United Nations Health Partners Group in China, led by the World Health Organization (WHO), working closely with the Ministry of Health, recently released their China country health assessment report in July 2005. International experts at the said group agree China has made huge progress in its health situation during the past half century, but they also call for major efforts from the government and the society to co-operate to take China's healthcare reform to the next level.

At the 14th CEO roundtable on August 26, 2005, themed "Healthcare Reforms in China" and organized by China Daily, about 50 CEO and senior executives from multinational companies, hospitals, NGOs, drugs and insurance companies got together for a strategic dialogue chaired by Professor Liu Yuanli, director, China Initiative, Harvard School of Public Health and Dr Henk Bekedam, China representative, WHO.

I would like to point out at the outset that judging health sector performance is inherently a very difficult and complicated business. You cannot as easily say that a country's health sector has done extremely well or has totally failed, because one can use different performance criteria such as equity, efficiency, and quality, which can be defined and measured in different ways. There is no international consensus on what would be the best measurement to use.
Even though one may take issue with the rate of improvement and inequality in benefit distribution, there is no doubt that the general population health status has continuously improved in China over the past 20 years or so.

However, China has done not so well with regard to public health intervention. The principle of Prevention First has been by and large neglected. Focusing on revenue generation and economic growth, China's economic policy makers rarely take into account health implications when they develop industrial policies. For example, thus far, no major policy intervention has been put in place to seriously curb the supply of, and demand for, tobacco products.

Undoubtedly, the availability of modern medicines and services has improved remarkably over the past two decades.

However, while the availability of medical products and services has increased significantly, affordability has become a major issue due to a combination of price and insurance coverage effects. First, medical costs outgrow income. From 1990 to 2000, the average income increased five-fold in urban and three-fold in rural areas. But the average medical charges increased nine-fold, doubling or tripling the rate of income growth.

Global business coalition on HIV/AIDS

China's health officials are currently faced with some of the country's most pressing and unprecedented issues regarding public health and social development. In this setting, the debate rages on about reforms of the nation's health care system.

The role of private sector in nation's health care reforms

Alexander Wan: What would you like to tell our readers?

Allan Gabor, Pfizer: Pfizer is a pharmaceutical company with strong global resources and capacities, and would like to build partnerships among the public, private, and patient health sectors to support health care reforms.

We believe that emphasizing prevention, wellness, early diagnosis and early treatment can keep disease from many personal health care disasters. Pfizer China has provided philanthropic patient education on disease awareness on many disease categories, such as cardiovascular disease, mental disease, infectious diseases, men's health, hepatitis B, and HIV/AIDS even though we don't have products right now for hepatitis B and HIV/AIDS in China. On average, there is savings of more than US$2 for every US$1 invested in early prevention programs.

Healthcare has to be accessible

Over the past month or so, health care reform in China has been the subject of much discussion and public debate in the wake of a report issued by the Development Research Centre (DRC) of the State Council with the support of the World Health Organization (WHO) and the UK Department of International Development.

The report takes a long, hard look at China's health care reform process - and candidly lists the challenges of the past, the present and the future.

Health care reform has been firmly on the government's agenda for some time now. The DRC study has elevated the discussion to a new level - and, at the same time, narrowed the debate to defining more clearly the role of the government when it comes to reinvesting in health. The question remains: how to do this? Where should government funding be focused? What should the levels of expenditure be? What are the mechanisms that need to be created and strengthened? How can these best be implemented?

Many of the health challenges relate to the major transitions that are taking place in China. Rapidly increasing urbanization, an ever-widening gap between the rich and the poor, an ageing population. All these factors contribute to a range of health challenges - from tuberculosis to HIV/AIDS, from emerging infectious diseases like SARS and avian influenza to the fast-growing, silent epidemic of non-communicable diseases.

It's important to recognize that China achieved significant health gains before economic reforms took hold. China's health picture in 1980 - with a life expectancy of 65 years - has been recognized as a major contributor to sustained economic growth. Decades of economic reforms have made China a powerhouse. But economic reforms have also made citizens the main financiers of health services through the introduction of user fees - thereby making it very expensive to be sick.

The SARS outbreak of 2003 and the cracks it revealed really brought home the fact that the government had to reinvest in health across the spectrum. The health care system - once a model of its kind, especially in rural areas - has crumbled. The government has realized that public health is indeed a public good, integral to the nation's economic might.

Post-SARS, health systems such as disease surveillance and reporting are being modernized and strengthened. Still, for much of China today, what is available is not affordable - and hence not accessible. As medical costs continue to escalate, health care has become, for all practical purposes, a luxury for millions.