Health Care in Continental China

Name: ADRIANA ILHA DA SILVA

Publication date: 05/05/2017
Advisor:

Name	Role
PAULO NAKATANI	Advisor *

Examining board:

Name	Role
HELDER GOMES	Internal Examiner *
MARIA ANGELICA CARVALHO ANDRADE	External Examiner *
PAULO NAKATANI	Advisor *
ROGÉRIO NAQUES FALEIROS	Internal Examiner *

Summary: This PhD thesis presents the changes and reforms for health care in Mainland China, facing Deng Xiaoping’s “open doors” policy and economic reforms since 1978. As a result of political and economic decisions, a series of reforms on health care were implemented starting in 1980, with the introduction of a market mechanism. This has gradually altered health insure systems practiced under Mao Tsé-tung command in People’s Republic of China (PRC). We aim to demonstrate how health care has undergone a transformation from its centralized, preventive, collective and universal organization to one that is fragmented, decentralized, and of individual accountability, prioritizing high complex health sectors, with advanced technology and prescription of drugs with rising costs. In addition, that Hu Jintao’s (fourth generation) management has turned to some Maoist principles, such as universality, promotion of public health, prevention of major diseases, despite the remaining fiscal centralization. In the course of this work it has become evident that Cooperative Medical System aimed at rural population has collapsed, and was abandoned by the Ministry of Health from 1979 to 1981. There was a reduction of community funds; increase percentage of drug reimbursement; and full charge of health service by cooperative of which the fund was temporarily scarce for reimbursement (lack of loan repayment by the local government). In the 1990s, both the Government Insure System, which served government employees (9% of the urban population), and the Labor Insurance System were replaced by the Basic Medical Insure System, aimed at urban employees. In 2007, it became the Medical Insurance System for Urban Residents, adding migrant workers and farms who lost their land. Intending to replace the Rural Cooperative Medical System, some pilot initiatives of international organizations were experimented with in the 1990s, but only in 2003 it was implemented the New Rural Cooperative Medical System. The Medical Financial Assistance was established in 2003 to provide health care payments to the poor in urban and rural areas. Moreover, finally, if Deng Xiaoping’s reforms and Jiang Zemin’s measures compromised the collective nature of public health contributions, promotion, access, and coverage by making health users “cooperative” with government in health financing. Under Hu Jintao’s government there were some attempts with the National Health Reform, especially between the years of 2008 and 2009, which intended for universal coverage of rural and urban based on some principles for basic public health care from the Maoist Era.

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