Healthcare in China. ASHK and SOA China Region Committee March 22, Pang Chye (852) pang.chye

Transcription

1 Healthcare in China ASHK and SOA China Region Committee March 22, 2003 Pang Chye (852) pang.chye

2 Overview Background Providers Financiers Current State of Events The Future 2

3 Background Who Delivers Care? Majority non-profit, government subsidized Government facilities: three tiers Rural Village stations Township health centers County hospitals Urban Street health stations Community health centers District hospitals Some with expatriate services 3

4 Background Who Delivers Care? Private providers Private clinics Illegal clinics 4

5 Background Financing of Care Since 1949 Rural social health insurance: Cooperative Medical System Voluntary >90m lives covered, mostly farmers Funded by combination of (mostly) personal and public monies Fixed rate reimbursement + some reimbursement of medical treatment at urban facilities 5

6 Background Financing of Care Urban social health insurance China Medicare Fund >85m lives covered Private companies and SOEs % payroll (employee and employer contributions) Varying use of medical savings accounts 50% - 80% reimbursement Government Insurance Scheme Essentially self-insurance by government entities, but now with increasing elements of risk-pooling Elements of cost control: user copays,, hospital capitation, fee schedules, drug formulary Encourage different cities to experiment 6

7 Private health insurance Approximately RMB6 billion? Out-of-pocket 7

8 Similarities to Hong Kong Delivery of tertiary care mostly provided by government facilities Low penetration of private health insurance 8

9 Differences China Has always focused on primary care Primary care delivery dominated by government Quality of care improving but still low Problems with rural access to care Hong Kong Generally biased towards hospital-based care but moving toward primary care Primary care delivery dominated by private doctors Quality of care is high Rural??? 9

10 The Biggest Difference: Public Healthcare Financing China Hong Kong Provider Provider Health Plan User User Govt Govt 10

11 Current State of Events Rising costs Uninsured / under-insured Illegal clinics Rural problems Access to care Poverty-induced illnesses Illness-induced poverty 11

12 The Future Uninsured increase with unemployment Under-insured increase with lack of financing of municipalities Private hospitals increase? Improvement in quality But access rationalized by ability to pay (as opposed to queuing) 12

13 Private Health Insurance Insurance is the foundation of healthcare financing Risk pooling services always in demand Affluent Demand for healthcare Demand for insurance Target group Middle to upper class individuals Urban uninsured / under-insured? 13

14 Problems Drugs 60% of hospital revenue Hospital has 85% market share Abuse / inefficiencies No negotiating with public hospitals Do private health insurers share the same fortunes as social health insurance programmes? What do private health insurers bring to the table? 14

15 Efficiency Total inpatient days per 1000 members US Well Managed* US Loosely* Managed Taiwan NHIP All facilities Excluding physician and dental clinics * Includes SNF and Home Care days 15

16 Measuring Efficiency Through Chart Reviews Milliman doctors and nurses have reviewed over 50,000 inpatient and outpatient medical charts in USA, Australia, and New Zealand Review how care could have been more efficiently delivered Use Milliman Care Guidelines as reference where appropriate 16

17 Chart Review Results From a Specific Assignment Potentially avoidable days (%) Hospital A Hospital B Hospital C Hospital D Hospital E Hospital F

18 Chart Review Results From a Specific Assignment Reasons for delays in discharge 70% 60% 50% 40% 30% 20% 10% 0% Physician Decision- Making Scheduling Infrastructure 18

19 From a sample of over 6,000 charts reviewed # of PAD/Case % Total Admits* % % % 5 2.4% 6 1.5% % Total 100.0% * Excludes Potentially Avoidable Admits and Perfect Cases 19