China's plan to revamp its healthcare system to get costs under control rests in large part on creating a professional culture among doctors and support staff in prescribing drugs and ordering tests, according to an article published last week in the New England Journal of Medicine.
Authors David Blumenthal of the Commonwealth Fund and William Hsiao of Harvard University said the issue assumes importance because of a practice of getting commissions for prescribing certain medicines and medical tests to augment salaries.
Overall, potentially unnecessary prescriptions and tests at large municipal hospitals in the main translates into less effective services in rural clinics and hospitals which are a prime focus of the government's efforts to provide more effective care regimes.
"Though China's extensive 2008 reforms are still in process, a number of problems, mostly concerning tertiary hospital care, continue to challenge its leadership," the authors wrote. "First, many of the country's publicly owned but profit-driven tertiary hospitals successfully resisted the latest reform efforts--a reality that probably reflects the hospitals' power within China's political system."
"As a result, frustrated authorities sought to use market forces once again to bring the hospital sector into line. In 2012, the leadership announced that they would invite private investors to own up to 20% of China's hospitals by 2015, double the preexisting rate."
"Second, major inequities continue between the health care available in poor rural areas and that in more affluent cities. Third, China continues to struggle with creating a high-quality, trusted, professionalized physician workforce. One legacy of China's market experiment is a widespread perception that physicians put their economic welfare ahead of patients' interests."
In many public hospitals, patients are seen on an assembly-line basis because of unwillingness to make a clinic appointment, stoking mistrust of doctors to the point of violence at times.
- here's the article from the New England Journal of Medicine