small hospitals, pay just slightly higher than the local average salary. As a result, hospitals in remote areas fail to retain good doctors, and thus cannot guarantee high quality medical treatments. Therefore, China must reform doctors’ pay as a matter of urgency; otherwise progress cannot be made. To this end, we suggest that doctors’ legal compensation should be improved. Using international experience as an example, we suggest that the salaries (basic salary and subsidies) of Chinese doctors should be between two and three times average national salaries. Basic salaries should be increased to around 70 percent of total salaries (basic salary and subsidies), and the salary system should be strengthened according to post, professional title and level of seniority. Doctors’ overtime salaries should also be improved. The United Kingdom’s experience, which will covers around 20 percent of doctors’ pay, should be used as an example. Medical reforms in Sanming City, Fujian Province, has shown that maintaining and redirecting medical insurance payments can effectively improve doctors’ salaries in rural hospitals with poorer services.
TAKE PRACTICAL MEASURES TO PROMOTE A HIERARCHICAL MEDICAL SYSTEM
132
英文.indd 132
In order to attract high-quality doctors to work at smaller hospitals, three measures can be taken. Firstly, the existing system that takes no account of needs or doctors’ specialties should be improved. Secondly, entry thresholds should be lowered through reforming administrative examinations and approval systems. Thirdly, the existing fixed compensation system for medical staffs should be reformed, and a mixed compensation system should be implemented. In order to encourage patients to attend local hospitals for diagnoses and rehabilitation, three measures can be taken. Firstly, service
fees for specialists at local hospitals should be reformed, and reimbursements through medical insurance should be increased. Secondly, medical insurance reimbursement ratios for chronic diseases should be increased at the local level. Thirdly, the range of drugs offered by medical institutions at local medical practices should be expanded.
ESTABLISH A SYSTEM THAT OFFERS EQUAL ACCESS TO BASIC MEDICAL SERVICES China should adopt a “capability-based fee payment” system, “as well as fee payment within the limit of capability when using” ─ in accordance with practices in middle and high-income economies. By establishing a fund allocation system, basic medical insurance funds can be allocated nationwide. At the provincial and municipal level, it is recommended to unify the basic medical insurance system for company employees, and government insurance systems for public sector employees. It will also be important to unify basic medical insurance systems for urban and rural residents. In addition, it is recommended to improve the insurance transfer system for employees and residents. The integration of all kinds of medical insurance schemes should be accelerated. Specific suggestions include: Firstly, it is recommended to further integrate the medical insurance system for urban and public sector employees, thus establishing a unified basic medical insurance system for all urban Chinese workers. This reform would abolish the current medical insurance system special to public sector and would incorporate it into a medical insurance system for all urban employees, based on international experience. In regions where these conditions are satisfied, rural migrant workers, farmers, rural laborers and agency workers would also be gradually incorporated into this medical insurance system.
2016-8-17 11:20:30