Text by Tang Chen

CCTV Economy Channel invited Li Bin, Directory of National Health and Family Planning Commission, to be the guest of its “Dialogue” Program in the evening of 28th August. Li Bin appeared before the public right at the time when the National Sanitation and Health Conference was convened and the Political Bureau of the CPC Central Committee reviewed and approved of the Outline of “Healthy China 2030” Plan, so his appearance drew lots of attention. It can be said that, to some extent, the presence of Li Bin as a guest in this Dialogue Program is to give comprehensive interpretation and communication of the spirit of the National Sanitation and Health Conference attended by all top leaders in the previous week.

[Breaking News] Xi Jinping set the pitch of medical reform! What signal is released in the conference attended by all seven members of the Politburo Standing Committee?

Abstracts of Sanitation and Health Conference

Xi Jinping stressed that, the overall well-off objective cannot be achieved without realization of universal health. We should take universal health as strategic priority of our development, focus on promoting a healthy lifestyle, perfecting health services, improving health protection, building a healthy environment, and developing healthy industry, speed up and promote the construction of Healthy China, and strive for protection of people’s health in all aspects and in all periods, in order to achieve robust healthiness and lay a solid foundation for attaining the “Two Centenary” goals and realizing the China Dream for rejuvenation of the great Chinese nation.

China is now facing a complicated situation.

Xi Jinping stressed that, due to industrialization, urbanization, population aging, and changing disease spectrum, ecological environment and lifestyle, China is still facing a complicated situation where multiple diseases and factors are threating and impacting our health. We are not only facing those sanitation and health issues that the developed countries are facing, but also those that other developing countries are also facing.

From focusing on disease treatment to focusing on people’s health

Xi Jinping stressed that, we should unswervingly carry out the policy that focuses on disease prevention, persist in combining efforts of various groups for disease prevention and disease control, and strive for providing sanitation and health services to the mass people in their complete lifetime.

Medical and health system reform now comes to the period of cracking a hard nut.

We will focus on promoting the construction of basic medical and health systems, and use our great efforts to achieve breakthrough in construction of 5 basic medical and health systems including hierarchical medical system, modern hospital management system, national medical security system, pharmaceutical supply protection system and comprehensive regulatory system.

We will focus on promoting vibrant development of traditional Chinese medicine, keep attaching the same importance to both traditional Chinese medicine and western medicine, boost the complimentary and coordinative development of traditional Chinese medicine and western medicine, and strive for realizing the creative transformation and innovative development of the health care and preservation culture in traditional Chinese medicine.

We will focus on fully arouse the initiatives of the medical workers, care about their physical and mental health starting with elevating their remuneration, career development, practicing environment and social status, give them a higher sense of honor about their profession through many different ways, and create a good atmosphere in the whole society for respecting the medical and health care professionals.

Although Dialogue is a high-end interview program on CCTV Economy Channel, yet leaders from state ministries and commissions like Li Bin are rarely seen in the show. Then, what did Li Bin say in this “Dialogue” show, which still lasts 52 minutes after editing?

Talking about achievements: beginning with 3 figures

At the beginning of the show, Li Bin opened Page 1 of the National Health Handbook, on which there were 3 figures reflecting the great achievements that we had made in the construction of Healthy China. The first figure is 76.34 years, the average life expectancy of Chinese people in 2015; the second figure is 96.5%, the coverage rate of universal medical insurance in China (Li Bin stressed that, considering the 1.36 billion population in China, our medical security program is the largest in the world); and, the third figure is below 30%, which means, through our efforts in the past over 20 years, particularly through the deepening of medical reform, the percentage of individual payment for medical costs in China has been lowered from over 40% before reform to below 30% now.

Li Bin later showed the pregnant woman death rate and infant death rate, which are the two indicators used internationally for measuring the level of people’s health in a nation. These two figures both show that we have gone beyond the average level of middle to high-income nations in the world and have reached the Millennium Development Goals of the United Nations earlier.

Facing up to the national conditions of China

The “theory of national conditions” of Chinese characteristics seems to be a term that has been “overused” in some occasions. However, with regard to the medical and health issues, “facing up to the national conditions of China” is not just a term of excuse, but a rational starting point for us to formulate policies that meet the actual reality.

By carefully reading through the speech made by Li Bin in the Dialogue show, we have found that she stressed on facing up to the national conditions of China for at least 5 times. When talking about hierarchical medical system, she explained the reason for adopting such a system is “because China has a huge population of over 1.3 billion people and quality medical resources are insufficient and unevenly distributed”; when talking about development of talents at the basic level, she stressed that “our country is so big that we have to suit our measures to local conditions and make up for what is missing in reality subject to the actual conditions of different places”; and, when talking about the level of medical security, she frankly said that “because our overall level of [medical] security is not high, only a little bit higher than RMB 500 per capita of urban and rural residents this year, which is less than USD 100. While the United States input more than USD 9000 per year, we are still under USD 100 level. So we still need to gradually improve our capacity of [medical] security. After all, we are still a developing country”.

When being asked by the host if she had received any complaints from people about the issues of “being difficult to see a doctor” and “being expensive to see a doctor”, Li Bin frankly said that these are the “complaints often seen on the internet”. Then she showed her attitude by stating that “we should seek truth from facts, we should respond, and we should reform in response to people’s appeal.”

Sensitive people should easily discover that “we should reform in response to people’s appeal” was the statement of Xi Jinping when he presided over the 11th Meeting of the Central Leading Group for Comprehensively Deepening Reforms on 1st April 2015. It was also in this meeting that the Guiding Opinions on Urban Public Hospital Comprehensive Reform Pilot were reviewed, discussed and approved.

