Catalogue Economy Development and Society Advancement...... 4 1.Circumstance of the Province...... 4 2.Primary Characters of the Economic Development...... 5 3.The Population and Its Primary characters...... 7 4.Traffic, Post and Telecommunications Facilities...... 9 5.Education, Culture, Science and Technology...... 10 6.Living level of Residents...... 10 7.Social Security System...... 14 8.the Policy for Disadvantaged Groups...... 16 9.The Main Objects of Economy and Society in the Tenth Five-Years Plan...... 18 The Health Reform and Developing Actuality...... 19 1.The Health Standard and Situation of disease...... 19 2. The Demand of Hegelian Service...... 22 3. The Amount and Configuration Structure of Hygiene Resource...... 26 4.Quality and Efficiency of Medical and Health Care Service...... 30 5.The total amount, distribution and increasing rate of health care funding...... 32 7.Health care administrative management system...... 35 8.Main issued health care policies and the effects of implement...... 37 1.Health care economical policy...... 37 2.Health care policies in the countryside...... 38 3.Policies on the reformation of the health care prevention and supervision execution system....39 5.Policies on the reformation in drug distribution system...... 39 6.Policies on the price of medical health care service...... 40 Analysis on the main health care policy...... 40 1.The transformation of the government’s function does not apply to the development of the communist market-oriented economic system...... 41 3.The development of health care supervision executive department and personnel seriously lags behind the need by the development of the market-oriented economy...... 42 5.The public health care awareness and health care consumption sense need to be improved...... 43 6.The unbalance among the health facilities, insufficient investment and wasting of sources...... 44 7.The investment environment of the development of health care for the private companies should be improved...... 44 9.The problems in the health care insurance for residents in the countries are prominent...... 45

1 The suggestion on the main health care policy...... 47 1.Reinforce the government’s function, support by the policies and macro management...... 48 4.Continue to reform and renovate, improve the quality and efficiency and the health care service ...... 53 5.Quicken the implement of the modernization in health care technology...... 54 6.Establish the system to share the risk of diseases, alleviate the diseases’ burden of the masses.55

Introduction

People’s health has dual meanings in the development of our country’s socialism modernization. On one hand, health is the essential character of labor force, it is the precondition that makes the education and economy input to converse more effectively, it also can expedite the development of economy; on the other hand, health is the purpose of economic development and the important content of the social development. Our government think much of the people’s health, concern the development of the hygiene business, and establish a series of hygiene policy that suits our country, tallies with the public opinion and adapts to the market economy gradually to improve the development of the hygiene. In the field of the country’s socialism development, hygiene is the component of the macroscopic policy. Hygiene policy has a close relationship with the country’s politics, economic system and the economy level; it includes the economic policy, population policy and social security policy related with the hygiene business. Hygiene policy embodies the character of the hygiene business, determines the level of hygiene service, it has important effect to maintaining and improving the people’s health.

2 From the 50 years since the foundation of our country, especially the 20 years since the opening reform in our country, through putting the series of hygiene policy making by our country into practice, the hygiene business has greatly changed and achieved remarkable accomplishment in our province as in other provinces. Retrospecting this course, summarizing and evaluating the experience in the procedure of establishing and implementing the hygiene business are the important work to improve the continuance development of hygiene business in our province. It has four parts in this report: The first part is to retrospect the main achievement getting through the development of economy and socialism since the reform of our province. It reflects the character of innovating the system, fostering the market, developing the demotic economy as one of the early areas in the along the sea cities which developed the market economy. The second part reflects the procedure of the reforming and developing of the hygiene business in our country with the development of the economy and society in the 20 years. Surrounded the basic aim of improve the health level of the people, it can reflect the hygiene reform and development at its best from the need of hygiene service, the stock and configure structure of hygiene source, the quality of the hygiene service and the rate of the increase in the hygiene fees, the difference of the economy and hygiene level, management system and the main policy conducted in these years. The third part is the analysis to the main hygiene policy of Zhejiang province. The facing to the pressure of curing infectious disease and chronic disinfectious disease, the prophylactic difficulties of the large numbers of exotic people, the people’s economy funding setting foot in hygiene business, etc. can be used for reference. The fourth part is the thought and suggestion to the hygiene reform and development in the future. In this, we considered the character of the economy and society development carefully in order to making our province to fulfil the aim of the modernization of the socialism ahead of time. The hygiene policy expatiated the thought of realizing the modernization of the socialism.

Through this report, we hope that, it can bring useful revelation to the people who established the policy and performed it, in order to promote more effective management. Through the implement of the policy, the hygiene organization can offer better service, the people can enjoy fairly and effective service, and to raise the health level of our people. In the drafting out procedure of this report, the related department of our province offer many precious information to us, some specialist gave us technical consultation, the related official and specialists of our country brought forward precious amending suggestion to the primary draft.

3 Especially the Statistical and information commission gave us great care and help to our work, the west pacific area of the World Health Organization offered financial aid to us, we give the deepest thanks to them all.

4 Economy Development and Society Advancement

1.Circumstance of the Province Zhejiang Province, having the position of lat 118º123º E and long 27.12º31.31º N, is on the southeastern seaboard of China and the south of Changjiang Delta, and neighbors on Shanghai, the biggest city of China. Owning the beautiful scenery and glorified by talents and great men, Zhejiang is well known as "the land of fish and rice, silk, cultural relic, and travel industry sites". It was named after the flexuose Qiantang River, which is the biggest river of the province and has the alias of "Zhejiang River". The abbreviation of Zhejiang is Zhe. The distance from the north to the south of the province is about 450 km, as long as the distance from the east to the west. Of the land area, which is about 101,800 square km, mountain and hill area account for 70.4%, plain and basin area account for 23.2%, river and lake area account for 6.4%. The province has a expansive sea area, 3,061 islands whose area is larger than 500 square meters, 6,486 km of coastline, 1,607,000 hectares of plough, and 6398,000 hectares of woodland. Hangzhou, Ningbo, Wenzhou, Jiaxing, Shaoxing, Jinhua, Quzhou, Zhoushan, Taizhou and Lishui, are the 11administrative areas of the province. And it exercises jurisdiction over 39 counties, 24 county level cities and 25 county level districts. Hangzhou is the capital, and Ningbo is an independently listed city. The province has a population of 45.01 million. The population of the total 47 minorities in the province is 0.4 million and accounts for 0.85% of the province's. The She and Hui are the two minorities having the largest population therein. Zhejiang has ascendant geographical conditions, vivid economic characteristics, and large developmental potentials. It has the longest coastline in China, about 160 km, can be built 26 deep water berth over ten thousand displacement tons. Rivers, lakes, sea, mountains, wood, caves, stones and humanity sights make up of the abundant tour resources. The province has 11 state and 27 province regions of scenery, and 5 historically and culturally famous cities. Being the north of sub-tropic, influenced by the monsoon, having trenchant four seasons and plenitudinous sunshine, the ground is very fit for the cropper’s growing. The Hangjiahu and Ningshao plain are the famous producing areas of tea and silk. Zhoushan has the biggest fishery of China. Tea, silk, small commodities, orange, bamboo production and other etceteras have important status in the country. Zhejiang has a good industrial base, especially in machine and electron manufacture,

5 light and textile, chemistry, food and architecture industry. The output of Baichang silk and satin account for one third of the nation. A lot of professional talents in science, technology and management compose the abundant human resources of Zhejiang. Taking market as the direction, Zhejiang's economy started early and developed quickly.

2.Primary Characters of the Economic Development Zhejiang is one of the coastal provinces that having the developed economy and open to the outside world. Over the past 20 years, especially the years from 1996 to 2000, Zhejiang implemented the historical turn from a province short of resources to a developed province, through deepening the reform, opening further and expanding the socialist market economy intensively. Gross domestic production of Zhejiang increased from 12.4 billion Yuan in 1978 to 603.6 billion Yuan in 2000, by 10.4% every year. At the same time the place of the province, municipality directly under the Central Government and self-government region, rose from 12th in to 4th. And the average per-capita GDP increased from 331 Yuan to 13,461 Yuan, with the place rose from the 16th to the 4th, only less than Shanghai, Beijing and Tianjin (Table 1).

Table 1 Zhejiang’s GDP from 1996 to 2000

Index 1996 1997 1998 1999 2000

GDP（in billion Yuan） 414.606 463.824 498.75 536.489 603.634

GDP per-capita（Yuan） 9455 10515 11247 12037 13461

The industry structure of Zhejiang had a distinctness change. In agriculture, economy cropper planting, stockbreeding and aquiculture developed very quickly. The proportion of economy cropper to all croppers has risen from 43.6% in 1978 to 64% in 2000. And in industry, three traditional industries, cotton spinning, silk and cement production, had reduced losses and increased profits through compressing gross and regulating structure. The proportion of machine, electron, chemistry and medicine industry to the accessorial value of state enterprises and non- state enterprises having the sales income more than 5 million Yuan had risen from 36.2%to 45%. Zhejiang also has a rapidly developmental hi-tech industry, which has annual increments of 20%, 7.2% more than the average increment of the industry in same time. The tertiary industry, especially traffic, communications, commerce, tourism and social service, has expanded its area, enhanced its service levels and is 36.2% of the GDP in 2000, which was only 18.6% in 1978. The

6 fast developing of economy of Zhejiang contributes the country more and more (Table 2).

