What are the reforms in the rural health system

China is a developing country with an overwhelmingly rural population, and how to deepen the reform of the rural health system, promote the development of rural health undertakings, and improve the health of rural residents is directly related to the realization of the strategic objectives of national economic and social development, and to social stability in rural areas. Since 1994, China has been carrying out pilot health-care reforms, and in 1998 the health-care reforms entered the organizational and implementation phase; in July 2000, a working conference on the reform of the basic medical insurance system and the medical and health-care system for urban workers was held, and the reform of the rural medical and health-care system was carried out in a comprehensive manner. On the whole, however, the reforms have had little effect, and rural health work is still relatively weak, with many problems and new challenges. First, plagued by China's rural health system reform of several issues since the founding of the country, rural health undertakings have developed greatly, rural counties, townships, villages, three-tier health service network, cooperative medical system and rural health team building have made remarkable achievements, to protect the health of rural residents, and to promote the economic development of rural areas and social progress has played an important role. However, with the deepening of China's economic system reform and the gradual establishment of the socialist market economic system, the original collective economy-based rural health care system has lost its vitality, and farmers' health care is seriously lagging behind relative to China's economic development. 1. Rural public **** health investment is seriously inadequate. The growth of rural public **** health expenditure is mainly due to the growth of personnel expenses, official expenses and operating expenses almost no growth or even decline. Rural public **** health official fees and operating costs, government spending gradually lower, official fees and operating costs from the 1991 258 million yuan fell to 184 million yuan in 2000, excluding the price impact factor, the average annual growth rate of -10.7 per cent; resulting in the public **** health institutions through the "paid services" to "generate income". "Income generation", to solve the problem of insufficient funds for operational activities (see Annex Table 1 [1]). Rural grassroots preventive health care services are seriously underfunded, preventive health care has weakened, and certain infectious, parasitic, and endemic diseases that have been eradicated or have been brought under control have resurfaced from time to time in some localities, and there are different degrees of prevalence of newly occurring diseases. Exhibit 1: Analysis of Changes in Trends in the Structure of Fiscal Expenditures in the Rural Public*** Health Sector 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Total Government Fiscal Expenditures on Public*** Health 7.49 8.27 9.14 11.40 12.70 13.90 15.68 17.33 17.67 19.66 Personnel 3.70 4.68 5.49 7.69 8.67 9.96 11.48 13.45 15.21 17.49 Official and operational expenses 2.58 2.12 2.08 2.10 2.21 2.15 2.01 2.05 2.10 1.84 Project grants 1.21 1.48 1.58 1.61 1.82 1.80 2.19 1.83 0.36 0.32 2. The distribution of health resources is unreasonable, and the health status of farmers is significantly lower than that of urban residents. The allocation of health resources in China is seriously irrational; according to statistics, in 1998, the total national health expenditure amounted to 377.65 billion yuan, of which 58.72 billion yuan was invested by the Government, while 9.25 billion yuan, or only 15.9 per cent of the Government's investment, was spent on health in rural areas. In that year, the urban population was about 379 million, with an average of 130 yuan per person for government medical and health services, while the rural population was 866 million, with an average of 10.7 yuan per person for government medical and health services, the former being 13 times as much as the latter. The lack of medical care for farmers is a serious problem, and Zhu Qingsheng, vice-minister of health, said that many people in China's rural areas are indeed unable to afford to see a doctor nowadays. According to statistics and the results of rural surveys and studies, it is estimated that 40 to 60 percent of the people who cannot afford to go to the doctor become poor and return to poverty because of illness. In the central and western regions of China, the number of people who die at home due to illness because they cannot afford to see a doctor or stay in a hospital is estimated to be 60%-80% [2]. The World Health Organization usually uses three indicators to measure the health level of the population in a country (or region), namely maternal mortality rate, infant mortality rate and life expectancy per capita. According to the statistics of the Ministry of Health, there is a clear gap between urban and rural areas in maternal and child mortality rates in China (Table 2 [3]). 2002 Maternal Mortality Rates in Urban Areas Table 2: Maternal and Child Mortality Rates in Monitoring Areas Total Urban Rural 2001 2001 2001 2001 2001 2001 2002 Maternal Mortality Rate (1/100,000) 50.2 43.2 33.1 22.3 61.9 58.2 Neonatal mortality rate (‰) 21.4 20.7 10.6 9.7 23.9 23.2 Infant mortality rate (‰) 30.0 29.2 13.6 12.2 33.8 33.1 Mortality rate of children under 5 years of age (‰) 35.9 34.9 16.3 14.6 40.4 39.6 22.3 per 100,000, whereas in rural areas the maternal mortality rate is 58.2 per 100,000, higher than the rate for rural areas. The urban infant mortality rate is 12.2 per 100,000, while the rural infant mortality rate is 33.1 per 100,000, which is 2.7 times higher than the urban rate. The main results of the Ministry of Health's Third National Health Service Survey in 2004 showed that, over the past five years, the average annual income level of urban residents increased by 8.9% and that of rural residents increased by 2.4%, while annual medical and health expenditures in urban and rural areas increased by 13.5% and 11.8% respectively. As Nobel Prize-winning economist Sen (1989) pointed out in the late 1980s, China's agricultural products and farmers' incomes have been relatively stagnant or regressive in vital statistics, despite the substantial growth in agricultural products and farmers' incomes after the reforms. [4] It can be seen that the problem of farmers' health care has seriously constrained the further development of China's rural society and economy. 