Affordable clinics taking load off hospitals

Editor's note: China has established a basic medical insurance system with universal coverage. This has played an important role in making medical services more accessible and affordable, especially improving people's well-being and maintaining social harmony and stability in rural areas, writes a veteran journalist with China Daily.

Former US president Barack Obama signed the medical reform plan, Obamacare, in 2009, the same year when the Chinese government launched the New Cooperative Medical System. Both programs aimed at providing medical insurance to vulnerable groups who cannot afford to pay expensive medical bills.

More than a decade later, while about 30 million Americans are said to have benefited from Obamacare, many aspects of the law have got embroiled in litigation with opponents forever trying to overturn it.

In China, more than 800 million rural residents have signed up for the NCMS. For 350 yuan (about $49) each year, each payee gets about 70 percent of their medical expenses covered by insurance. The central authorities have also carried out several bulk-buying programs to bring down medical costs per patient and so far helped save about 300 billion yuan in medical insurance costs and patient expenditure.

Medical care has become affordable — 1.36 billion Chinese people are covered under medical insurance now — thanks largely to the government's persistent efforts. In the past decade, governments at various levels have worked hard at building and improving the primary medical institutions to make healthcare accessible for all citizens.

China now has nearly 980,000 primary medical institutions supported by 4.4 million grassroots healthcare workers. Such a network enables 90 percent of Chinese families to reach the nearest clinic in their community or village within 15 minutes.

Chinese citizens used to complain about difficulties in making an appointment with doctors who were overwhelmed by patients. Absence of institutional arrangements such as primary checking and treating by family doctors or grassroots clinics compelled many patients to throng hospitals to consult the best doctors possible for even a mild cold.

The establishment of the grassroots network diverted this stream of patients who were otherwise flowing into hospitals. Reportedly, of the 7.7 billion patients who visited medical institutions in 2020, around 55 percent went to community or village clinics, thus greatly reducing the load on hospitals.

To encourage more patients to visit such clinics, the authorities have introduced preferential policies such as not asking for any registration fee or charging just a token 1 yuan. The proportion of medical bills covered by medical insurance is also higher at clinics — 90 percent, as compared with 70-80 percent at hospitals.

Different from hospitals for disease control and prevention, primary health institutions provide both basic medical and public health services by treating mild diseases, as well as following up on patients with chronic diseases and newborns. In the past decade, Chinese people's life expectancy has grown by 2-3 months every year — last year it was 78.2. Credit for this goes largely to these grassroots-level health workers.

Efforts have also been made to improve the service quality in primary institutions. For instance, there used to be two community clinics close to each other in my neighborhood. Two years ago, they were merged into one. The new clinic is better equipped and armed with more doctors who are specialized in various fields and can attend to most cases.

The new clinic also employs doctors trained in traditional Chinese medicine and, on certain days of the week they invite experts from bigger hospitals — where appointments are generally difficult to get — to attend to the patients.

Rural clinics are simpler, usually having just one or two doctors. Judging by a few village clinics I have visited, they generally have a refrigerator and two shelves to store medicines in and instruments to measure patient's blood pressure and carry out blood sugar tests. A good thing about such clinics is that some of them provide basic medicines for free, thanks not only to the NCMS, but also government subsidies at different levels.

Now that a network of primary healthcare centers has been established, more efforts should be made to improve the quality of medical service in the institutions, especially in the rural clinics, because it is the villagers who need such help the most.

The author is former deputy editor-in-chief of China Daily.

kangbing@chinadaily.com.cn