Speech at the Inauguration of China Center for Health Development Studies at Peking University(CCHDS)Qide Han, April 27, 2010

Distinguished guests, colleges and friends, ladies and gentlemen,

Good morning,

China and Global Health in the 21st Century – the Lancet Series were published in October, 2008 and have produced positive effects. The series introduce to the world the healthcare system, major health threats and the trends of healthcare reform in China. Today I’d like to take this opportunity to celebrate the meaningful publication of the second series of China Health. I hope that The Lancet will keep watching and promoting the development of health service in China.

It has been one and a half years since the publication of the first Lancet Series, during which time, medical and health service in China has made considerable progress. Last April, the Chinese government issued Opinions of the CPC Central Committee and the State Council on Deepening the Health Care System Reform, in which the State Council has worked out implementation plans for the following three years. It is fair to say that China’s health service has developed by leaps and bounds. Just take the example of the medical insurance system. By the end of 2009, the coverage of new rural cooperative medical care system has reached 94%, the population of urban employees and residents covered in medical insurance has also seen great increase. The total coverage of medical insurance in the urban and rural area has almost reached 90%. It is really impressive for China, a developing country with 1.3 billion population whose GDP per capita has just reached 3,000﹩ to have such large coverage of medical insurance. All these achievements fill us with confidence in the success of China’s medical and health system reform. Nonetheless, we did encounter many problems in the implementation of healthcare reform. Due to time limit, I will just list some typical ones to exemplify the situation.

The first problem is about basic medical service. The key task of this medical and health system reform is to establish a basic medical and health system covering urban and rural residents, the core lies in the word “basic”. For one thing, the government can only afford the “basic”, for another, only when the public finance provides the “basic” can equity and justness be reflected. But there are so many questions concerning “basic”. How to define “basic”? How much money should the government put into it? What level of “basic” can the input bring about? How to avoid unrealistic expectations from the public? How to deal with different understandings of and appeals for “basic” from individuals and groups? It is an especially troublesome situation that different groups of people are entitled to different levels of medical insurance due to historical reasons.

Given the definition of “basic”, it is still difficult to ensure the implementation of “basic”. For example, as we planned, the basic medicine system has been implemented in 30% of the grass-root units and is progressing with a fast pace. Meanwhile, we encounter great difficulties. Because of the present market imperfections, limited administrative management and leftover problems, it is difficult for us to consider the understandings and interests of all parties, the patients, hospitals, pharmacists and pharmaceutical companies. Besides, the achievement of “basic” is also challenged by incapacity of grass-roots health institutions, especially the scarcity of human resources there.

Then it comes to another fundamental problem, one that involves the roles of government and market. In theory, there are still disputes over this issue. More importantly, in practice, we need to appropriately work out and implement related policies and measurements. For example, what channel and approach should the government adopt to compensate public service; is it true that only public hospitals can provide public service; how should public hospitals make use of market mechanism to facilitate public service? We need to make adjustment and try to fix these problems in practice.

The third problem is how to elevate the entire population’s health level from improving social determinants of health. This is quite urgent, difficult and large a problem. Only a small portion of health problems are solved by medical treatment, some research reported the proportion to be 8%. Whether the figure is reliable or not, it is agreed that health is determined by various social factors. There have been a number of researches on the social determinants of health and relatively clear and consistent conclusions have been reached. However, because the factors belong to the social category, it is difficult to solve related problems. Let’s take an example of the prominent tobacco control problem. We have advocated tobacco control for a long time, but have seen little effect, as it should be admitted. We need to ask ourselves where the problem lies, are there obstacles distinctive to China rather than other countries and regions, what measures should we take to remove those obstacles? To me the current scientific quality of Chinese “smokers” is still not good enough to easily comprehend and accept the probability-based modern medicine. Chinese smokers generally do not believe the conclusions drawn from probability theory of modern science. This entails the popularization of science. There are many statistics showing how smoking affects national economy. But exactly how scientific are the figures, and why is it hard for both our cadres and masses to accept them? Our statistics are calculated by models, but to what level are these models feasible? Actually in practice, the models sometimes do not fit the real situation, which needs further efforts from the economists and statisticians. In addition, tobacco control involves extremely complicated social issues, such as local government finance, income sources for past tobacco growers in poor areas, government interest, coordination among government sectors, etc. Tobacco control cannot be pushed on without efforts from all sectors of society and feasible policies and measures. Other health related problems, such as vaccination, public nutrition, prevention and treatment of diabetes and hypertension, and environmental protection, etc., are also very complicated social problems and cannot be solved by the health sector only. Related government sectors should mobilize the broad masses and social organizations to make concerted efforts in order to solve the problems.