Table 2 Zhejiang’s GDP of every sectors from 1996 to 2000 (in billion Yuan)

Sector 1996 1997 1998 1999 2000 Agriculture 60.918 63.748 63.131 63.194 66.416 Industry 196.280 225.490 244.543 263.000 288.337 Construction Industry 23.739 25.466 26.365 27.281 30.010 Wholesale, Retail, Hotel 56.784 61.769 66.580 71.242 82.778 Traffic and Communication 23.489 28.893 32.175 36.491 42.830 Finance and Insurance 15.866 15.794 17.219 19.091 20.925 Social Servers 11.106 13.199 14.716 16.626 22.020 Nation, Party and government organizations, Social 7.033 8.178 9.305 10.421 12.671 organization sodality Others 19.391 21.287 24.716 29.144 37.647

The marketization of Zhejiang is enhanced obviously. Advancing the urbanization, regulating the social structure and fostering special markets, Zhejiang has established 4347 markets for a wide assortment, has the total finished transaction amount of 360.6 billion Yuan, whereas 409 markets have the amount more that 100 million Yuan therein by the end of 2000. The Yiwu China Small Commodity Market's and Shaoxing China Light and Textile Market's finished transaction amount were 17.54 billion and 19.1 billion Yuan in 2000 respectively. The industry consumable market is the primary in folk markets. The establishment agricultural by-products markets made peasantry being rich, and created a road of "the markets link to the bases, and the bases bring peasantry on". These years, lots of the markets had gotten great evolvement on exploiting the out- province and overseas markets. The establishment and development of the markets bring nice future to Zhejiang's economy revitalization. With the strategy of realizing the business and trade of higher levels, Zhejiang took a great effort to increase the amount of foreign trade operational entities and help the middling and small enterprises, especially the private enterprises to take part in the international competition and market. By 2000, Zhejiang had established business and trade relation with more than 200 countries and regions, the full year's total imports & exports achieved 27.93 billion US dollars, 52.1% higher than 1999's, whereas the imports was 19.44 billion US dollars. The exports of key merchandise, especially the hi-tech, dress and textile products enhanced more quickly, making the export structure better. The collectively owned and private enterprises' exports in 2000 achieved 3.37 billion US dollars, 1.1 times more than the year before. The number of the foreign trade

7 enterprises except the ones invested by foreign merchants has exceeded 2000 in Zhejiang now. And there were 1,642 foreign merchants investing enterprises authorized in 2000, 47.5% more than 1999, and used negotiated foreign capital of 3.07 billion US dollars and virtual foreign capital of 1.61 billion. State, foreign, collectively owned and private enterprises have a complete development in the province totally (Table 3). Table 3 Situation of Zhejiang’s import and export from 1996 to 2000 (in million US dollars)

Item 1996 1997 1998 1999 2000 Export 8041.47 10111.13 10866.23 12871.25 19443.69 Import 4499.79 4166.19 3987.59 5434.15 8389.85 Balance of trade 3541.68 5944.94 6878.64 7437.10 11053.84

The tax revenue of Zhejiang increased annually with the economy development, and it was 36.572 billion Yuan in 2000(not including expropriated by the customs), 4.7% more than the 34.92 billion in 1999.

3.The Population and Its Primary characters The total population of Zhejiang was 46.7698 million (including the extraneous registrants) in the fifth national census in 2000. And there were total 14.4497 million families, having the average population of 2.99. And 24.0186 million men accounted for 51.35% of the total population, and the sex ratio (male/female) was 1.0557. The primary characters of population are: (1) The population birth rate drops relaxedly, the total population has been controlled availably, and the growth of population has been slowed. Over the population of 41.4460 million in the fourth national census (1990), the total population of Zhejiang had an increase of 5.3238 million. In those ten years and four months, it increased 515.2 thousand persons every year, had an annual average increase rate of 1.18%, more lower than the period before the implementing of birth control (1950-1978), which is 2.05%. The population accrual rate in 2000 was 4.85% less than that in 1990. Over the past 50 years since the founding of the people's Republic of China, the increase model of Zhejiang population turned from the traditional model (high birth rate, high death rate, and low accrual rate) to the transitional model (high birth rate, low death rate, and high accrual rate), and now be the modern model (low birth rate, low death rate, and low accrual rate).

8 Natural increasing(‰) birth rate(‰) Death rate(‰) 40

30

20

10

0 1949 1957 1972 1978 1980 1985 1990 1995 2000 Figure 1 Situation of the birth rate, death rate and natural increasing Year in Zhejiang from 1949 to 2000

(2) The scale of Family dwindles with the total family amount increasing. The national census in 2000 shows that there were total 14.4497 million families in Zhejiang, and each had the average population of 2.99. The total family amount increased 2.765 million more from that in the fourth national census (1990), and the average population reduced 0.47 at the same time. (3) The agedness is the main group of all the age-brackets. And the process of greying in Zhejiang quickens more and more. Of the total population, people in the age-bracket 20-30 account for 18.07%, 5.22% less than that in the national census in 1990, and people in the age- bracket 15-64 account for 73.09%, 3.21% more than that in 1990, and people over 65 account for 8.84%, 2.01% more than that in 1990.

100% e t

a 80% r

g Over 65 n

i 60% s

o Age-bracket 15-64 p 40%

m Age-bracket 0-14 o

C 20% 0% 1953 1964 1982 1990 2000 Year Figure 2 Situation of the population composing of Zhejiang in the fifth census

(4) The quality of population has been enhanced observably, and the rate for illiteracy and semiliterate of the total population dwindled annually. People having the college education increased from 1,171 per 0.1 million people in 1990 to 3,189 per 0.1 million people in 2000, with an increase of 172%. And in the same period, people having the senior high school education

9 increased from 7,021 per 0.1 million people to 10,758 per 0.1 million people, with an increase of 53%, people having junior high school education increased from 23,766 per 0.1 million people to 33,336 per 0.1 million people, with an increase of 40%, and people only having primary school education reduced from 39,660 per 0.1 million people to 36,622 per 0.1million people, with a reduction of 8%. d

e 50000 t a c u

d 40000

e Primary school

f o e

l 30000 Junior high school n p o o i t e Senior high school a p l 20000

u College and upon p o

p 10000

e h T 0 1982年 1990年 2000年 Figure 3 The population of educated people in every census

The gross illiteracy rate (the share of people over 15 and having no literacy or little in the total population) for the province, reduced from 17.61% in 1990 to 7.06% in 2000, with 10.55% reduced.

30 The gross illiteracy 25 rate(%) 20 15 10 5 0 Figure 4 Change 1982年 of the the gross 1990年 illiteracy rate in2000年 the three censuses of Zhejiang

(5) The population density in Zhejiang is much higher, compare with the other provinces in the

10 nation. It has achieved 442 people per square km in 2000. Especially with the fast economic development in the last ten years, the population flow had turned from 0.7 million moving out in 1990 to 3 million moving in now.

4.Traffic, Post and Telecommunications Facilities The Zhejiang's traffic of road, rail, air, water and so on, had a great development since implementing of the policies of reform and open-up. In Zhejiang, highway is the main traffic. The total province had a mileage of 41,970 km (including 627 km express highway), 41.2 km per 100 square km in 2000, which were 29,509 km and 28.9 km per 100 square km in 1990. 99% of the townships and 96.3% of the administrative villages had been connected with the highway. And there are 250 thousand transportation specialist households, 603 thousand professionals, and 450 thousand passenger and cargo motorcars. The post and telecommunications industry had a great development too. The total installation amount of fixed-line telephones achieved 8.822 million in 2000, and the popularization rate was 30.61 telephones per 100 people.

