Page 41 - Genomic Medicine in Emerging Economies

30 CHAPTER 3: Genomics and Public Health: China’s Perspective

health care systems between urban and rural areas, that is, Urban Health Care
System versus Rural Health Care System, but both urban and rural health
services deliver through three levels: primary, secondary, and tertiary (Shao
et al., 2013).

Urban Health Care System
In the urban system, the Center for Disease Control and Prevention (CDC)
operates at provincial, city or district, and community levels (Zhao et al., 2011).
Meanwhile, there are three types of hospitals in the urban medical care system,
which are tertiary, secondary, and primary hospitals. A primary hospital has
basic facilities and fewer than 100 beds, offering prevention, sanitation, health
education, and treatment services for a specific community. The urban pay-
ment system has two stages. Before 1994 the Government Insurance Scheme
and Labor Insurance Scheme were the mainstream insurances, and only the
employees of government agencies, public institutions, and state-owned enter-
prises were covered by these two insurance schemes, which also partly cov-
ered the cost of health care for the dependants of employees. According to a
national survey in nine provinces in 1986, less than 14% of the urban popula-
tion was not covered by any health insurance or plan (Ministry Health, 1989).
After 1994 a new urban employee basic health insurance scheme—which cov-
ered more of the urban population, including the employees of the institu-
tions as mentioned above, foreign-invested enterprises, individual enterprises,
and those who were urban inhabitants but had no stable jobs—was developed
to replace the two schemes. In this scheme, government-run schemes have
decreased while nonmainstream insurances (e.g., commercial schemes) have
increased.

Rural Health Care System
In the rural system there is a three-tier health care network based on an adminis-
trative relationship. The county and township tiers play a communication role
between the higher and the lower tier. Village clinics deliver all health services
directly to rural populations, including diagnosis, treatment, prevention and
health education, vaccination, and women and children health care. Payment
in the rural health care system has changed a lot since the People’s Republic
of China was founded in 1949. Before the economic reform was launched
in 1978, over 90% of the rural population was covered by the Cooperative
Medical Scheme, but from the late 1980s to 2000, when the rural economic
system changed a great deal, while the Cooperative Medical Scheme was not
improved, less than 10% of the rural population was covered by insurance
schemes (Liu et al., 1998).
Since 2002 a new rural health care system has been established by the Chinese
government and is administered by the central and territorial governments.
The fund is collected from private entities, local governments, and central