3, the low quality of rural health personnel, a lack of talent. Health technicians are an important part of health resources, but also an important symbol reflecting the level of health services in a country and region. As of the end of 2000, ① China has 1067,269 rural doctors, compared with 776,859 in 1990, an increase of more than 290,000 people; ② the average number of rural doctors per village is 1.56, compared with 1.01 in 1990, an increase of 55 percentage points; ③ the rural doctor training qualification rate of 86.01%; of which 45 years old and under the rural doctors to accept the The qualified rate of "two education" (systematic and formalized secondary medical education) reached 82.27%; the qualified rate of rural doctors aged 46 and above who received secondary school level and item-by-item business training reached 89.77%. [5] According to the Ministry of Health's "China's Health Statistics Summary 2004", China's township health centers have zero senior health technicians with doctoral or master's degrees, 1.6% of university undergraduate degree holders, 17.1% of college degree holders, 59.5% of middle school degree holders, and 21.8% of high school degree holders or less. The above data reflects the status quo of rural health technicians in China: there is a shortage of highly educated personnel and the quality of health personnel is low. Exhibit 3: Composition of health technicians' academic qualifications Doctorate Master's Degree University College Junior college High school or below Total Hospitals o.3 1..3 17.9 29.5 41.7 9.3 100% Rural health centers o o 1.6 17.1 59.5 21.8 100% (Note: Source: Ministry of Health's "China's Health Statistical Abstracts, 2004"). 4. Implementation of the new type of cooperative medical care system for the rural areas has been difficult. The establishment of the new rural cooperative medical care system is a major initiative of the CPC Central Committee and the State Council in the new situation to effectively solve the problems of agriculture, rural areas and farmers, and to coordinate urban and rural areas, regions and economic and social coordinated development. But after the pilot work found that many problems, first of all, farmers on the new rural cooperative medical system is not enough to understand, doubtful. There is a lack of publicity and education here, but the more important reason is that farmers have little confidence in the stability and systematic nature of the country's rural health policy, and the benefits of predictability are slim. Secondly, the price of medicines remains high, which is too much for farmers to bear. After the reform and opening up, although farmers' incomes have increased and the problem of food and clothing has been solved, the difficulty of seeing a doctor has become more and more serious; in 2003, the per capita income of farmers in China was 2,622 yuan, and the average cost of hospitalization for a farmer was 2,236 yuan. In other words, if a farmer is hospitalized, his entire year's income may be spent on medical expenses. Third, the management of rural medical institutions is chaotic. By the end of 2003, 515,000 village health centers had been set up nationwide, of which 277,000 were village-run, 36,000 were jointly operated, 26,000 were set up by township health centers, and 158,000 were privately operated.[6] And the number of rural health centers is still very low. [6] And a considerable number of village-run health centers do not live up to their name. So private or family-type medical service outlets make farmers feel insecure about their financial investment. Second, the positioning and direction of rural health reform to promote the reform of rural health care, the state has also adopted a series of policies, such as the separation of medicine, the bidding and purchasing of drugs, the classification and management of medical institutions, the integration of rural health service management, the establishment of a new type of rural cooperative medical system and so on, but none of them has fundamentally solved the problem of farmers' health care. The effectiveness of the reform is far from people's expectations, in which the positioning and direction of rural health reform is not clear is an important reason. First of all, we must adhere to the idea that rural health care is a social public **** product, is a welfare public welfare. "Agriculture, rural and peasant issues, is always a fundamental issue related to the overall situation of our party and country" [7]. The development of rural health undertakings the government has an unshirkable responsibility, mainly by the government financial support, but never simple marketization. China's public **** product supply has been the implementation of urban and rural division of the "two-track" system. The provision of basic and guaranteed public **** products for farmers is conducive to breaking the basic pattern of urban-rural division, to promoting coordinated urban-rural development, and to adapting the Party's basic rural policy to the process of reform and development.Since the 1980s, the rural cooperative medical system has basically been