5.Education, Culture, Science and Technology The education of Zhejiang has been a great step forward. All the counties of the province had completed the mission of basically popularizing the elementary education by the year 1989. The enrolment rate for children of school age (in the age-bracket 7-11) was 99.7%, and the stability rate for enrolled students was 99.4% in1989. The nine-year compulsory education had been basically popularized by the year 1997, with 99% of the pupils entrancing the junior high school, and having the stability rate for junior high school students of 99.3%. And 68% of the students who having finished junior high school entranced the senior high school in 1999. There were 150 thousand students (including 7,460 graduate students), 109 programs for doctor's degree and 269 for graduate's in the regular institutions of higher learning. And in addition, there were 127 thousand students in adult schools. Richly endowed by nature and glorified by talents, Zhejiang has been well known as a land of culture. At the end of 2000, Zhejiang had 1,932 mass culture institutions, 83 public libraries totally owning 15.29 million books, 2,129 institutions those were permitted to screen films, and 79 professional troupes. Fast developing in the reform and open-up, Zhejiang's science and technology contributed more to the economic building and social development. It had enhanced the developmental ability of the institutions for scientific research through reforming the managing system and operational mechanism, adjusting the institutions, resettling the labor force, deepening the reform, aiming at

11 the integration of researching, production and management, carrying out the system of "two different rules in one institution", sharing the labor income as the scientific and technical elements, and setting up economic entities. The scientific and technical investment is being multiplication. The total societal scientific and technical investment in 2000 was eight billion Yuan, increased by 45.5% from that in 1999.With the rapidly development, the total 648 hi-tech industry enterprises had the sales income of 611.15 billion Yuan, and handed the tax of 10 billion Yuan over. The governmental financial investment on education, science, technology, culture, and sanitation, is increased annually with the economic development of Zhejiang. It was 12.91 billion Yuan in 2000, when the total financial appropriation of provincial government was 43.136 billion Yuan. 6.Living level of Residents The residents of city and countryside have benefited straight from the reform and open-up. In 1978, city residents of Zhejiang had the average disposable income per-capita of 332 Yuan one year, which was 3.6% lower than the average of the nation. And in 2000, it had achieved 9,279 Yuan, 27.95 times more than that in 1978. The net income of countryside residents increased from 165 Yuan one year in 1978 to 4,254 Yuan one year in 2000, it had an increase of 25.78 times. The significant improvement for the income level of city and countryside residents, improved the quality of life obviously. Assessed with 14 criterions of city little comfortable standard in five aspects constituted by the State Statistical Bureau, Zhejiang's city little comfortable total score was more than 93 in 1997. 11 criterions had achieved the little comfortable standard. These were the average per-capita GDP, average residential area per-capita, rate of housing set, average virtual income per-capita, average daily calorie intake per-capita, average daily protein intake per- capita, average daily fattiness intake per-capita, average anticipant life-span, enrolment rate of middle school, working days per week, and average garden and greenbelt area per-capita. It showed that the residents of Zhejiang had anticipated owning a little comfortable life. The human development index of Zhejiang was the sixth in the nation in 1997(Table 4).

Table 4 Zhejiang’s human developing index in 1990 and 1997 Seating Seating Average arrangement of Human arrangement of anticipant Education GDP Sex human developing GDP in the life-span developing in the nation nation

12 1990 0.780 0.694 0.446 0.640 … 6 6 1997 0.780 0.735 0.949 0.821 0.767 4 6

The living level of Zhejiang's residents has turned from warm-and-full phase to little comfortable phase. The particular manifestations of this are in several fields: (1) The consumption structure is being rationalized with the distinct advance of consumption level. The cities and villages’ average payout of living per-capita were 6,170.3 and 3,944.8 Yuan in 2000, 19.5 and 24.1 times more than those of 301 and 157 Yuan in 1978 respectively. The average food expenditure per-capita of countryside residents in 1978 was 92.71 Yuan, and the Engel’s coefficient was 60%. The average food expenditure per-capita of city residents in 1981 was 264.43 Yuan, and the Engel’s coefficient was 55.6%. But in 1997, the Engle’s coefficient of city residents and countryside residents were low than 43.9% and 48.52% respectively. (2) The living environment has obviously been ameliorated with the expanding consumption domain. Residents now expend more on the education, medical treatment, communication and services than before. The small-scale peasant consciousness, which is self-sufficiency and self- service, is disappearing in the rural residents' minds. The ceaseless change of life style and the annual increase of currency consumption make people depend on the market more and more. Especially the payout of residential consumption, increased more quickly than others with the obvious improvement of residential condition. The average residential area per-capita in cities and towns increased from 5.77 square meters in 1980 to 14.04 square meters in 2000. And the rural average residential area per-capita increased from 16.07 to 46.42 square meters at the same time. (3) In cities and countries, the spiritual life of residents has been abundance increasingly with the improving of material life conditions. The possession amount of color televisions per one hundred families in cities and towns increased from 0.53 in 1981 to 139.17 in 2000. And the purchase amount of color televisions per one hundred rural families increased from 0.70 in 1985 to 9.02 to 2000. In 2000, Zhejiang had published 4110 kinds of books with the total press amount of 270 million, 90 million magazines, and 1.7 billion pieces of newspaper. The population coverage rate of broadcast and television increased from 71% and 42.5% in 1982 to 93.7% and 95.8% in 2000. And people began to choose the tour as their new leisure manner. Analyzing the income of urban and rural residents by five-part measure, there were 62.4% and 62.1% of the residents in cities and villages being under the average level in Zhejiang. The difference of average income per year between the highest and the lowest was not small yet, and

13 it had the trend to be much larger. From 1996 to 2000, the difference between the highest and the lowest in city enlarged from 3 times to 3.5 times, and it enlarged from 5 times to 5.5 times in the countryside (Table 5-6).

Table 5 Average income per year of Zhejiang’s residents from 1996 to 2000 1996 1997 1998 1999 2000 Covering Average Coveri Average Covering Average Coverin Averag Coverin Averag Income group% income ng income group% income g group e g group e level (Yuan) group (Yuan) (Yuan) % income % income % (Yuan) (Yuan) First 20% 20.2 4141 21.6 4127 21.5 4242 21.4 4410 21.4 4534 Second 20.4 5413 20.5 5646 20.4 5873 20.7 6223 20.6 6801 20% Third 20.5 6473 20.3 6941 20.3 7352 20.3 7859 20.4 8650 20% Forth 19.6 7876 19.5 8587 19.3 9136 19.4 9952 19.4 10959 20% Fifth 18.7 11339 18.1 12324 18.5 13370 18.3 14592 18.3 16520 20%

Table 6 Average income per year of Zhejiang’s rural residents from 1996 to 2000 1996 1997 1998 1999 2000 Coverin Average Coverin Average Coverin Average Coverin Avera Coverin Average Income g group income g group income g group income g group ge g group income level % (Yuan) % (Yuan) % (Yuan) % incom % (Yuan) e (Yuan) First 21.8 1369 22.1 1267 21.5 1337 21.2 1356 21.1 1574 20% Second 21.3 2280 20.6 2383 20.7 2421 20.8 2501 20.5 2737 20% Third 19.8 3115 20.0 3316 20.3 3339 20.3 3457 20.5 3800 20% Forth 19.3 4174 19.1 4463 19.3 4442 19.2 46606 19.5 5058 20% Fifth 17.8 7066 18.2 7674 18.2 8210 18.5 8350 18.4 8679 20%

14 The consumption structure of urban and rural residents showed that the rate of food expenditure had been obviously reduced in city, but in countryside, of the group with the lowest income (about 20% of the total rural population), it was not less than 60% of the total expenditure yet. Not only in city, but also in countryside, lower the total expenditure was, and higher the rate of payout for medical care would be (Table 7-8).

Table 7 The share of expenditure per-capita in income of Zhejiang’s urban residents Expendi Food Clothin Living Education Health Others The ture g and care share level Entertainm of ent expen Expe Prop Expe Prop Expen Prop Expe Prop Expe Prop Expen Prop diture nditu ortio nditu ortio diture ortio nditu ortio nditu ortio diture ortio per- re n re n (Yuan) n re n re n (Yuan) n capita (Yua （% (Yua （ % （ % (Yua （ % (Yua （% （ % in n) ） n) ） ） n) ） n) ） ） incom e % First 2059 45.4 294 6.5 467 10.3 502 11.1 297 6.6 695.5 15.3 95.2 20% Second 2567 37.8 454 6.7 530 7.8 736 10.8 447 6.6 1092 16.1 85.8 20% ．4 Third 2761 31.9 586 6.8 578 6.7 938 10.9 564 6.5 1391 16.1 78.9 20% ．5 Forth 3081 28.1 669 6.1 712 6.5 1072 9.8 626 5.7 1913 17.5 73.7 20% ．6 Fifth 3409 20.6 898 5.4 737 4.5 1416 8.6 814 4.9 3341 20.2 64.3 20% ．8 Average 2752 29.7 570 6.1 600 6.5 917 9.9 541 5.8 1639 17.1 75.7 ．8

Table 8 The share of expenditure per-capita in income of Zhejiang’s rural residents Expendi Food Clothin Living Education Health Others The ture g and care share level Entertainm of

