Healthcare Newsletter – February 2010
- Premier Wen Jiabao faults the system for problems between doctors and patients (Wen Jiabao: The System is the Fundamental Reason for Doctor-Patient Problems) and advocates Confucius’ values to address issues concerning healthcare and food safety (Chinese Premier Emphasizes the “Power of Morality” to Combat Crises in Modern Society).
- Separately, a survey of health workers in Guangzhou found the group to suffer from a higher than average level of stress (Psychological Problems Afflict Many Medical Workers in Guangzhou).
- A lack of trust in the quality of community hospitals is cited as the primary issue deterring residents in Shenyang from seeking care at these facilities, even though policies are enacted to lower service and medicine costs (No Crowds Observed in Community Hospitals Following the Launch of “Zero Price Difference” Policy; Close to Half of Survey Respondents Indicate Willingness to Visit Community Hospitals Following the Unveiling of the “Zero Price Difference” Policy; Shenyang Government to Buy Public Health Services).
- The issue of trust also underscores the public’s reaction to a new standard introduced by the Ministry of Health (Public Concerned with Possible Abuse with New Standard Allowing Hospitals to Sign Consent Forms on Behalf of Patients).
- A number of public hospital directors are reluctant to participate in the public hospital reform pilots ahead of further clarity on the compensation system (With the Compensation System Remaining Unclear, Public Hospitals Reluctant to Participate in Reform Pilots), while an expert opines that health authorities should not be allowed to play both the regulator and investor of public hospitals (Experts: Health Authorities Should Not be Allowed the Identity of Public Hospital Investor).
- China issues the first national standard prescription drug formulary that is expected to curtail prescription abuse (China Issues Prescription Drug Formulary; Prescription Abuse Expected to be Curtailed).
Feb 2
Doctor-Patient Disputes are More Involved than a Matter of Expression
With the goal of resolving medical disputes, the Ministry of Health plans to initiate a project to promote the use of colloquial language in consent forms for surgical procedures. The reform in the communication model between doctors and patients will be tested in two public hospitals in Beijing for 6 months before a test pilot report is prepared and submitted to the ministry for consideration of a national rollout. From my perspective, the escalation of medical disputes is not just an issue of expression. The issue may be as what the Minister of Health Chen Zhu wrote recently that unreasonable systems have contributed to the dilution of public service mission of hospitals and contributed to the economic adversarial positioning between doctors and patients. The fundamental way to improve doctor-patient relations is by aligning doctors and patients that let the two parties join to become one party with shared interests. (Link to Chinese text)
Feb 5
With the Compensation System Remaining Unclear, Public Hospitals Reluctant to Participate in Reform Pilots
On February 2, the Executive Meeting of the State Council passed in principle a guiding opinion on public hospital reforms. According to the director of the Office of Reform of Nanjing Health Bureau, “Hospital directors do not want their hospitals to be selected for the pilot.” Until further clarifications are made on the issue of the financial compensation scheme, public hospitals are all cautious. This newspaper reporter learned that after the elimination of allowing sales margins on prescription drug sales, differences of opinion exist pertaining to the compensation schemes for hospitals to make up for the shortfall in revenues and the issue of separating hospital [regulatory] management from operations. Taking Nanjing for example, the city’s three-year pilot program requires over 8 billion yuan, but fiscal financing represents less than 10% of hospital revenue. Moreover, reforms of public hospitals’ property rights structure remain absent in this round of medical reform. (Link to full Chinese text)
Feb 8
Public Concerned with Possible Abuse with New Standard Allowing Hospitals to Sign Consent Forms on Behalf of Patients
The “Basic Standard for Medical Record Writing” issued by the Ministry of Health will be implemented starting March 1. The “Standard” specifies that during the course of saving a patient’s life, in the absence of a legal representative or authorized person for signing [the required medical authorization forms], a legal person or authorized person of the medical institution can sign [the required forms]. Some doctors acknowledged that the “Standard” might mean a greater share of responsibility for hospitals. One doctor commented, “The purpose of signing the forms on behalf of a patient is to save lives. However, should the medical procedure fail, the patient’s family members may turn around and pursue a legal judgment against the hospital.” Another doctor commented that given the strained doctor-patient relations today, patients and their families may believe that hospitals use the “Standard” as justification for ordering unnecessary tests and procedures in order to make a profit. Some citizens have expressed concern that individual doctors might abuse the “Standard” and believe that it needs further specification and clarification. (Link to full Chinese text)
Feb 27
(??????)Wen Jiabao: The System is the Fundamental Reason for Doctor-Patient Problems
During an online exchange with netizens, Premier Wen Jiabao commented that the overall situation between doctors and patients is good. He added that there are some problems that are not attributable to issues with doctors or patients and that the fundamental problem is with the system. (Link to full Chinese text)
Feb 27
Psychological Problems Afflict Many Medical Workers in Guangzhou
According to a survey conducted by the Guangzhou health authority, slightly over 17% of doctors and nurses in Guangzhou have had thoughts of suicide; close to 90% believe that they have had to deal with difficult patients; over 90% feel that they need to defend themselves against questions or investigations brought on by patients; and close to 50% indicate that given another career opportunity choice, they would not choose their present occupation. The survey was conducted in 2008, targeting 84 hospitals in 12 districts. It interviewed 1,182 medical workers. The survey found that the level of depression among medical workers is higher than in the overall population. Another recent survey found that over the past six months, close to 30% of medical workers have been assaulted verbally by patients, while 0.42% have experienced physical assaults. (Link to full Chinese text)
