??????????? Chinese healthcare system reformation

1
???????????Chinese healthcare system
reformation

• ????????????
• Chinese Pharmaceutical Enterprises Management
  Association
  President
• ???????????
• Beijing Pharmaceutical Group Co., Ltd.
  Honorary Chairman

??? Yu Mingde
2009.5.15
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? ?executive overview

• ???????????????
• Chinese healthcare system reformations
  retrospection
• ????????????
• System reformation is the key
• ???????
• Newly passed healthcare reformation scheme

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?? ?????????? Chinese healthcare system
reformations retrospection

• (?)?????????????????,??????
• 30 years of open-up policy realizes the change
  from planned economy to market economy, from
  shortage to surplus.
• 1978?65??
• 2008?8660?? ??133?!
• 2008??,???????? actual production
• ??3456?? ??821?? ???106??
• ??92?? ??10?? ??72??\?
• ??33??

??????????,????????,??? General drug market is a
surplus market with fierce competition.
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?? ?????????? Chinese healthcare system
reformation retrospection

• ?????????challenges pharmaceutical companies are
  confronted with
• 1.???? surplus manufacturing capacity
• 2.???????????????? Quality management system is
  not sufficient to direct manufacturing process.
• ??as of now
• ?????FDA????2?(???????)
• 2 products owned completely by local Chinese
  company are approved by FDA.
• ???????????14?(???????)
• 14 products owned completely by local Chinese
  company are approved by EMEA.
• ?????WHO?????10?(???????)
• About 10 products owned completely by local
  Chinese company are approved by WHO.

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?? ?????????? Chinese healthcare system
reformation retrospection

• (?)???????Chinese healthcare system
• ??????????,????,????
• Free medical care system
• ?????????
• Barefoot doctor
• 1998??????????
• ??????????
• The first medical insurance system Systems on
  Medical Insurance of Employees of Cities and
  Towns took effective
• ??????????????????
• But medical insurance for poverty stricken
  population? For severe diseases?

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???????????? The Key issue is the reformation of
system itself

• ???? -- ???? -- ????-- ????
• government-sponsored institution
  ----cardre----insufficient investment by
  government---medicine dispensed is hospitals
  biggest revenue source
• ???????? -- ??????-- ????
• Healthcare industry experience fast
  growth---patients shoulder a relatively big part
  of the healthcare expenditure---system
• 1.??????????????????? Contradiction between the
  fund needed to satisfy healthcare requirement and
  actual financial investment provided by the
  government
• ( ?1??2)
• 2.?????????????????????????????(?1??2??3??4??3)
• Contradiction between healthcare service and
  medicine supply system, the former is
  characteristic of planned economy, the latter,
  market economy.

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?1 ????????GDP??? The Percentage Chinese
healthcare expenditure accounts for GDP
5.54
????????????????? Healthcare expenditure/GDP rate
ranks top level among developing countries.
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?2 ????????GDP???????? Chinese healthcare
expenditure/GDP rate and tendency
Growth rate of healthcare expenditure
Growth rate of GDP
Growth rate of healthcare expenditure/GDP
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?????????????????
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????????,????????????healthcare industry
experiences fast development, peoples health are
improved greatly as well

• ??????????????
• fast developed healthcare industry drives the
  boom of medicine market.
• ??????7590?????,?GDP5.54,???????????
• Healthcare expenditure surpassed 759 billion RMB,
  accounting for 5.54 of GDP and ranking the top
  level of developing countries.
• ?????336??(???????3.6????2.6????0.8?)
• 3.35 millions sickbeds (USA3.6 sickbeds/1000
  persons, China2.6/1000 and India0.8/1000)
• ????525??(??????????2.7?, ??1.5????0.4?)
• 5.25 millions healthcare service employee(
  USA2.7 licensed physician/1000person, China1.5
  and India0.4)

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• WHO???????????????
• WHOs indexes to evaluate peoples health profile
  of a country
• ?????35???73?(??78? ??61? ????49?)
• Average life expectancy improved from 35 years to
  73 years (USA78, India61, Nigeria,49)
• ??????????200/??, ??????15.3/10?(??7 /??,??30
  /10?, ????112 /10?)
• Infant mortality rate decreased from 200/100000
  to 15.3/100000(USA7/100000,India,30/100000,
  Nigeria,112/100000)
• ??????????1500/10???????36.6/10?(??8/10?
  ??410/10? ????700/10?)
• maternal death rate decreased from 1500/100000 to
  36.6/100000(USA8/100000,India,410/10000 and
  Nigeria,700/100000)

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• ?????????????????????
• Central government decided to reinforce the
  construction of suburban and community healthcare
  system
• (2007??200????????????????100?)
• In 2007, central government invested more than
  RMB 20 billions into this project
• New Rural Cooperative Medical system will be
  extended to all counties.
• 2007???????312????????,?2006???86
• in 2007, RMB31.2 billion Central financial
  budget was invested to healthcare industry, 86
  higher than that of 2006.
• ????,????,???????????????
• Why the Giant and fast growing investment does
  not satisfy the peoples requirement accordingly?
  

