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China's Ministry of Health (MOH) will realize its promise to reform the current healthcare system, according to Minister Gao Qiang, who mapped out a reform sketch to the public for the first time at the national health work conference on January 8. The four basic systems, namely the basic healthcare system, basic heath insurance system, basic medicine system, and public hospitals management, altogether serve the goal of "basic healthcare covering all urban and rural citizens".

Under the new systems, the government will provide financial support as well as services and medicine supply. Although the sketch has been lauded as the right step forward, questions have been raised over many of the proposed changes, resulting in continued debate between ministries.

One of the more pressing issues is the amount of money that needs to be injected into the project. According to the preliminary calculations of a working team to intensify healthcare reforms, the government should invest 260 billion yuan in the project to guarantee access for everyone to free basic medical services. However, officials from the Ministry of Finance say: "In practice, the project will require an endless investment."

Speaking at a regular press conference, the Health Ministry's spokesman said: "In our opinion, it's the right time to carry out the project," arguing that China's rapid economic development can provide the financial support needed to fund the new system. Gao also said that the budget was affordable.

Another question that has been raised is how and who has the responsibility of defining "basic medical services". The MOH intends to make a list of basic medical services, medicines and diseases that come under the general definition of "free medical services" that is accessible to everyone.

"Primary medical services already include the prevention and treatment of common and regularly occurring diseases at the community level. As such, the term 'basic medical services' is confusing even for medical professionals," said an official from the Ministry of Labor and Social Security.

When asked why the government plans to offer free treatment as part of "basic medical services", Mao Qun'an, the MOH spokesman said: "Early diagnosis should be included in public health." He added that the costs of diagnosis and treatment at an early stage of some diseases are reasonably affordable. Overall medical fees would increase if the disease is not treated in time.

Mao also acknowledged that while there is no clear definition for "basic medical services", as far as policy is concerned, it could be defined as medical services available in community and rural medical centers. Further, defining the term according to service levels is not only feasible but also acceptable.

But the Ministry of Labor and Social Security disagrees, arguing that "the definition is too ambiguous". In addition, if "basic medical services" is defined by the type and service levels of medical centers, this would result in the medical centers, while continuing to receive government financial support, making a profit from medicine sales, a feature of the current healthcare system that has already been severely criticized.

Then there is the issue who should have the authority to decide on the definition of "basic medical services”.

"It can't be defined by one single ministry," said the official from the Ministry of Labor and Social Security, adding that it would be unreasonable to give the term the status of a system. "If that happens, there will be widespread buck-passing between medical centers and hospitals."

Experts from the ministry have also questioned the plan to put service suppliers in charge of basic medical services. If financial support corresponds to the number of services provided, the suppliers might push overpriced and unnecessary services to patients. On the other hand, there could result in a deficiency of services if patient numbers become a criterion.

A third issue that is being debated involves the relationship between finances and service quality.

Under the proposed changes, service suppliers are to distribute medical services fairly and impartially, ensuring that more people benefit from healthcare system. However, this could start to go wrong if suppliers are not motivated to improve their services because their funding is guaranteed.

There are also concerns that in the event of a funds shortage, this will directly impact the range of medical services available. Therefore, Ministry of Labor and Social Security experts maintain that medical resources will be more effectively utilized under a scheme of services purchasing, which involves a third party, not the government, investing directly in medical centers, be they public or private.

(China.org.cn by Huang Shan, January 24, 2006)