Project Scope and Relationship to China's Agenda 21

The project seeks to strengthen China's health insurance system in rural areas through a focus on laws and regulations, through the development of pilot programmes, and through the provision of training. The project is based on programme area 9A of China's Agenda 21, and is related to programme area 8A.

1. Background

• 1.1 Significance
  • Health is the first priority for human beings existence and development. WHO proposed the global strategic goal "Health For All By 2000" to which the Chinese government has responded actively. In China, of crucial importance and great difficulty is attaining the goal in rural areas. Establishing a Cooperative Medical Care System in rural areas is an essential measure to attain this goal and it also is the central task of rural health work in China.

  • A Cooperative Medical Care System is an important component of a social insurance system. Reforming and perfecting the Cooperative Medical Care System, helping peasants to eliminate diseases and improve their health level are essential for stable development in China.

  • This will be a great help to develop rural social economy by assisting poor families affected by disease and poor conditions. Due to increasing medical costs, peasants cannot afford medical attention by themselves. As a result, they usually fall into poverty after suffering from diseases; this affects agriculture directly. According to investigation in some rural areas,there are more than one third of poor families suffering from diseases.

  • Farmers need the Cooperative Medical Care System and the state also pays great attention to it. The National People's Congress, the State Council and the Chinese People's Political Consultative Conference have appealed to reconstruct the Cooperative Medical Care System and started to investigate and study this issue.

• 1.2 Previous works
  • The national health authorities continue to put emphasis on rural health work. Recently, the financial agencies of the central and local governments have given a large part of their health budgets to township hospitals, especially to central township hospitals so that they can reach the standard that their buildings, staff and equipment are suitable to their obtain. According to health statistics of 1992, there are 46,117 township hospitals, 651,031 village health stations which cover 88.5 percent of total administrative villages and employ 816,557 village doctors, 452,504 auxiliary health workers and 446,072 midwives in China.

  • According to some statistics, the coverage of Cooperative Medical Care system is about 10% of the total villages in rural areas of China.

  • WHO and other international organizations are very interested in establishing Cooperative Medical Care System in rural areas of China and try to find the way to promote the work together with the government.

• 1.3 Problems

  Although having carried out Cooperative Medical Care System for several decades and accumulated some experience, we still have some difficulties:

  • Lack of qualified persons to operate the system
  • Lack of stable financial resources and effective fund collecting mechanism
  • Lack of essential health facilities and equipments

  Since the developed countries have experiences on medical insurance, we hope to get international support to assist in the management of the system.

2. Objectives

• Long-term Objectives
  • The project is to find out the way to strengthen the health insurance system in rural areas, to speed up the achievement of "HFA/2000" and to support China Agenda 21.

• Immediate Objectives
  • To make trials in various counties which are selected according to economic levels.
  • To establish health care laws and regulations which are suitable for China.
  • To establish China Rural Doctors Audio-visual Training Centre.

3. Activities

• 3.1 Establish health care laws and regulations which are suitable for China, including:
  • Management methods for a Cooperative Medical Care System;
  • Ways of raising and spending of the funds of Cooperative Medical Care;
  • Monitoring and management methods of the fund budgeting;
  • Identifying essential drugs needed for rural health organization. The duration of this activity will be thirty months.

• 3.2 Make experiments in setting up the four levels of health insurance management system. The four levels are state, province, prefecture and county. This will involve pilot projects to test the feasibility of the system. The duration of this activity will be thirty months.

• 3.3 Establish China Rural Doctors Audio-Visual Training Centre, to train the rural doctors and health care workers. The duration of this activity will be thirty months.

• 3.4 Make experiments on setting up health insurance system in several areas with differing economic conditions, through pilot activities in areas including:
  • Experimental areas selected from minority, remote and poor areas are Wengniute Banner and Owenk autonomous banner in Inner Mongolia autonomous region, Yining County and Shihezi City in Xinjiang Uyger autonomous region;
  • Experiment areas selected from areas where economic condition are middle level are Suizhuo County and Macheng County in Hubei Province, Yushu City and Yanji City in Jilin province, Tongshi County and Qionghai County in Hainan Province;
  • Experiment areas selected from developed areas are Jiading District and Chongming County in Shanghai municipality, Ji County and Wuqing County in Tianjin municipality, Jiangshan City and Xiaoshan City in Zhejiang province, Jianou City and Ninghua County in Fujian province, Shunde County and Conghua County in Guangdong province. The duration of this activity will be thirty months.

• 3.5 On the basis of above 4 activities,the experiences gained from the pilot areas will be spread throughout the country to perfect the Cooperative Medical Care management system, to improve the management of Cooperative Medical Care System and to strengthen the information system. The duration of this activity will be forty-eight months. This project will be implemented by the Ministry of Public Health.

4.1 Chinese Inputs

• Project Management costs.
• Domestic consultants and auxiliary staff transportation, some essential office equipments and study costs.
• Provision of scientific and technical standards and statistic data, the experience gained from collaborative projects with UN system or other countries.
• 4.2 International cooperation
  • Aid on strengthening capacity including setting up the health care administrative organizations, training personnel and drafting health care laws and regulations.
  • Technical cooperation including the cooperative research on Health Finance with foreign experts who have experience in medical insurance and health care systems
  • Establishing an information system including use of techniques and equipment for establishing information system.

5. Benefits

Improved rural health care systems to ensure peasants' health conditions and living quality are essential for the development of social economy.

As peasants gain access to essential health services, the work of disease prevention and treatment will make obvious progress. The Chinese general health level will approach that of the middle developed countries.