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Beijing City Goes Local in Health Care

by Fred Fortin

In the U.S., states like Massachusetts, California and others have taken the initiative to address the needs of their uninsured population. So when we look at the nation as whole, we see a very complicated and confusing web of coverage mechanisms highly dependent on your personal demographics. Equal access to affordable, quality care is by no means assured. So it’s not pretty to look at, and certainly inefficient. Yet there are plenty of good things to say about local control, and local solutions. They engage the public more directly around real problems and are more responsive to their concerns. In fact the overall history of the the government’s role in health care in the U.S. has generally tended to be far more retail than wholesale with some well known exceptions.

China’s history of large central government programs is quite different. The emphasis has been on universality, nationwide equity, and the uniformity of all things health care. Problems here come in various forms including a very thin line of coverage, the inertia of massive bureaucracy, an anemic private sector, and limited innovation. But that was then and this is now.

China is in the mood for experimentation and local initiative. This time it’s in the nature of a large municipality pursuing a strategy for coverage of an especially vulnerable population: minors and senior citizens. The Beijing Labor and Security Bureau has drafted new policies seeking to extend national health benefits to these residents with the difference being that funding for the policy (400 million yuan per annum) will be wholly provided by the Beijing municipal authorities.

As all things are in health coverage everywhere — and especially in China — it is a quite complicated path that these residents will have to travel to secure benefits from the program. It is far from user-friendly. But the effort does speak to localities chipping away with more specific interventions to meet the needs of its people. Next year the city also plans to extend the system to disabled and unemployed people of working age.

Of course Beijing is not just any city in China. It is the national capitol after all. So new experiments here say something about flexibility and of what maybe possible elsewhere in China. And given that the provinces and municipalities are very competitive with each other, it could signal a new round of these kinds of local efforts.

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