15 ent expen Expe Prop Expe Prop Expe Prop Expe Expe Prop Expe Prop Expe diture nditu ortio nditu ortio nditu ortio nditu nditu ortio nditu ortio nditu per- re n re n re n re re n re n re capita (Yua （ % (Yua （ % (Yua （ % (Yua (Yua （ % (Yua （ % (Yua in n) ） n) ） n) ） n) n) ） n) ） n) incom e First 955 60.7 89 5.7 305 19.4 174 11.1 107 6.8 248 15.8 119.5 20% Second 1142 41.7 124 4.5 290 10.6 277 10.2 155 5.7 355 13.0 85.2 20% Third 1332 35.1 157 4.1 505 13.3 323 8.5 254 6.7 467 12.3 79.7 20% Forth 1553 30.7 194 3.9 539 10.7 377 7.5 203 4.0 665 13.2 70.0 20% Fifth 2146 24.7 287 3.3 1348 15.5 512 5.9 291 3.4 1084 12.5 65.3 20% Average 1406 32.2 167 3.8 580 13.3 328 7.5 200 4.6 548 12.5 73.9

7.Social Security System In 1997, according to the fundamental of "uniform policy, uniform management, and separation of affair from administration." Zhejiang established the provincial Social Security Committee and the Social Security Bureau. The provincial Social Security Committee is a coordinating and discussing institution for the reform of the provincial social security system. And the Social Security Bureau is a administrative management institution for managing and coordinating the reform of the provincial social security system. At the same time, Zhejiang established the special office and supervisory institution for the social security fund, and it had formed the Social Security Manage System with the administrative, fund and surveillance, those were detached and coordinating to each other. Zhejiang has made a lot of beneficial explorations for the reform of the Social Security System about the endowment insurance, unemployment insurance, medical insurance, social salvation pay and so on. Carrying out the Provisional Regulations on the Social Security Fees, the Regulations on Unemployment Insurance and the Regulations on the Employees' Basal Endowment Insurance of Zhejiang, the local people's government at all levels and the relational departments enlarge the amount of people having the social security gradually. By the end of 2000, 5.6715 million

16 employees, 92.53% of the all, had joined the endowment insurance in the cities and towns. In 31.4 thousand administrative villages of 1,464 villages and towns, there are nearly six million people, about 34% of the all, having joined the rural endowment insurance, which was begun in 1992. From the year of 1992, the comprehensive arrangement for serious disease fees has been the main medical insurance in Zhejiang. In 2000, the medical insurance for serious disease had been actualized in more than 50 counties in the province. After the provincial government put out the Measures on the Employee Medicare System of Cities and Towns, the employee medical insurance of cities and towns had been roundly developed in the province. By the end of 2000, 2.28 million people, about 37.56% of the all had joined it. There are 244 thousand unemployed people in the cities and town of the province (the unemployment rate was 7.2%). Because Zhejiang's economy had a sustaining development, and the private enterprises engaged lots of the social work force, the amount of unemployed people reduced to 211.7 thousand in 1999 (the unemployment rate was 3.4%). And in 1995, Zhejiang had already put out the Regulations on the Employee Unemployment Insurance, and it was the first in the nation. The unemployment insurance cover rate was constantly extended in the five years after the putting out of the regulation. Of the total province, the amount of people who had joined the unemployment insurance increased to 3.88 million in 2000. With the combining of almsgiving and accelerating the re-employed, the unemployment insurance served for the unemployed people on employment introducing, employment training and self-salvation through production (Table 9). Table 9 The population of joining the social insurance of Zhejiang from 1996 to 2000 (In thousand)

Species 1996 1997 1998 1999 2000 Endowment insurance 3571.8 3488.9 3780.6 5165.7 5617.5 Unemployment 3322.3 3210.3 3003.4 3654.5 3885.0 insurance Medical insurance 1072.8 1704.4 1907 2000.4 2280.5 Employee’s liability 1794.4 1727.6 2299.7 2310.6 2120.9 insurance Birth insurance 194.40 195.92 202.67 213.86 200.02

The rural community-sponsored medical treatment was a way created by the rural residents for medical treatment with mutual help, and it was widely extended in Zhejiang's country, covering

17 75% of the total farm population at that time. After the implementing of contract system with remuneration linked to output, as the collective economy, which was the main source of the community-sponsored medical treatment fees, had been weakened, and the crowd's attending consciousness was not intense, the financial supervision was not enough powerful, lots of the cooperation hospitals were closed. The CPC Central Committee and State Council again affirmed that the system of community-sponsored medical treatment was a fit rural medical insurance system for the realities of the country. According to the Opinions on Consummating and Developing the Rural Community-Sponsored Medical Treatment, promulgated by the provincial government in 1998, the province took the developing of the rural community-sponsored medical treatment as the main point of the health work. At present, the main forms of rural community- sponsored medical treatment in Zhejiang are: cured and using medicine together, cured but not using medicine together, using medicine but not cured together, comprehensive arrangement for serious disease when need to be in hospital, assistance for indisposition, giving attention to outpatients and in-patients, subsidy system, giving compensation for onefold health care, and so on. By the end of 2000, the amount of villages and towns that joined the community-sponsored medical treatment cured and using medicine together was 39.97% of the total amount of the province, and the attendees was 24.56% of the total farm population. In addition, 20.89% of the population had joined the planned immunity, maternity and child hygiene, and other health work. It made a great effect for the rural residents to gain the essential health care services. These years, some places of the province began to actualize the rural insurance for serious disease, and it made an active effect for solving the poverty of rural residents that caused by the disease.

8.the Policy for Disadvantaged Groups Women Under a series of lows for protecting women's legal rights and interests, women have the same status, power and treatment as man. The provincial government laid a developing programming for woman in 1997, to improve women's status and diathesis, and brought forward the idiographic object and requirement on bringing out the woman's effect. Women assume the office of all levels, and it shows the women's legal rights and interests (Table 10). It has been showed statistically that there were 1,341 thousand women joining the labour union, which had the total members of 3,651 thousand in 1997. Table 10 Situation of women delegate to provincial People’s Congress and Political Consultative of Zhejiang

18 People’s Political People’s Congress Consultative Item The first The fifth The ninth The The fifth The ninth in 1954 in 1977 in 1998 second in in 1983 in 1998 1959 Delegate amount 451 1008 598 155 625 648 Amount of women 73 237 123 27 88 117 delegate Rate of women 16.2 23.8 22.1 9.3 14.1 18.1 delegate（%）

The female youth and children have the same essential rights and interests as male. In the years between 1996 and 2000, the share of female in the middle and elementary school students was 46%47%, and the share of female in the junior college and university students increased from 39.1% in 1996 to 43.3% in 2000. Women work in every walk of life just like men. According to the statistics of 2000, the amount of female employees in manufacture, retailing, catering, finance and insurance, social service, health, sports, social welfare, education, culture, art, broadcasting and television, and other industries was over 40% of the total employee amount.

The Handicapped In 2000 there were two million handicapped people in the province, and it was 4.79% of the total population. Of all the handicapped, there were 867 thousand audition disabled, 323 thousand intelligence disabled, 266 vision disabled, 235 limb disabled, 83 mental disabled, and 225 integrate disabled. The government takes the policy of "using any ways to arrange the handicapped to work pro rata" to solve the employment problem of the handicapped. In 1997, there were 4,651 welfare enterprises that placed nearly 100 thousand handicapped people and completed the total production value of 35.04 billion Yuan, and realized the retained profits of 0.817 billion Yuan. In 2000, it placed more than 9,600 handicapped people, and in the country there were 370 thousand handicapped doing the planting and breeding job. Thousands of people, each helps one handicapped to get elevated from poverty, and then the amount of the poor handicapped reduced from 145 thousand in the beginning of 2000 to 105 thousand at the end of year. The government pays more attention to the education of handicapped child and youth. There are 62 special schools in the province. Among these schools two are for the blind, 37 are for the

19 deaf, 1 is for the blind and deaf, 16 are for the retarded, and 6 are integrative. In general schools there are 92 classes for the special education and 32,696 handicapped students. The enrollment rate of blind, deaf and retarded child and youth is more than 90%. The total province takes the community healing as the main point to roundly develop the healing work for the handicapped. Leaded by the government and the Association for the handicapped, assisted by all the sectors, sharing the resource, all the society offers the handicapped the guarantee of healing. In 2000, through the operations more than 20 thousand cataract patients were able to see again, and 563 limb disabled people had the orthopedic operation, 588 trained deaf children were trained to talk, 720 asthenopia people got well, 623 retarded children and 996 limb disabled people accepted the healing training, and 43 thousand psychopaths were in custody. All of these increased over 1999 in different degrees. The province established 95 up county level direction institutions serving for the handicapped healing. The amount of social welfare institution that invested by the government and managed by the civil administration sector increased from 14 in 1987 to 59 in 2000.

