The transcript of President William A. Haseltine’s speech at the Fourth United States China Healthcare Summit is now available online. The October 2014 presentation, “Innovation and the Future of Healthcare in China,” addresses the current status of healthcare in China and future directions for healthcare finance, healthcare systems, medical education, the aging population, and technical innovation.
What follows is an excerpt from the speech. Click here to download the full speech.
It is a truism, deeper than it may appear, that you get what you pay for. So it is for much of life, so it is for healthcare. Finance underpins what health services exist, what services are available, and who receives treatment. In my opinion, finance is the proper primary focus of healthcare innovation. Each payment alternative has profound implications for the health of individuals and for populations.
China is at a crossroad. There is general agreement that healthcare in China deserves improvement. China is now a middle income country with a rapidly rising gross domestic product and average income, yet high quality affordable healthcare services are not available to most people, especially in rural communities. Fundamental issues of social equity, social harmony, and social security are at issue.
The future direction does not seem entirely clear. Will the public or private sector deliver the majority of care? Will central, provincial, and local governments carry most of the burden? If so, how will the responsibilities be divided among various government entities? Will people pay out of pocket directly or through voluntary or mandatory insurance programs? Will out of pocket payments be admixed with state subsidies? Will payments be made as fee for service, as bundled payments for specific maladies, or as capitated payments for populations? Will doctors be salaried or paid by procedure?
Experience with health systems around the world reveal the profound consequence of each of these decisions. We know fee for service drives over prescription of services. We know capitation systems can increase emphasis on preventive health. We know reliance on out of pocket and insurance programs can lead to inequitable distribution of healthcare benefits.
We at ACCESS Health International have studied healthcare finance in both high and low income countries. We have some knowledge as to what may work and what may not. We have seen highly innovative effective systems radically change the health prospects for broad populations. We have witnessed failed public and private approaches. As a not for profit think tank and advisory group, our mission is to share our knowledge with those planning for the future health of their country.
The systems we have seen that function best are public private partnerships, wherein the local and central governments pay for services delivered by both the public and the private providers. The state sponsored systems are often found side by side with fully private healthcare providers for those able and willing to pay.
We are happy to share what we know. We know this: Finance is the key to health outcomes. Get it right, and the health of a nation improves. Get it wrong, a nation flounders at the expense of its population and finance.
Only those responsible for the health and well being of their country can decide what is best in their own context. We at ACCESS Health can offer the benefit of experience elsewhere…