The fourth problem, also a fundamental yet perplexing one, is about our basic view toward the development of medical technologies. Although the fast-evolving medical technologies have enhanced the wellbeing of the people, they have also accounted for a great part of the surging medical cost. For instance, in the US 2/3 of the increased medical cost is caused by the development of medical technologies. It thus seems to me that new medical technologies have gone beyond the capacity of the social economy. So how can we handle this problem? Obviously, it is neither advisable nor viable to halt the technological development. Then should we put in place more strict approval mechanism for new technologies? Or should we take into consideration whether the society can afford them when we are making decisions to approve new technologies? Yet at the same time, we are imposing too many and sometimes impractical requirements that new technologies and new drugs have to meet to get approval, which have added to the cost of their research and development. Then should we lower our requirements in this respect? The research of appropriate technology has been faced with a lack of enthusiasm and many other obstacles. What measures can we take to propel the development of appropriate technology?

These are part of the problems we need to address. It is therefore clear that the healthcare reform and health services in China are still facing steep challenges, and that there are still a number of theoretical, policy and practical issues that we need to see to. Without thorough understanding on these issues, without rational strategy and long-term plan, the healthcare reform may get off the track, causing irreparable damages. Sometimes if you do it the wrong way on the first time, it becomes impossible for you to repent later. We have had some bitter experience of this kind.

Peking University has always taken it its responsibility to strive for the interest of the nation and the country. Now at this critical moment of healthcare reform and health services development, we feel obliged to contribute our share. After preparations over the past two years, eventually, we can declare here, today, the foundation of China Center for Health Development Studies at Peking University (CCHDS). This is an important event.

I believe there are sufficient qualifications for the establishment of CCHDS. The most important factor is the stimulation of demand. It is our biggest motivation for research to deal with the pressing problems occurring in the development of health services in the process of healthcare reform in China. Besides, Peking University has a well-established foundation for further work. A few years ago, when the former Peking University and former Peking Medical College merged and formed the new Peking University, China Center for Health Policy Studies (CCHPS) was set up and the Institute for Global Health (IGH) was also established afterwards with the support of Ministry of Health. Peking University has played a very important role in the formulation of national healthcare reform schemes and even drafted one of them. In the past two years, we have also taken part in the strategy research of “Health China 2020 Medium and Long-term Plan”. These experiences provide us with a strong research foundation. Moreover, Peking University has the advantage of multidiscipline. We have not only strong health research capacity, but also policy research capacity. Some other academic disciplines like law, economics and sociology, can also support related researches. Multidiscipline sets up a firm foundation for interdisciplinary researches to solve comprehensive and complicated problems in this field. Another advantage is international cooperation. Our international friends were very enthusiastic about this research center, and have made a lot of contributions to its establishment.

We have put in-depth thought into the development of this center. I would like to further propose three suggestions:

First and foremost, we should get the accurate position of this center. As I concluded, we should set up a high-level academic institution for health policy research and personnel training. There are four dimensions of this explanation: 1) the major task of the center is doing health policy researches studying strategic, overall, prospective and feasible health policies; 2) the center is an academic institution which focuses on basic researches, emphasizes academic perspective and scientificity, maintains independent academically, and builds a strong basis for the formulation of health policies of China; 3) we not only do researches, but also cultivate talents. Personnel training is the most essential and profound issue of health services development, and also the basic task of universities and colleges; 4) “high-level” have different meanings in different phases, and different people may have different understandings of it. That said, we will always pursue the highest.

Secondly, we should establish the Center as an open institution that is closely connected to and cooperating with the government, health institutions, media, international communities and other research institutions. We should stay open in our choice of research topics and provide the public with full access to our results and data. More importantly, we should have a dynamic staff force. Not only should we have full-time staff, but we also need to enroll large numbers of part-time researchers. In a topic-oriented way, any researcher happening to be working on the topic that is in our plan is welcome to be an important component of the Center.

Thirdly, we should innovate the management system. The Center should be organized as an academic institution instead of a public service. It should assume in real earnest a system of director responsibility led by the council. The administrative organ and the academic committee, as necessary parallel bodies, should be coordinated and balanced.

I am glad to tell you that the first council session of the Center was held successfully yesterday morning. We discussed in depth about the Center’s strategic goal, short-term research directions and focuses, and managerial system, with consensus reached and some detailed decisions made. Many of the Center’s regulations have been put into words and the Center has been equipped with complete basic hardware. Therefore, after today’s ceremony, the Center will start right off to work at full tilt.

I would like to say thank you to our friends from abroad and to the China Medical Board (CMB) for their support. I want to thank Commission on Education of Health Professionals for the 21st Century for their decision to have their commission session and forum held here to propel the medical education and health reform in China. I would also like to thank the Lancet for its cooperation with us to publish the Lancet China Health Series II and to continue to promote health services and health research in China.

The China Center for Health Development Studies is just like a big ship which sets sail today. With clear goal, accurate course, profound power and excellent sailors, I truly believe we are to tide over all the obstacles and setbacks in our way and to make it to our destination. Let’s work together to make today a glorious touch in the history written by us.

Thank you all!