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• 2.?????????? confrontation between planned and
  market economy
• ??????????,??????(7)? ????---??---???????
  ??? ??????
• State-owned hospitals hopes the government to
  provide enough investment to cover all its need
  while the government can only cover 7.
• Low governmental investment---profit
  generation---target medicines as revenue
  resource---big prescription\high priced medicines
  are preferred\unnecessary diagnosis
• ??????????????????????????...
• Red packets, backhander, too expensive healthcare
  service, confrontation between physicians and
  patients---angel and wolf?
• ???????????????????????????????????
• Government sponsored institution\cadre\tenure\huma
  n resource and allocation systems can not
  encourage the employees.
• ??? ????,????,???????
• Difficult to get access to proper medical
  treatment and high medical expenditure are
  mostly blamed by patients.

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• ???????????????,????????
• medicines dispensed generating revenue system
  blocked the development of healthcare industry
  and conditioned the construction of harmonious
  society.
• ??????????50
• Revenue generated from medicine accounts for 50
  of total.
• ???????42
• Drug add rate is 42
• ????????500?
• Hospitals revenue from medicine price
  appreciation is more than RMB 50 billions.
• ?????????????????
• Hospital\physician and medicine salesman are
  economically tied to each other.

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???????New healthcare reformation scheme

• (?)???????????????????
• ???????????????????????????,?????????,????????,?
  ?????,???????????????,??????,??????,????????,?????
  ???????????????????

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???????New healthcare reformation scheme

• President Hu Jintao clarifies that
• to implement the separation of the functions
  of the government from those of enterprises, the
  separation of the function of management and
  operation, the separation of medical service and
  medicine and the separation of profitable and
  unprofitable hospitals. The government should be
  more responsible and put more investment on the
  scheme, should consummate citizenship healthcare
  policy and encourage the participation of the
  whole societys contribution and eventually
  realize a universally covered public healthcare
  system, medical service system, medical assurance
  system and medicine supply assurance system to
  provide the public safe, efficient, convenient
  and low-cost medical service.

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??????? New healthcare reformation scheme

• (?)????????
• Three for the first time
• ?????????????????????????????
• For the first time such an accurate, specific and
  clarified medical reformation policy and target
  is discussed at party congress.??????????????????
  ????
• For the first time nation-wide solicited opinions
  are used for a policy concerning to all
  nationals.
• ????????????????
• For the first time the country clarifies and
  implements universal medical healthcare coverage.

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??????? New healthcare reformation scheme

• (?)09.01.21?????????????(Opinion on deepening
  medical healthcare system reformation)
• 2009-2011???????????????(Scheme of deepening
  medical healthcare system reformation through
  2009 to 2011)
• ???? ???? ??8500????(?3318 )
• 3 years 5 concerns 850 billion new
  investment

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??????? New healthcare reformation scheme

• 1.??????????????(accelerate the establishment
  of basic medical healthcare system)
• ???90??,??????120?/?.?( 90 and above
  nationals are covered and the reimbursement
  standard is increased to 120yuan/person/year).
• 2.??????(national basic medicine system)
• ?????????????????????????????(basic medicines
  are covered by the reimbursement list, zero error
  rate , price ceiling and provincial tender price.

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??????? New healthcare reformation scheme

• 3.???????? Strengthen basic healthcare service
• ???????????,??2.9??????3700?????1.1????????????
  ??????
• The focuses are the lower level medical service
  providers, including the county, community and
  neighborhood level. China will newly establish 29
  thousands neighborhood level hospital, 3700
  community center and 11 thousand community
  station. The Three-A level hospital (the top
  level) will establish a long term cooperation
  relationship with county level hospital.

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??????? New healthcare reformation scheme

• 4.??????????? gradually equalized basic
  healthcare reimbursement
• 2011???20?,??????
• by 2011, government will provide all nationals
  20 yuan annually.
• 5.?????? the reformation of state-owned hospital
• ????????????? ????????
• System and mechanism reformation, diversified
  investment, reimbursement channels decreased to 2
  from 3
• -- 2009?? ? 2011??
• Experiment from 2009 and implement from 2011

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??????? New healthcare reformation scheme

• (?)???? key points
• 1.???????????????
• Medicine price will gradually decided by the
  market.
• 2.??????,??????
• Government will increase its investment and
  encourage the marketing economy.
• 3.?????
• Diversified investment
• 4. ??????,????
• Public supervision system is implemented

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??????? New healthcare reformation scheme

• (?)??????????????????
• 5 medical insurance systems aiming at universal
  coverage are ongoing establishment or perfection.
• 1.???????? medical insurance system for township
  employee
• 2.????????? new cooperative medical system for
  rural areas
• 3.???????? medical insurance system for
  township citizens
• 4.?????? supplementary medical insurance
• 5.?????? commercial medical insurance
• ???????? benefit the nationals
• ????basic medical service
• ??(residents in rural areas)120?360?500?/?
  maximum of 30-50 thousands ??35??
• ??(residents in the cities)120?1100?1500?/?
  maximum of 70 thousands ??7??
• ??????????
• Public healthcare government pays the check

?????????????,??????????
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• ?????
• ??!

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