Sunday, 20 July 2014

Sunday snippets: health reformer sidelined, Hong Kong-style hospital fails, HIV activist banned

Three stories stand out this week: firstly, the  'open' reporting of Caixin is a refreshing change from the routinely stultified, narcissistic column fodder of the official English language publications such as China Daily. This week they have an interesting profile of Guangdong doctor-turned-health bureaucrat Dr Liao Xinbo. He is portrayed in Caixin as an outspoken critic of the system, who has put a few noses out of joint. One incident in particular seems to have seen him sidelined for not toe-ing the Party line - when he made promises to some pregnant women who were protesting about the one child policy. However, on closer reading Dr Liao doesn't seem to be that much of  maverick. His outspoken-ness relates to his advocacy of two policies that are already at the forefront of NHFPC reforms, namely allowing doctors more flexibility to work in the private sector and promoting 'social capital' (ie private investment) in medical facilities. Perhaps Dr Liao's real crime is to have highlighted the fact that the NHFPC is a relatively weak government ministry, and the real decisions are being made by ministers for finance and social security and the he National Development and Reform Commission. To the embarrassment of the NHFPC he also points out that local governments are a major barrier to real reforms - because they have a huge financial vested interest in running local hospitals (and the profits from drug sales).
On a related note it is interesting to see a model health reform project faltering. Shenzhen has set up a joint venture hospital with Hong Kong, in an attempt to bring in Hong Kong-style health systems - most importantly a 'gatekeeper' system in which patients are triaged by a generalist practitioner before going to see a specialist. Unfortunately for the project, mainland Chinese residents do not seem to be taking to this new model of care. Despite huge overcrowding in Shenzhen hospitals, they are staying away in droves from the Hong Kong-China hospital. And it's not because of the cost - fees are subsidised by the Shenzhen government to an embarrassingly generous  extent. According to one report, the HK joint venture hospital is costing a billion yuan a year - almost all of the Shenzhen city budget for supporting city hospitals. And yet it is operating at only a quarter of its capacity. The hospital management are pinning their hopes on the opening of a VIP section of the hospital to bring in some much-needed revenue - and yet VIP medical wards are exactly the opposite of what China's health reforms are supposed to achieve, and other hospitals have been ordered to phase them out. It looks like China health reforms have a rocky road ahead of them.
And finally, just when you think China is opening up and showing a more enlightened approach to health, the government shows that its repressive, authoritarian ways extend to advocates for appropriate HIV treatment.  Ms Ye Haiyan, a Hubei-based advocate for sex worker health, was banned from attending the International AIDS Conference in Melbourne. Her crime, it seems, has been to criticise Xi Jinping's crackdown on the sex trade, pushing brothels and sex workers further underground.Ye says this will inevitably make it harder to detect and treat HIV. Another more high profile HIV activist, Hu Jia, was assaulted by plainclothes police in Beijing. We can only hope that these regressive actions by the Xi Jinping administration  are raised at the International AIDS Conference.

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