The poverty group By the end of 1997, the average income per-capita of the eight poverty counties in Zhejiang exceeded 1,400 Yuan, and the average grain ration per-capita exceeded 250 kg, the poverty rate reduced to 5%. It took the way of combining the centralized fending and dispersedly fending to help the rural poor household, with the five-guarantee (in food, clothing, fuel, education and expenses) fees paid by farmers for overall villages and towns planning. 91% of the poor households were fended by the society now. In 1999, the province issued the national relief and collective subvention of 233 million Yuan, 14 thousand people received the governmental term relief and 290 thousand person-times received the governmental temporary relief, and there were 41.7 thousand five- guarantee households fended by the collective, receiving the collective fending sum of 65.983 million Yuan, 1,580 Yuan per one person. It has formed a salvation system on the whole for the typhoon. In the past 20 years, nearly 60 million people (person-time) had took part in fighting with the disaster, and 6.9 million victims of a natural calamity (person-time) had been displaced and nestled, 160 thousand persons were helped to rebuild their home. It solved the problems of food, clothing, living, healing and so on for about one million people in the serious disaster area every year.

The Old Group

20 In 2000, the population of people up 65 years old was 3.9791 million, 8.84% of the total population. The greying has been paid attention to by the government and the society. The building of senior citizens home has a durative development with the fast developing of economy. The amount of rural senior citizens home increased from 34 in 1978 to 1,961 in 1997, having an increasing of 50 times. And it realized the object of having senior citizens home in every villages and towns on the whole. The government at all levels and the society at all circles increase the devotion annually. According to the statistic, in 2000, it had been invested 304 million Yuan in the building of "Xiyanghong project" (a project for the old group) in the province, and the share of government was 34.7%. It had built 924 new active centers, 20 agedness houses, 44 senior citizens homes, 5 beadhouses, 172 colleges for the old, and one healing center. The increasing welfare establishments for the old people created conditions for the old on fending, healing, studying and entertainment.

9.The Main Objects of Economy and Society in the Tenth Five-Years Plan The main objects of economy and society in the Tenth Five-Years Plan of Zhejiang is "make the speed of national economy growth be higher than the average of whole nation, improve the quality and profit of economy growth, enhance the comprehensive strength obviously, to create conditions for the average GDP per-capita of 2010 to double over that of 2000; improve the socialist market system, hold the predominance for advanced system and mechanism, and take part in the international cooperation and competition in the more ranges and deeper degree; the increasing income of the city residents and rural residents could make the people having the better little comfortable life; strengthen the environmental protection and the ecological building; try to make the average GDP per-capita of one third of the cities and counties over 3,000 US dollars, and up to the standard of medium-developed countries, realize the modernization basically. The anticipative objects in main aspects are: The economy retains a quick increase. The GDP increases by 9% per year, and will exceed 920 billion Yuan by the year 2005; and the average GDP per-capita approach to 20 thousand Yuan. The whole social investment for assets and the total amount of import and export increase by 11% per year, and the amount of export increases by 10% per year. The local finance income increases by 10% per year, and the total price level would be steady. Optimizing the industrial complexes, that will develop the profit agriculture quickly, enhance the industrial predominance, and improve the proportion for the service industry. The proportion of three industries (the first industry, the second industry and the tertiary industry) will be adjusted to 8:51:41, and the increment of hi-tech industry will approach 25% of the total

21 industrial increment. The information degree and the building of information network will be in the top of the whole nation, and the main cities' will close to or approach the developed countries'. The telephone popularization rate will over 86%, and 87% of the families will have the cable television, the popularization rate of the families owning the data and multimedia service will be higher than the average level of the nation. The urbanization level will be improved obviously. The harmonious development of metropolises, medium-sized cities, small cities and central towns, will enhance the leading action of the central cities to the region economic development. The rate of non-farming population will be 63%, and the urbanization level will be about 45% by the year 2005. It will expedite the development of science education and society undertakings, increase the contribution of science improvement to the economic development; the technological financial investment of the province will be 7.8% of the total financial expenditure by the year 2005. It will popularize the nine-year compulsory education with a high level, essentially popularize the middle school education, and make the enrollment rate of higher education exceeding 20%; the share of provincial education outlay in the total financial expenditure has an increase of 1.2% per year. And the conditions and the coverage rate of the establishments for city and country's culture, health and sports will be both improved. The enhancement of the ability for preventing or controlling the flood and tide, fighting the drought, and the water supply, will enhance the ability of sustainable development obviously. It will make the using of land and other important resources more reasonable, and the total quality of entironment will be advanced level in the nation. The natural population increase will be controlled under 0.565%, the proportion of clean energy will be about 9%. The forest coverage rate and the city greening coverage rate will be over 60% and 35%. And compare with the year 2000, the emission amount of the important contaminations reduces by 10%. People will have a much richer little comfortable life. The city residents' average disposable income per-capita and the rural residents' average net income per-capita will both have an increase of 5% per year. The city residents' average residential architecture area per-capita will increase to 22 square meters, when the rural residents will have a much better residential condition too. The registered unemployment rate in cities and towns will be controlled below 5%. And the living environment, living quality and social culture degree will all be improved obviously.

22 The Health Reform and Developing Actuality

In the over 50 years since the founding of the people's Republic of China, especially in the years of the reform an open-up, with the lead and care of the provincial Party committee and the provincial government, and directed with the Deng Xiaoping Theory of building socialism with Chinese characteristics, Zhejiang insisted the health work policy of "taking country as a focuses and prevention first, paying equal attention to Western medicine and Chinese medicine, depending on the scientific improvement and mobilize whole society to take part in, to serve the people and the socialistic modernization building" in the new historical period since 1978, deepened the health reform and had gotten a notable success. The main indicators of national health have approach the average standard of medium-developed countries in the world. With the improvement of economy, science and the living level, the people have more requirements on improving the health service and the living quality. The health problems about the entironment and living styles is being worse increasingly with the fast process of industrialisation, urbanization and greying. With the deepening of reform, the deep-seated contradictions in health department become more and more visible. The health development is facing the new challenges.

1.The Health Standard and Situation of disease (1) The level of the people health has increased obviously. It is owing to the rapid development in the social economy, the gradual increase in the hygienic input and the incessant improvement in the medical treatment. According to the statistics of 2000, the birthrate of the population all across the province is 10.30‰, and all inhabitants’ expectation of life is 74.88. Woman care aims at reducing the mortality of pregnant and lying-in woman and concentrates on improving the service quality of tocologist, in the course of women during and after pregnancy 42 days, it carries out a complete medical care service. The rate of childbearing in hospital has been increased to 98.7%, the mortality of pregnant and lying-in woman decline stepwise along with the elevated rate of childbearing in hospital and the ascending overlay of systemic pregnant and lying-in woman care. In 2000, the mortality of pregnant and lying-in woman is 19.59/100,000. (Figure 5)

23 45 )

0 40 0

0 35 , 0

0 30 1 /

1 25 ( e t

a 20 r

h 15 t a

e 10 D 5 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Figure5 The mortality of pregnant and lying-in woman from Year 1990 to 2000 in Zhejiang

With regard to children care, it aims at reducing the mortality of infant and children below 5 years old, to promote breast-feed and prevent the hackneyed disease of child. It established a healthcare system for children below 7 year-old, of what the management rate had increased gradually. The mortality of infant and 5-year-old children and below has been dramatically reducing. In 2000, the mortality of infant is 15.57‰, and the mortality of children below 5 years old is 19.49‰. (Table 11) Table 11 The mainly index of health of resident from 1996 to 2000 in Zhejiang Index 1996 1997 1998 1999 2000 The mortality of infant (‰) 23.54 21.59 19.44 17.67 15.57 The mortality of 5-year-old 27.94 25.93 23.12 22.05 19.49 children and below (‰) The mortality of pregnant and lying-in woman 23.2 24.9 25.4 22.1 19.6 (1/100,000) Expectation of life (year) 73.15 73.60 73.75 74.32 74.88

(2) The prevention and treatment of endemic and infectious diseases has obtained prominent effect. Some endemic such as ague, filariasis, schistosomiasis, endemic goiter, endemic fluorosis and lepra has been ever seriously prevailed in our province, for example, in fifties, schistosomiasis was widely promulgated in 53 counties, there were 2040,000 patients. By means of all-around step of prevention and cure, including shutting off the path of prevalence, enhancing the people ’s immunity and improving the condition of sanitation in town and countryside, in middle of eighties, the schistosomiasis, filariasis, ague and lepra had been controlled, and even

24 been annihilated basically. The incidence of endemic goiter and endemic fluorosis had also been dramatically reducing. The strict implementing of law and statute, such as the Law of the People's Republic of China on the Prevention and Treatment of Infectious Diseases and the Law of the People's Republic of China on Food Hygiene, the full advancing of planned immunity of children and the stepwise improving of environmental establishment of town and countryside, the incidence of first and second infectious diseases of legal report decrease year after year. The total incidence of diseases in legal report’s infectious diseases of 2000 has decreased to 299.95/100,000. In recent year, with the quick urbanization construct and the increased float population, the incidence of acute and chronic infectious diseases relating to ill life style always very high, that of some infectious diseases even has the increasing trend. For example, the local prevalence of cholera and hepatitis appears in some year and some areas; there were 22809 cases of tuberculosis in 1999 all across the province, 22991 in 2000, increased 0.29%; the incidence of venereal disease increased quickly. Our province is the earliest one that found HIV infection in our country, 4 cases of HIV infection had been examined in 1986,they are all haemophiles that using the imported eighth gene. Because of someone’s ill life style, AIDS infection also increased. Up to 2000, there are 236 HIV infected person that were examined all across the province, and 31 people were taken bad and 23 people died. According to the experts’ estimate, the actual HIV infected people in our province are more than 4000. (Table 12) Table 12 The incidence of infectious diseases of legal report (1/100,000)from 1996 to 2000 in Zhejiang