Feb 28
Chinese Premier Emphasizes the “Power of Morality” to Combat Crises in Modern Society
On the eve of the NPC and CPPCC 2010 session, Premier Wen Jiabao has once again joined netizens online. This is the second time that the premier has conducted an online exchange with citizens. Regarding the issue of problem infant formula, Wen reiterated that business people need to have a sense of morality in their blood. He highlighted that credibility and morality are urgent issues requiring resolution in modern society. He called upon youths and doctors to respond to the call for the “power of morality.” Analysts believe that the reiteration of the “power of morality” shows that, confronted with various crises, the government has given the “power of morality” a high level of consideration in order to rebuild Chinese moral and value systems, in addition to the government’s efforts to improve laws and other systems. Scholars pointed out that China is in the midst of a transition in which the old value system is being dismantled while the nation is still in the process of searching for a new value system. Wen Jia-bao’s promotion of concepts such as “loving others” and “compassion” are the core values of Confucius’ philosophy and should also be the common values of the modern civilized society. (Link to full Chinese test)
Feb 28
China Issues Prescription Drug Formulary; Prescription Abuse Expected to be Curtailed
The Ministry of Health issued the “China National Formulary (Chemical and Biological Products Volume)” on February 7. The volume is China’s first authoritative national standard formulary. The director of the Chinese Hospital Association, Cao Ronggui, remarked, “[The objectives for] the preparation and release of the National Formulary are to regulate medical practices, to improve clinical drug application, and the implementation of clinical path management. The National Formulary is also of significance for promoting better physician-patient communication and establishing a harmonious relationship between doctors and patients.” Some experts also commented that, in addition to providing citizens with a guiding reference on frequently used medicines, the “National Formulary” is also expected to curtail practices of prescription abuse. (Link to full Chinese text)
Feb 28
Experts: Health Authorities Should not be Allowed the Identity of Public Hospital Investor
Following the issuance of the guiding opinion on public hospital reform pilots, voices for promoting and supporting private sector participation in the medical sector have become clearer and louder. Some opine that the business environment for private hospitals will change for the better. Others believe that private hospitals will face further challenges. Yu Hui, an analyst at the Industrial Economics Institute of the Chinese Academy of Social Science, believes that the guiding opinion specifying that “the government is responsible for the basic building of public hospitals and the purchase of large-scale equipment” suggests that the government maintains a role to intervene in the internal management of public hospitals. This suggests that health authorities continue to play the role of an investor in public hospitals. This overlap of interests—health authorities as both the regulators and “bosses” of public hospitals—would be unfair to non-public hospitals. He further pointed out that discrimination remains in the scheme for qualifying hospitals for the [public] medical insurance. (Link to full Chinese text)
Feb 28
Close to Half of Survey Respondents Indicate Willingness to Visit Community Hospitals Following the Unveiling of the “Zero Price Difference” Policy
Following the implementation of the “zero price difference” policy on medicines in Shenyang community hospitals, a survey conducted by the Chinese Business Morning Post shows that close to half of the respondents indicated an interest in visiting community hospitals for care. The survey also showed that because many residents do not trust community hospitals, many would not be able to enjoy the benefits of the policy. A hospital director commented, “Until we address the issue of residents’ distrust of community hospitals, additional government policies will not translate into real benefits for residents.” Another hospital director pointed out that in order to achieve the goal of directing patients to visit community hospitals for common conditions and large hospitals for life-threatening diseases, it is not enough to rely solely on the “zero price difference” policy on drugs. The survey distributed 120 questionnaires of which 103 questionnaires were returned. (Link to full Chinese text)
Feb 28
No Crowds Observed in Community Hospitals Following the Launch of “Zero Price Difference” Policy
Yesterday was the first weekend following Shenyang’s implementation of a “zero price difference” policy for basic medicines in community hospitals. Patient traffic remains quiet at several community health centers and stations visited by a reporter from the China Business Morning Post. Residents’ reactions to the news of the policy were mostly uninspired. One resident commented, “I learned from TV about the ‘zero price difference,’ but I don’t have a favorable impression of public hospitals, so I will not visit there for care.” Another resident reported, “I will only buy medicines when I need them. I will not buy a lot of medicines simply because they are cheaper.” (Link to full Chinese text)
Feb 28
Shenyang Government to Buy Public Health Services
Shenyang issued a guiding opinion on a compensation scheme for community health organizations. According to the guiding opinion, Shenyang’s municipal government will now pay for residents’ healthcare services in community healthcare centers, in effect acting as a purchaser of public health services. The guiding opinion affirms the role of the government as the primary responsible party for basic health investments. Most of the public health services will be provided through government financing. (Link to full Chinese text)
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