Our national conditions determine that there must be long-term pressure from having insufficient fund to meet the actual demand for health protection in China. “The limited funds should be used where they are needed most.” Therefore, Li Bin mentioned that the payment method should be reformed. Li Bin deemed that previous medical insurance programs mainly adopted the pay-by-item method, which payment method in essence encouraged “pay more and use more medical measures”. In the future, we will mobilize hospitals to find their own motivations to save money. The medical insurance program must become a thrifty program. The system needs to be changed, and a hierarchical medical system should be added at the same time.

Li Bin admitted that, due to “lack of resources”, we cannot spend all of our money on disease treatment but on the last stage of the therapy, just in order to improve the overall health performance. “This does not make any sense, particular for such a big nation as ours. We cannot bear all the costs like some western countries or Nordic countries do. We also cannot afford to spend so much money on disease treatment. So we will have to ensure our people to suffer from diseases less often, avoid severe diseases and not to get sick too soon. This is a general idea out of considerations about both economical factors and people’s own interests. So, disease control and treatment must be combined together.”

The hierarchical medical system has never been so important.

The hierarchical medical system has never been so important as it is seen at the venue of National Sanitation and Health Conference and in the Outline of “Healthy China 2030” Plan.

At the scene of the “Dialogue” show, Li Bin explained in details about how to promote the general approaches to a hierarchical medical system from four main aspects, including “signing a contract with a family doctor”, setting up a medical treatment union, providing better remuneration to doctors at a basic level, and developing doctors at a basic level.

Li Bin stressed that establishing a hierarchical medical system is a way to radically address the difficulties in seeing a doctor.

Li Bin introduced the experiences of Shanghai and Xiamen in establishing a hierarchical medical system, and particularly mentioned about developing a service chain that integrates rehabilitation, prevention and treatment services by bringing large hospitals and medical service institutions at the basic level together into a consistent and continuous service body in the form of medical treatment union.

Li Bin also told an anecdote in the show: When Margaret Chan Fung Fu-Chun, Director-General of World Health Organization (WHO), visited China in 2014, she said to Xi Jinping that, “I also have a China Dream, that is, when I retire and come back to live in China, I can have a family doctor (High-end Private Doctor Service WeChat Account: kgn091) to look after me.” Li Bin said, she later told Margaret Chan that, “Please feel rest assured that one day your dream will surely come true in China.”

The public should also undertake their responsibility.

The times when the government plays the role of the “night watchman” to safeguard people’s health may become the past. From Li Bin’s statement, the government also seems to have no intention to continue to play that role. Hence, Li Bin highly stressed that the public should change their minds and undertake their own responsibility.

Li Bin stressed on the public responsibility for the first time when she talked about the hierarchical medical system. “The public should also trust our doctor. Sometimes people believe that the doctor in a smaller hospital is less qualified and the doctor in a larger hospital is better. In reality, this may not be necessarily true. For example, a family doctor who keeps an eye on you every day should undertake your conditions best in details and in time. Sometimes the doctor in a large hospital who sees different people every day may not be able to precisely understand your daily conditions.” So Li Bin encouraged people to “make an active search for the contractual doctor or family doctor in the community service center near you and sign a contract with him/her boldly.”

Li Bin stressed on the public responsibility for the second time when she talked about the health issue. She thought that the current disease spectrum in China has been greatly changed. In 2013, the chronical disease incidence rate reached 20%, the number of deaths from chronical diseases represented 83% of the total number of deaths, and the chronical diseases accounted for over 70% of the total disease burden. Therefore, “in this health building plan, we also have to stress that, each of us is the first responsible person for our own health. Every one of us should participate in this plan and every one of us should be responsible for our own health.”

Li Bin made one very interesting expression in her speech. She said, health is definitely not a simple medical issue, as we are living in a big country with 1.3 billion population, and we should not merely rely ourselves on small medical and health care prescriptions, but must rely on the big prescription from social governance when addressing the health issue.

“It can be inferred from the several new terms for the health and medical industry that, more social resources in China will be inclined towards the health sector in the future, but we should also shift our thoughts from “focusing on medical treatment” to “focusing on health care””, said Eric Chong, Director of Hong Kong Ailibi Hospital Management Research Center.

Regarding mobile health, Li Bin did not throw cold water but talked positive about it.

Of course, Li Bin did not avoid talking about the growing mobile health in this “Dialogue” interview.

One of the audiences asked the following question, “There are different views and voices about many mobile health applications. I would like to hear your views, suggestions and requirements, Director Li, on the application of information technology and internet to Healthy China.”

When answering this question, Li Bin did not throw any cold water on mobile health, but rather made an optimistic statement that, “I think there will be a very promising future for either the health [sector] embracing the internet [sector] or the internet [sector] closely integrated into the health [sector], as their applications may cover all aspects.” From Li Bin’s answer it could be easily seen that she was very familiar with various application scenarios of the mobile health, such as remote medical treatment, reservation for diagnosis and treatment, in-hospital information management, big data assisted R&D, wearable devices, and regional imaging center. It proves that the director general of the national health department in China keeps herself highly focusing on and familiar with the current ecology of mobile health.

Li Bin revealed that, at the National Sanitation and Health Conference, Premier Li Keqiang specifically talked about making great efforts to develop the health industry, and building the health industry into a new pillar industry in China. He mentioned five integrations, including the integration of mobile internet and health sector.

Interestingly, Li Bin again mentioned Margaret Chan, Director-General of WHO, when talking about mobile health. Margaret Chan gave a wrist band she bought from the Chinese market as a gift to the leader who met her in her last visit to China. Li Bin said, “the performance was very good”, but she could not tell out the brand name, or she would be suspected of making an ad for the brand.

The host, Chen Hongwei, said, “It doesn’t matter. It is a local wrist band brand in China. We don’t need to tell out the name but we all know which brand it is.”