Name 1996 1997 1998 1999 2000 The incidence of first and 257.19 289.39 294.52 321.31 299.95 second infectious diseases Virus hepatitis 113.10 108.80 101.90 115.10 105.00 Venereal disease 34.62 39.81 63.96 87.84 75.74 Phthisis -- 47.62 48.79 51.17 51.27

(3) The pedigree of illness and death reason of inhabitants in the whole province changed obviously. In the order of death reason, the malignant tumour, cardiovascular, cerebrovascular and breath system diseases have become the first three death reasons. By the survey of part counties (section) in 2000, the mortality of malignancy is 148.3/100,000, and the order of the first five malignant tumour is lung cancer, stomach cancer, liver cancer, esophageal cancer and colic cancer. In the city, the incidence of lung cancer is higher than that in the countryside, it is reverse for stomach cancer. The mortality of cardiovascular cerebrovascular diseases in the third order of

25 death reason in 1995,but in 2000,it go up to the second order. The incidence of hypertension, as the most serious nosogenesis of cardiovascular cerebrovascular diseases, also has increasing trend, increasing from 9.7%in 1991 to 25.6% in 1998 (figure 6).

City Coutryside ) 0

0 60 0 , 0

0 50 1 /

1 40 ( e t

a 30 r

h

t 20 a e 10 D 0 肺 肝 胃 食管 结直肠 Figure 6 The contrast of mortality of 5 main malignancy in Zhejiang in 2000

(4) Along with the acceleration of industrialization, urbanization and greying, deterioration of entironment and alteration of life rhythm and life style, accidental damage, old people’s disease, mental handicap, cacotrophia and adiposity of children and occupational and environmental harm that followed by have become new hygiene problems that affects health. For example, since from 1986, the mortality of accidental damage is in the fifth order of mortality of disease at all times. In 2000, it was 59.79/100,000, and death because of traffic accident is 33.1%, suicide is 23.2%. With the development of social economy and urbanization, life rhythm has expedited, social competition has pricked up, all kinds of mental handicap has increased sharply and mental and hygiene problem has stood out increasingly. Based on survey of Hangzhou in the early 90’s, the incidence of mental disease is 12‰. From 1995 to 1996,the incidence of teen-age mental and hygiene problem is 13% in primary school, 17% in high school, and 25% in college. In addition, the incidence of mental handicap in the aged over 60 is 12.91%, among this, hypochondria cal handicap is 18.4%, worrying handicap is 20.3%, and the unwellness caused by mental reason is 17.2%.

2. The Demand of Hegelian Service In order to understanding the demand of hygiene service in our province and the actuality of hygiene resource configuration, mastering the variety of hygiene resource investment and the demand of hygiene service, providing the external gist for forecasting of the relationship of

26 supply and demand trend in hygiene service for the future, in 1998, according to uniform deployment of ministry of health, our province carried out spot check of the demand of hygiene service and hygiene resource, by means of multistage layered unitary stochastic sample , we sampled sanitation institution of 12 county (city, section) ,7200 families and 25,000 people as object. It divided into enquiry about familiar health survey and hygiene institution service survey. The results provide us abundance material. (1) Spot check of town and countryside’s inhabitants showed two-week incidence of disease is 12.8%, analyzing by sex, the incidence of disease of woman (13.3%) is higher than that of man (12.3%), analyzing by classified disease system, two-week disease mainly include familiar and frequent disease, five type of disease, breath system, digestive system, circular system, muscle and bone system, damnification and toxicosis, is 80.63% in total disease. In city, the total incidence of disease is higher than countryside, on the one hand, aged degree of city is higher than that of countryside and the incidence of chronic disease is high, on the other hand, the education level, health consciousness and cognition degree of disease of city inhabitant is higher than that of countryside. (Table 13)

Table 13 Inhabitant’s two-week incidence of disease (%)of hygiene service survey by disease classified stat. in Zhejiang province in 1998 Total City Countryside Incidenc Percent Incidenc Percent Incidenc Percent Item e of e of e of disease disease disease Two-week incidence of disease 12.80 20.60 11.50 Breath system disease 5.33 42.72 9.31 46.23 4.66 41.67 Digestive system disease 2.24 17.92 2.73 13.58 2.16 19.22 Circular system disease 1.02 7.93 2.57 12.62 0.76 6.52 Muscle and bone system 1.00 7.87 1.53 7.54 0.91 7.96 disease Damnification and 0.54 4.19 0.81 3.98 0.50 4.25 toxicosis

27 Analyzing by age grouping, not only in city but also in countryside, two-week incidence of disease showed U type curve in different age group. In the age group from 0 to 4,The incidence of disease is 15.93%, in the age group from 15 to 29,the minimum is 12.16%, then it increased by the increasing of age, in the age group from 60 to 69 and over 70, it is more than 21%, which

35 Total ） % 30 City （

e Coutryside s 25 a e s i 20 d

f

o 15

e c 10 n e d

i 5 c n I 0 Age-braket 0～ 5～ 10～ 15～ 20～ 30～ 40～ 50～ 60～ 70- Figure 7 Inhabitant’s two-week incidence of disease (%)of hygeian service survey by age in Zhejiang in 1998 suggest that the children and the aged are the important population of disease prevention and treatment.(figure 7)

Analyzing by medical safeguard system, two-week incidence of disease has relationship with the degree of enjoying the medical safeguard system. In city, two-week incidence of disease of people who enjoying the socialized medicine is highest, they are 24.55% and 20.67% respectively. In countryside, two-week incidence of disease of people who enjoying socialized medicine and labor insurance medicine is highest, they are 15.02% and 13.94% respectively. Two-week incidence of disease of people who enjoying the medical insurance is lowest, it is only 6.73%, which is under the half of that of enjoying socialized medicine and labor insurance medicine. (Table 14)

Table 14 Inhabitant’s two-week incidence of disease (%)of hygiene service survey by different medical safeguard system in Zhejiang province in 1998 Item Socializ Labor Half- Medical In Cooperative Persona Other ed insuranc labor insurance planni medical l e insurance ng treatment Total 19.14 18.49 15.37 8.91 16.67 7.61 11.87 3.88 City 20.67 19.52 17.33 20.51 24.55 -- 20.18 8.33

28 Countrysid 15.02 13.94 10.83 6.73 10.00 7.61 11.42 2.15 e (2) Chronic disease is the chronic non-epidemic disease that investigated object sickened in half year diagnosed by doctor. Results showed, the incidence of chronic non-epidemic disease is 12.1%, 11.8% in man, 12.4% in woman, in city it is 22.3%, but in countryside it is 10.4%, which is under the half of that of city. The incidence of chronic disease increased by the increasing of age. In the age group of 60 and above 60, it is double in city of that in countryside. In the age group from50 to 59,it is 26% higher in civic woman than that in man. In the distributing of disease type in chronic disease, in city and countryside, the incidence of hypertension is in the first order and second order respectively. (Figure 8)

70

60 ） % e

s 50 a

e City and s i

d 40 coutryside

f o

City e

c 30 n e

d Coutryside i 20 c n I 10

0 0- 5- 10- 20- 30- 40- 50- 60- 70- Figure 8 The incidence of chronic non-epidemic disease by age

Professional analysis of chronic non-epidemic patient, not only man but also woman, for career man, people in department and manager, the incidence of disease is maximum (Table 15).

