HEALTH SYSTEM

Government role

Supervision by health authorities (Health and Family Planning Commissions) at the national, provincial, and local levels; some direct provision through public ownership of hospitals.

Public system financing

There are three main publicly financed health insurance types with local-area risk pooling: urban employer-based (mainly payroll taxes, for formally employed urban residents), urban resident basic (mainly government-funded, for urban non-employed residents), and rural cooperative medical scheme (government-funded, for rural residents).

Private insurance role

Complementary to cover cost-sharing and gaps, as well as better health care quality and/or higher reimbursements. No data on coverage, but growth has been rapid.

Provider ownership

Primary care: Private/public mix (private village doctors and clinics; public township and community hospitals providing general practitioner services)

Hospitals: Public (~55%)/private (~45%) mix (mainly public in rural areas, public and private in urban areas)

Provider payment

Primary care payment: Fee-for-service for private providers, salaries and fee-for-service for general practitioners employed by hospitals.

Hospital payment: Mainly fee-for-service, with some pilot projects using case-based payments, capitation, or global budgets.

Primary care role

Registration with GP required: Not generally, with exceptions in some areas.

Gatekeeper: Not generally, with exceptions in some areas.

HOW IS THE MEDICAL SERVICE ORGANIZED

Primary care

Primary care is mainly delivered through village doctors and health workers in rural clinics, GPs in rural townships and urban community hospitals and medical professionals in secondary and tertiary hospitals. Registration with a GP is not required except for a few areas. Referrals are normally not needed to visit outpatient specialists. GPs rarely work solo or through partnerships but instead work in hospitals with nurses and non physicians clinicians. GPs in hospital receive a base salary along with activity based payments which induces demand.
The physician is paid through a combination of methods ranging from negotiated fees with the private insurers to administratively set fees for the public insurance. Mostly the patient is directly responsible for a portion of the payment.

Outpatient specialist care

Outpatient specialists work in hospitals as employees. Most specialist work in one single hospital only. They – as the GP – receive a base salary as well as an activity based payments. The patient can see the specialist without referral and has freedom of choice.

Direct payments to providers

Patients pay deductibles and co-payments to hospitals at the point of service. Hospitals directly bill insurers for the covered payment at the same time if the payment mechanism is fee-for-service or a diagnosis-related group (DRG) system.

After hours care

In the villages the local village doctor voluntarily provider after-hours care. In rural township hospitals and urban secondary and tertiary hospitals there are emergency rooms or departments (EDs) where both primary care doctors and specialists are available. In these EDs there exist no access barriers like nurse triage so that people can simply walk-in. This reduces the need for after hours care centers. The After hours is not substantially more expensive than usual care for patients.

Hospitals

Hospitals can be both private or public, for profit or non-for-profit. However most township and community hospitals are public. Rural and urban community hospitals are more seen as primary care facilities – closer to village clinics – rather than “true” hospitals. Hospitals are paid true out-of-pocket payments, health insurer payments or for public hospitals government subsidies. Fee-for -service is still dominant but also diagnosis related group DRG, capitation and global budget are becoming more popular. Doctors salaries and fee schedules are set by local health authorities.

Mental Health Care

Mental health care services are provided in special psychiatric hospitals and in psychology departments of tertiary hospitals which treat the more severe case. Mild cases are often treated at home. Mental healthcare is not integrated in the primary care services.

Long-term Care

Long-term Care is – in line with Chinese tradition – usually provided by family members. Therefore there are relatively few long-term care providers. Long-term care insurance is locally almost non-existing. Payment to such facilities is almost entirely out-of-pocket. In these facilities conditions are often poor with only few services.