Interv iew China’s Latest Health Reforms: A Conversation With Chinese Health Minister

Chen Zhu, a hematologist and Ph.D. systems biologist, became Chinese health minister in 2007 after serving as vice president of the Chinese Academy of Sciences (2000–2007); he is a member of three national academies of science (Chinese, U.S., and French) and one of only two Chinese cabinet members who are not Communist Party members. In this interview by Tsung-Mei Cheng, Minister Chen discusses China’s health care priorities, its vision behind pending reforms to provide health care for all citizens (from financing and coverage, through delivery and public/private roles), and the role of health care in broader societal objectives. The discussion also reaches into disparities, health care costs, mandates, provider payment, and more. [Health Affairs 27, no. 4 (2008): 1103–1110; 10.1377/hlthaff.27.4.1103] Tsung-Mei Cheng: Thank you very much for agreeing to sit for this interview during this busy time. I feel both honored and privileged by your willingness to do so. Readers of Health Affairs worldwide are fortunate to have this rare opportunity to hear from the top health official of China on what I hope will be a wideranging conversation about a host of issues concerning health care and the current health care reforms in China. Minister Chen: Certainly; it is my pleasure. Challenges Facing China’s Health Care Cheng: It can safely be said that every country is now engaged in some kind of health reform. Most of the problems addressed by the reformers are the same the world over: namely, (1) the strain that the provision of modern health care puts on household, government, and business budgets; (2) the high variance in the quality of care among the providers of care; and (3) the associated high variance in the cost-effectiveness of medical treatments—that is, the relationship between the cost of care and the benefits it yields. But some problems are countryspecific. For example, in the U.S. the millions of uninsured Americans pose a serious problem for policymakers, because these Americans lack financial protection from the often high cost of health care. Europe, Canada, and some countries in East Asia do not have that problem any more. They solved it years ago. If you were to address an American audience about health reform in China, what top three or four “problems” in your system would you tell them about? Minister Chen: With China’s rapid and susI n t e r v i e w : C h e n & C h e n g H E A L T H A F F A I R S ~ V o l u m e 2 7 , N u m b e r 4 1 1 0 3 DOI 10.1377/hlthaff.27.4.1103 ©2008 Project HOPE–The People-to-People Health Foundation, Inc. Chen Zhu is the Chinese minister of health. Tsung-Mei Cheng ([email protected]) is host and executive editor of International Forum at Princeton University’s Davis International Center, in Princeton, New Jersey. tained economic and social development, the Chinese government, through careful evaluation of our national situation, has placed the livelihood of the people at the top of our national policy agenda. The heightened attention on this topic at the highest level of government thus has created a highly favorable policy environment for China’s health care reform and further development. We believe that realizing the coordinated development of China’s health sector and China’s economy as a whole will be a new shining spot in the next period of China’s economic and social development. The Chinese government’s most pressing concern now is with delivering on its principles of “equalization of access to public services” and “everyone enjoys,” meaning that all Chinese should enjoy equal access to basic health care and medical services. To put these principles into practice, the government seeks effective systems changes in order to provide our whole population equitable and universal basic health care and medical services, to improve the health status of every Chinese. Second, through improving our public health system, our health care systems, our health insurance systems, and the safety and availability of our drug supply systems, we will improve our capacity to cope with the new challenges posed by changing disease patterns and the burden associated with our aging population and ongoing urbanization, thereby contributing to China’s sustained, coordinated, and comprehensive economic and social development. Third, through innovations in systems reengineering, we would like the government to play the leading role in overcoming the failure of the market to provide health care and insurance efficiently and to provide people with protection from the cost of illness. Ethical Values Underpinning China’s Health Reforms: “Building A Harmonious Society” Cheng: China is now on the eve of unveiling a major reform of its health system. It is to be made public this year. To help our readers get a good sense of such a massive undertaking, permit me to break the reform down into components, the way policy analysts usually do to describe such reforms. When health policy people talk about health reform, they usually talk about (1) the overall social goals to be achieved with the reform, by which is meant in large part the ethical values the system should pursue; and (2) the operational steps or functions that must be performed to achieve those social goals. Before going into the operational details of China’s proposed reform, I would like to ask you to talk about the social—that is, ethical— values underlying China’s reform. What ethical goals do China’s leaders espouse with the proposed reform? Minister Chen: The Chinese government has clearly stated its objective of achieving a “harmonious society” as a national priority. What this means is that the government intends to build a socialist harmonious society in which every Chinese enjoys the benefit of education, income from work, health care when sick, care when old, and a home to live in. I think this clearly demonstrates the Chinese government’s keen attention to the question of the people’s standard of living, which includes health care. It also demonstrates the government’s strategic commitment to, and humanitarian concerns about, providing equal access for all the people to basic public services. Underlying all this is the government’s core central value and belief that health care is a right as well as a foundation for the realization of an individual’s full potential. The right to health care is not only the ultimate objective of social development, but it also is a means to economic and social development; it is an important indicator of a harmonious society. “Basic Health Care Protection For All” Defined Cheng: As I understand it, one of the major goals of the current reform is to provide for every Chinese what you have called “basic health care protection.” Exactly what does that mean? Minister Chen: As already noted, the Chinese government has firmly established as a new re1 1 0 4 J u l y / A u g u s t 2 0 0 8 I n t e r v i e w