Table 15 The incidence of chronic disease (%)of hygiene service survey by professional statistic in Zhejiang province in 1998 Manage Career Operation Business Manufac- Forestr r man man and service turing y and Item man and Agriculture breed carrying aquatics trade Man 24.86 20.93 17.67 12.16 12.23 13.16 10.45 Wom 19.57 23.22 9.63 9.78 16.35 12.58 12.28

29 an Total 23.02 21.97 13.74 10.84 14.06 12.88 10.71

(3) Healing of residents’ two-week disease: the two-week disease’s healing rate of the residents is 54.7% and 59.5% in cities and villages respectively. The non-healing, mainly adopted self- treatment in city, but adopted nothing in countryside. The unit for patient, is the room of health in hamlet and yard of health in villages and towns (the total is 66.4%), individual clinique is 10.7% in countryside, is the hospital in county and the high level of county (the total is 65.3%). The expense of outpatient has biggish difference in different level of medical hygiene institution. (Table 16) Table 16 The ratio of ()of inhabitant’s two-week disease (%)of hygiene service survey by the different unit for patient in Zhejiang in 1998 The Out- The Individu The hospital Health patient Yard of hospital at Item al hospital at at room departm health county hospital city level province ent level level Total 9.32 35.23 2.01 21.46 15.72 11.22 2.93 City 4.50 16.75 5.50 4.75 11.25 42.50 11.50 Countryside 10.66 40.35 1.04 26.09 16.96 2.56 0.55 (4) Analyzing by the expenses of two-week outpatient: the average expenses of investigated outpatient is 59.3 Yuan, by the further analysis of the data, the distributing of the expenses show the obvious skewness distribution, the average obtained by calculating median is 32.5 Yuan. The expense of outpatient has biggish difference in different level of medical hygiene institution, below the yard of health in villages and towns level of medical institute, it is under 35 Yuan, in the province level of hospital, it is 120 Yuan, and it is also the maximum. In the county level of hospital, the expense every time in herbalist is 25 Yuan more than in other hospitals. (Table 17) Table 17 The expense (Yuan, RMB) of two-week outpatient of hygiene service survey by the different medical institute statistic in Zhejiang in 1998 The percent expense of outpatient The average Medical institute expense of 25% 50% 75% out-patient Total 32.5 59.3 Individual 12 20 50 49 Room of out-patient 10 20 35 31 Clinic 20 35 63 64 Yard of health in villages and 20 33 60 52

30 towns The hospital at county level 40 75 150 112 The hospital at city level 40 70 150 107 The hospital at province level 80 120 200 155 Chinese medical hospital at 60 100 200 134 county level Other hospital 27 49 50 39

(5) Suffering inhabitant in hospital. The rate of suffering inhabitant in hospital is 2.9% in the year before the surveyed; it is higher in city (4.5%) than in countryside (2.7%). The rate of the patient who should be in hospital but not is 19.9%, it is also higher in city (21.6) than in countryside (19.5%). It is 53.9% because of money difficulties, and it is 54.6% in city and 53.7% in countryside; in addition, it is less than 1% because of no beds. With respect to medical institute, in countryside, the first one is the county level of hospital (61.6%), the second one is the yard of health in villages and towns (21.31%), and the third one is the hospital at city level (10.2%). And in city, the first one is the city level of hospital (58.8%), the second one is the province level of hospital (26%), the third one is the section level of hospital (13%). Among the 57.7% patient in hospital, the expenses is within 3000 Yuan every time, and in the hospital of city (province, city), the expenses is twice higher than that in and below the county level of hospital. The expenses of patient every time of the people that enjoying different medical safeguard system has the large difference. (6) Hygiene habits of the inhabitants. Survey shows, the smoking rate of 15 and upwards of 15 is 25%, 44.2% in man and 1.8% in woman, it is 20.90% in city, 39.9% in man and 1.7% in woman, it is 25.7% in countryside, 44.9% in man and 1.7% in woman. The drinking rate of 15 and upwards of 15 is 20.4%, 33.9% in man and 3.6% in woman. The proportion of people aged more than 15 who always take part in physical exercise is 10.5%, 38.3% in city and 5.5% in countryside. (7) Using the share system for the disease in city and countryside, the proportion of people who enjoy the socialized medicine, the labor insurance medicine, the half-labor insurance medicine and half-insurance of medicine, cooperative medicine, personal medicine and others is 3.5%, 7.2%, 2.6%, 5.7%, 79.4% and 1.6% respectively. The proportion of people who enjoy personal medicine in countryside is 88.1%. They endure great pressure of disease. The depressed family that caused by disease and damage is 35.7% of all depressed family, which is the important reason of poverty.

31 3. The Amount and Configuration Structure of Hygiene Resource (1) Zhejiang’s health institution takes the public-owned as the principle part, and has the two forms of collective ownership and the ownership by the whole people. Up to 2000, there are 7465 medical hygiene institutes in our province, that held by hygiene department is 3696, that held by industry and other department is 3736, that held cooperatively is 18 and held privately is 15. Classifying by service function, there are 434 hospitals, 2736 yards of health, 18 sanatoriums, 3669 clinic, 303 prevention institutes, 68 woman and children care institutes, 75 medicine inspection institutes, 21 medicine research institutes, 83 medicine education institutes and 58 other hygiene institutes in our province. Besides, there are 9531 personal clinics and 22725 country medical spots. A relatively perfect hygiene service system has come into being in our province. There are 107221 beds in hospitals, the amount of beds is 2.38 every thousand people. In hygiene system, there are 200307 health officers, including 157875 health technic officers. The amount of doctors and nurses is 1.65 and 0.89 every thousand people respectively. (Table 18) Table 18 The average amount of beds and health officer every thousand people from1996 to 2000 in Zhejiang

Item 1996 1997 1998 1999 2000 Bed 2.27 2.29 2.33 2.34 2.38 Health professional 4.23 4.33 4.37 4.39 4.45 officer Health technic 3.38 3.47 3.51 3.48 3.51 officer Doctor 1.57 1.63 1.58 1.64 1.65 Pharmaceutist 0.34 0.34 0.35 0.35 0.33 Nurse 0.79 0.82 0.87 0.85 0.89 Paramedic 0.05 0.05 0.05 0.03 0.02 Other 0.22 0.23 0.28 0.24 0.24

(2) Classifying by administration domination, the medical institute include 396 hospitals in the county level and above, 38 other hospitals, 2736 yards of health in town and villages. The proportion of medical beds of the hospitals in the county level and above is 80%, such hospitals possess the relatively advanced furnishment and establishment, but in the wide countryside, the basic sanitary establishment is still very weakness. The manpower resource is the main body of medical institute. The county level and above of hospital possess of 109131 health technic officers, classifying by educational background, the proportion of people who acquire the diploma of junior college and above, the diploma of technical secondary school and no normal is 31.5%, 42.9%, and 25.7% respectively. But in the wide grass roots medical institute of countryside, the proportion is 10.3%, 38.5% and 51% respectively. Furthermore, there are 23243

32 country doctors and 5011 health person in countryside, and the technology making of these people is lower generally. (Table 19) Table 19 The educational background statistic of the personnel in different level of medical institute in Zhejiang in 2000 Classifying the health person by educational background (%) The sum of health Item Undergradu Technical No person Junior ate college secondary educational college and above school background The county level of 109,131 16.6 14.9 42.9 25.7 hospital and above Other hospitals 2,457 3.8 12.7 28.4 55.1 The yard of health in 48,169 1.5 8.8 38.5 51.0 countryside

In recent years, our province carried out the admittance test of professional physician (including the professional assistant physician) and registered nurse. (3) With the development of birth control, its technological guidance is receiving greater attention. A great many of technological guidance institutes have been set up all across the province, forming part of the whole society’s health care resources. According to the statistics of 2000, of the 1864 villages and towns (including residential districts) in the province, 1647 have established the birth control service station. The province’s whole financial input (starting from the county level) in birth control reached 0.29 billion Yuan, an increase of 21.23% over the previous year. (4) Inspired by the development of market economy, that of non-state run economy in particular, motivated by the public’s varied demands for medical care service and stimulated by the great potential for the development of medical care market, non-state investors of the province already set their goal in the field of medical and health service even ten years ago, establishing non-state run hospitals in some economically developed areas like Wenzhou and Taizhou. Up to sep, 2001, the province has 42 non-state run hospitals (accounting for 9.7% of all the hospitals in Zhejiang) with 2298 beds (accounting for 2.14% of the total beds in the province). Now most non-state run hospitals are still located in areas like Wenzhou and Taizhou where the non-state run economy is fairly developed. These hospitals are usually small or medium-sized (ten of which have more than 100 beds, 11 of which have beds ranging from 50 to 100 and 21 of which have beds fewer than 50), devoting chiefly to pediatry, rehabilitation and the treatment of heart disease, skin disease,

33 mental illness and tumour. Of the 920 works and staff members in the 42 non-state run hospitals, professional medical and health workers account for 77.7%, but most of them do not have a high- level academic degree (bachelor’s degree holders and those having a higher degree than that account for 17.83%; those having the title of a senior professional post account for 16.05% and those having the title of a junior professional post or having no professional title account for 77.9%). According to the statistics in 2000, on average every non-state run hospital in the province received 240,000 outpatient and emergency calls and 790 inpatients (those discharged from hospital after recovery averaged 14.9 days in hospital), with an annual income of 4,350,000 Yuan (the income from drugs accounts for 40%) and with an annual expense of 3,770,000 Yuan. Individual investment is the chief capital resource for non-state run (NSR) hospitals (accounting for 68.4%) and the remaining capital is gathered through the share-holding system or the share- holding cooperative system. As most NSR hospitals have not received much investment and are usually small, their equipment and service quality cannot be compared with those of public hospitals. Owing to the various methods used to develop medical care institutes, now these institutes have been set up all across the province. According to a sampling investigation about health care, 85% of the urban and rural residents can find a medical institute within the distance of one kilometer. Therefore it has already become a reality that most people can receive basic medical and health care near their houses. (Table 20) Table: 20 The distance of residents that can find a medical institute of hygiene service survey in Zhejiang in 1998 Upwards of Short of 1 Item 1 kilometer 2 kilometers 3 kilometers 4 kilometers 5 kilometer kilometers Total 79.83 9.90 3.89 4.13 1.26 0.99 City 88.08 7.25 2.58 1.50 0.17 0.42 Countryside 78.18 10.43 4.15 4.65 1.48 1.10