dismantled, and the vast majority of farmers have become self-financing medical groups. Because the growth rate of farmers' incomes has not kept pace with the rise in medical costs, the problem of farmers being unable to afford to see a doctor has become more prominent. For the majority of farmers, "health is wealth, and disease is poverty". Therefore, rural health care should be treated as a basic public **** product, requiring strong financial support from the State. Only if the government effectively provides rural public **** health services, resolves rural social conflicts and reduces social risks, can we maintain the country's long-term stability and sustainable socio-economic development. Secondly, it is necessary to set up a concept that is people-oriented and farmer-oriented, and to narrow the gap between urban and rural areas. For the sake of sustainable socio-economic development and the long-term interests of our country, a policy of "rest and recuperation" has been implemented in the countryside to increase the income of peasants and improve their ability to withstand natural and man-made disasters. For example, in 2004, document No. 1 of the Central Government decided to implement the "two exemptions and three subsidies" for farmers (abolishing special agricultural production taxes other than on tobacco, reducing and exempting agricultural taxes, and providing direct subsidies to grain farmers, subsidizing the purchase of good seeds and subsidizing the purchase of large-scale agricultural machinery), which has directly benefited farmers in China to the tune of 45.1 billion yuan. At the same time, through fiscal transfers and tax exemptions, subsidies are provided to grain farmers to stimulate food production and increase farmers' incomes, which belongs to the camera decision-making in the public ****conomic decision-making. Emergency corrective interventions in response to China's seven years of slow growth in farmers' incomes and slippage in food production have been very effective. In terms of rural health care, Document No. 1 of 2005 stipulates, "Adhere to the health work policy focusing on rural areas, actively and steadily push forward the pilot of the new type of rural cooperative medical care and rural medical assistance, implement the planning for the construction of rural medical and health care infrastructures, speed up the training of rural medical and health care personnel, and improve the level of rural medical services and the ability to respond to public ****health emergencies capacity." Substantial measures to benefit farmers are also needed to ensure this. Thirdly, we must enhance a sense of adherence to the law and strengthen health legislation. The reform of rural health care must have a clear direction and stable policy, and must not be changed from one day to the next. Otherwise, farmers will be so skeptical that they will wait, wait and see, or even resist the state's guidelines, policies and measures. Our government has issued a number of supporting documents for the reform, and has formulated reform documents on regional health planning, community health services, integration of rural health service management, the health supervision system, and the health personnel system, thus forming a policy system that comprehensively promotes the reform and development of China's urban medical and health care system. in October 2002, the CPC Central Committee and the State Council issued the "Decision on Further Strengthening the Work of Rural Health" and convened a national conference on the reform of rural health care. In October 2002, the CPC Central Committee and the State Council issued the Decision on Further Strengthening Rural Health Work, held a national conference on rural health work, and decided to establish a new type of rural cooperative medical system. However, because of the complexity of the area of health-care reform and the need for concerted efforts at a deep level, and because it involves the vital interests of farmers, legislation must be adopted to ensure the reform and construction of a multilevel medical security system and rural health care. In addition, the State's financial input into the public health-care system and the transfer of payments to rural areas for health care should also be legally guaranteed, so as to eliminate the arbitrariness and repetitiveness of the State's decision-making intentions. With regard to the operation of the rural cooperative medical and health system and the management of the fund, the normal operation of the cooperative medical system should be ensured through the formulation of fair, just and open rules and regulations and the establishment of a non-profit rural medical security administration, as well as a supervisory and reviewing body with the participation of the farmers, the Government, the management organizations and the specialists***. Third, strengthen the rural health reform countermeasures to think to achieve "to 2010, in rural areas across the country basically established to adapt to the requirements of the socialist market economic system and the level of rural economic and social development of the rural health service system and rural cooperative medical system" [8] of the rural health work of the goal, we must take into account the overall situation and reasonable Decision-making. 