China is increasingly becoming an urbanized and mobile society, and with that tremendous growth has come a number of health-care challenges. The country has a rapidly rising elderly population and increased rates of cancer and other chronic diseases. The expanding upper and middle classes are changing their expectations on the delivery of health-care services, and more than 800 million low-income individuals in rural and remote settings need better access to health care.
To meet these emerging needs, Chinese officials have begun a massive strategic planning process to update the health-care delivery system. Last month, they invited Kenneth W. Kizer, director of the Institute for Population Health Improvement at UC Davis Health System, to deliver the keynote address and discuss reform strategies in Beijing, China, at the first international conference on restructuring China's public hospital system.
The conference was organized by and held at the Chinese Academy of Social Sciences (CASS), the primary "think tank" for the People's Republic of China. CASS includes 31 research institutes and more than 50 research centers and is China's highest academic research organization.
"China's health-care delivery system is at a pivotal point," said Kizer. "The country is poised for major change although the challenges are enormous. Health care is perhaps at a comparable stage today as their manufacturing industries were in the mid-to-late 1990s, and a central question they are wrestling with is to what degree the health-care transformation should be driven by initiatives in the public or private sectors, or both."
Public hospitals and other publicly funded programs provide nearly all of the health care for China's 1.3 billion people. About 4.5 percent of China's gross domestic product is spent on health care, compared to 17.3 percent in the U.S. and 8 to 9 percent in most other western countries.
Private health insurance and private hospitals are largely not available in China, although there is growing interest in establishing private sector health-care options.
Kizer's lecture focused on lessons learned in transforming publicly funded health-care delivery systems in the U.S. His talk was followed by a question-and-answer session with administrators, clinicians and researchers who were most interested in health-care financing strategies, the role of competition in health care, and the advantages and limitations of public versus private-sector financing strategies.
"Governments can provide high-quality and efficient patient-centered care, and rapid and dramatic change is possible even in large, politically sensitive and financially stressed publicly administered health-care systems," said Kizer. "Having a clear vision of and explicit goals for the new system, and measuring and publicly reporting performance data, are essential to ensuring the success of health-care change efforts."
Kizer also emphasized the importance of continuously involving front-line clinicians in the planning and implementation of changes, incorporating automated information-management tools such as electronic health records, communicating frequently about goals and milestones, and educating and training the workforce in essential new skills.
Kizer is a distinguished professor at UC Davis and former Under Secretary for Health at the U.S. Department of Veteran Affairs (VA). In the latter capacity, he engineered what is widely regarded as the largest and most successful health-care "turnaround" in U.S. history. He transformed the VA system from a fragmented hospital-centered system to a system of integrated regional networks of care that routinely provides some of the highest quality health care in the U.S.
Kizer currently leads the Medi-Cal Quality Improvement Program, a partnership between UC Davis Health System's Institute for Population Health Improvement and the California Department of Health Care Services aimed at improving care delivery in the state's $46 billion a year Medicaid program (Medi-Cal).
During the past few years, UC Davis has established new partnerships and collaborations with China to advance medical education, medical research, patient care, hospital management and health-care policy. These include the agreements with BGI, the world's largest genomics organization, and memoranda of understanding with Tongji University School of Medicine, Soochow University and Nanjing Medical University, as well as leaders of the Shanghai Medical Tourism Products & Promotion Platform.