initial
healthcare reform efforts, there is dissonance in quality of healthcare.
[2]
Studies on public
reception of the quality of Chinas healthcare in more rural Chinese provinces shows
continued gaps in understanding between what is available in terms of medical care and
affordability of healthcare.
[15]
There continues to be a disparity between the quality of
healthcare in rural and urban areas. Quality of care between private and publicly funded
facilities differs, and private clinics are more frequented in some rural areas due to better
service and treatment. In fact, a study by Lim, et al. showed that in the rural Chinese
provinces of Guangdong, Shanxi, and Sichuan, 33% of rural citizens in these provinces
utilize private clinics as opposed to governmentally funded hospitals. The study showed
that it was not so much the availability and access to health care for citizens, as it was the
quality of the public health care people were receiving that drove them to opt for private
clinics instead. The continued lack of health insurance, especially in the majority of rural
provinces (where 90% of people in these rural provinces lack health insurance)
demonstrates a continued gap in health equality.
[15]

Challenges[edit]
Many minority groups are still facing challenges in gaining equality in healthcare access.
Due to the 1980s health reform, there has been a general increase in government health
subsidies, but even still, individual spending on health has also increased. A disparity in
inequality between urban and rural areas persists, since much of recent government reform
is focused on urban areas.
[16]
Despite efforts by the NCRMS to combat this inequality, it is
still difficult to provide universal healthcare to rural areas. To add to this rural inequality,
much of the elderly population lives in rural areas and face even more difficulties in
accessing healthcare, and remains uninsured.
[16]

Like minority groups, health policy makers are also faced with challenges. First, a system
that keeps basic wages low, but allows doctors to make money from prescriptions and
investigations, leads to perverse incentives and inefficiency at all levels.
[2]
Second, as in
many other countries, to develop systems of health insurance and community financing
which will allow coverage for most people is a huge challenge when the population is
aging and treatments are becoming more sophisticated and expensive. This is true
especially in China, with the demographic transition model encouraging a larger aging
population with the one-child policy.
[16]
Several different models have been developed
across the country to attempt to address the problems, such as more recent, local,
community-based programs.