1, rationalize the rural health management system, the implementation of integrated management of rural health organizations. Governments at all levels in accordance with the hierarchical management, county (city) based rural health management system, the rural public **** health work to assume full responsibility for strengthening the leadership of rural health work. The implementation of integrated management of rural health organizations and the establishment of the management status of township health centers in rural health service work, with county (city) level governments taking responsibility, is conducive to resolving the contradiction between the lack of supervision and management of rural health services. In the township health centers as the main unified management, rural health institutions at both levels can form a hierarchical management, complementary functions, the coordinated development of the service system, only through the unified management of the township health centers, the county-level health administrative departments may be able to realize the rural health work of the whole industry management, rural health undertakings to lead to the healthy development of the track. The core of the integrated management of rural health organizations is in management, revitalizing existing health resources, mobilizing enthusiasm, and strengthening the functions of preventive health care and public **** health services. Strengthen the county of rural health business support and regulatory functions, improve the comprehensive service capacity of rural health organizations, and comprehensively improve the quality of service and management of rural health institutions. 2, increase rural health investment, support the construction of rural health care infrastructure. At present, China's health expenditure accounts for 1.6%-1.7% of financial expenditure. In this part of the financial expenditure, 70% of the medical cost in the city, 30% in the countryside; and 70% of our population in the countryside, that is to say, 30% of the population occupied 70% of the health resources, including government expenditure. Under the conditions of a market economy, the domain and guiding role of government investment in rural health care at all levels is irreplaceable by other sources of health costs (including community financing, social financing, fees for services, etc.), so financial investment in health should be appropriately tilted towards the rural areas and support for rural health increased. State finances should subsidize the construction of infrastructure and the purchase of equipment for rural health institutions in impoverished areas. A system of counterpart support and medical tours should be implemented, with counterpart support focusing on the construction of county-level medical and health institutions and township (township) health centers by means of aid in the form of medical equipment, personnel training, technical guidance, medical tours, two-way referrals, discipline construction, and cooperative management. To improve the effectiveness of input, the focus of financial support to adjust to support public **** health, preventive health care, personnel training and the establishment of a medical security system. 3, rational layout, unified planning, effective use of existing health resources. With the changes in rural economy, transportation, regional and grass-roots organizations, the original three-tier medical institutions are not set up reasonably, and even duplication of construction. There are all kinds of non-adaptation, need to be adjusted and reform. First, the layout of administrative divisions should be broken down to solve the problem of duplication in the establishment of township health centers, insisting in principle on the principle of "one hospital for one township" and "one room for one village". In principle, "one hospital for each township" and "one room for each village" should be adhered to. The establishment of township health centers and village health rooms should take into account the size of the population they serve and the size of their service radius. Secondly, township health centers and township family planning guidance stations should be ****enjoyed, in order to resolve the waste of resources caused by the two being established side by side. Third, for those township health centers that are too close to county-level medical institutions and have poor viability, they should be abolished, merged or transferred to realize resource *** enjoyment and avoid low-level duplication of construction. Fourthly, the number of rural doctors should be controlled and their quality improved. The access system for rural doctors should be strictly implemented. Fifth, under the premise of clear service function, strictly control the purchase of high-grade equipment, reduce the waste of idle resources. 4. Reform the training mode of rural health personnel and strengthen the continuing education system. The development of rural health care, the key is still talent. According to the low quality of rural health personnel in China, the lack of talent in the status quo, one should be directed to cultivate applicable talents, encourage graduates of medical schools and urban health institutions in-service or retired health technicians to rural services. The State can arrange special funds to commission higher medical schools to train general practitioners for rural areas, or medical schools and local governments to jointly organize rural-oriented tertiary-level classes, i.e., schools and local governments to sign agreements or contracts, and students are all directed to be assigned to work in counties, townships, and villages in medical and health institutions. Second, the continuing education system should be strengthened, and the training of rural health technicians in business knowledge and skills should be enhanced. At present, the age structure, cultural level, quality of medical knowledge, operational skills and service attitude of rural doctors around China are still far from the standard of general practitioners. To strengthen on-the-job rural doctors to take a variety of ways of general medical education and training, and encourage the conditions of rural doctors to receive medical education, and strive to 2010, most of the country's rural doctors have practicing assistant physician and above the licensing qualifications.