(5) The province has nine colleges and schools of higher learning, providing professional medical and health workers. In 2000, these schools enrolled 3,465 students, the total students on campus therefore reaching 12,972. These medical schools have more than 20 majors and have the right to confer a doctor’s degree in 30 different areas and a master’s degree in 59 different areas. The province also has three secondary medical schools (which have more than 30 majors), three adult educational colleges of medicine, eight secondary medical schools for workers and stuff members and 51 county in-service training schools of medicine, and has also initiated the further

34 education of clinic, nursing, prevention, pharmaceutics, and general medicine while carrying out the policy of training, assessment and promotion. (6) Scientific Research in Medicine. Centering with the prevention and treatment of disease facing the demand of economic development and following the motif “science and technology is the first productive force”, the province’s scientific research in medicine has promoted the development of medical and health work. Now the province has 11 independent scientific research institutes of medicine and 40 research institutes that are attached to the provincial medical and health care institutes and the institutions of higher learning. These research institutes include the WHO Human Reproduction Research Center, the Research and Cooperation Center for helminthiasis research and 12 national and provincial key laboratories, laboratory bases and research centers. From 1995 to 2000, the province won 8 national prizes for important achievements in scientific research and 5 similar prizes at the provincial or ministerial level, improving greatly therefore the quality and level of medical treatment and preventive service. (7) Traditional Chinese Medicine (TCM). TCM, a great treasure of China, has a long history in Zhejiang Province. To further the development of TCM in Zhejiang, the provincial People’s Congress issued the “Regulations for the Development of TCM in Zhejiang” in 1997. Now the province has 84 medical institutes of TCM with 11,285 beds. During the Ninth Five-Year-Plan, the province’s total investment in the hospitals of TCM reached 0.32 billion Yuan. The comprehensive hospitals at various levels have also established the TCM department and its beds. Now there are 7.698 TCM physicians and 3,117 TCM pharmacists in the province and 74 TCM physicians have been evaluated as the “Outstanding TCM Physicians of Zhejiang”. Now TCM has achieved remarkable results in the treatment of acute leucocythemia, lumbago, nephropathy and malignancy. Zhejiang is not only one of the important domestic producing areas for Chinese medicinal material, but also has a highly developed TCM pharmaceutical industry one of the important industries in the province. Now the province has 31 TCM pharmaceutical enterprises with the sales income of Chinese patent drug reaching 2.34 billion Yuan. Some TCM pharmaceutical enterprises like Tianmu Pharmaceutical Co. Ltd have issued shares and products like “Canmai Injecta” and “Kanglaite Injecta” have brought a sales volume of more than 0.1 billion Yuan to their manufacturers.

4.Quality and Efficiency of Medical and Health Care Service (1) Medical treatment service: Centering around the patient, the medical institutions of Zhejiang received 65,203,507 outpatient and emergency calls with the person times of those discharged from hospital after recovery reaching 1,616,167 in 2000. On average, one doctor (at a county

35 hospital or at a hospital above the county level) received 1749.9 person times of outpatient and emergency calls per year, and saw to the hospital stay of 592.3 per year. And the utilization ratio of beds in a county hospital or at a hospital above the county level is 74.9%, with those discharged from hospital after recovery staying 12.7 days in hospital. (Table 21) Table 21 the medical service circs of the county and above county level of hospital from 1996 to 2000 in Zhejiang

Item 1996 1997 1998 1999 2000 Average of hospital stay 14.7 14.3 14.2 13.2 12.7 Using rate of sickbeds（%） 78.6 74.0 72.5 74.1 74.9 Person-time of patient per 1549.4 1543.8 1595.4 1685.6 1749.9 doctor every year Hospital stay per doctor every 592.3 587.7 566.9 591.6 592.3 year

Emergency medical service is an important part of medical service. Now except for one county, the province has set up emergency centers in every county and city. The emergency in Hangzhou, Ningbo, Wenzhou, Jiaxing and Huzhou are independent and those in other cities dependent on the best hospitals, usually the No.1 Hospitals of these cities. The main responsibility of these emergency centers is to undertake the task of emergency treatment and to provide the on-the-spot first-aid to those injured in great accidents or disasters. The province’s emergency centers and those hospitals undertaking the responsibility of providing emergency treatment service have altogether 1200 emergency ambulances. 80% of the residents in cities and counties have access to emergency treatment service through making the “120” emergency call. After receiving the emergency call, the ambulance can average the spot within 20 minutes. On most occasions, however, the ambulance functions only as a means of sending the patient to the hospital, because the emergency treatment equipment on the ambulance is often old and ineffective. As a large portion of the emergency patients suffer from heart or brain disease, or are injured or poisoned, which demands instant emergency treatment on the spot, and as the knowledge of emergency treatment has not yet widely spread among the general public, the death rate of emergency patients is still rather high. The development of emergency treatment within the hospital, however, is very fast and a relatively comprehensive emergency treatment system has been established. All the city and county hospitals have now set up intensive care units. Public health and preventive health care: Carrying out the policy of putting prevention first in medical work and launching constantly the patriotic health campaign among the public, the province has obtained remarkable achievements in public health and preventive health care

36 service. According to a sampling investigation about health care service, 100% of the urban and rural children have the four conventional vaccination certificates, receiving 11.5 preventive inoculations annually. 95.6% of the urban and rural pregnant women receive 7.16 antenatal examinations and 72.7% of these pregnant women receive 1.7 postpartum calls per year. The parturition rate in hospital is 95.5% (the rates for the urban and areas are 100% and 95% respectively) (Table 22). Table 22 Situation of public health service of Zhejiang from 1996 to 2000

Item 1996 1997 1998 1999 2000 Inoculability rate of four bacterins for 90.0 98.1 95.9 96.8 98.7 children（%） Health management rate for the children below 7 year- 83.0 87.70 87.55 88.72 91.81 old（%） Health management rate for pregnant and lying-in 78.43 79.46 83.96 85.60 86.93 woman（%） Parturition rate in hospital（%） 96.49 97.64 97.94 98.67 98.70 Ratio of the farmer using 75.66 77.73 79.82 81.5 83.20 the tap water（%）

(3) Supervision and monitoring of hygiene (SMH): Institutes of SMH have been set up from the county level up to the provincial level, employing over 6,000 supervisors and monitors, forming thereby a preliminary comprehensive network of SMH. Owing to the cooperative efforts made by both the supervisors and monitoring workers and those units supervised and monitored, the SMH yield of food increased from 54% in 1997 to 85.3% in 1999, and 94% of the food supervised and monitored has adopted preventive measures against radiation. (4) Community health care service (CHCS): Recently CHCS in different areas of the province has been developing in a favorable way. The province has formulated “Suggestions for the development of urban and rural CHCS in Zhejiang”, conducted wide propaganda among the public and important step by step the relative policies, thus prompting steadily the development of CHCS. Hangzhou has put the construction of normalized CHCS institutes into its key projects aiming at serving the people. Up to 2000, 90% of the population in Hangzhou has access to CHCS. Ningbo

37 has also created a favorable environment for the over-all development of CHCS by improving the relative policies. The government of Jiaxing put CHCS into the No. 1 projects of its eight key projects and appropriated special funds to support it. Shaoxing, following the spirit of “Harmonious development between the urban and rural areas”, has also improved and carried out the relative policies for the development of CHCS. Now 34 cities proper, 57 counties, 430 villages and towns and 275 residential districts in the province have initiated CHCS stations (14 of which are regarded as models at the provincial level and 257 of which are regarded as models at the city level), covering a population of 1,260 million. In the different areas of the province, qualified CHCS institutes have also been chosen as designated units for medical insurance and family beds are also given part of the whole society’s funds for medical insurance.

5.The total amount, distribution and increasing rate of health care funding (1) The overall situation of health care expense The total amount of health care funding in Zhejiang province is 20.781 trillion in 1999. Compared with 13.638 trillion in 1996, it increased 52.38%, among which the increasing rate in 1997-1998 is the fastest as 23.92%, and the increasing rate in 1998-1999 is 5.66% with apparent fall after the rise in previous year. The proportion of health care funding in the GDP of Zhejiang province was 3.94% in 1998 and 3.87% in 1999, which is tending to decrease. And it is far lower than the proportion of total health care budget in the GDP of China, which was 5.1% in 1999. The health care expenses per capita in Zhejiang province increased from 309.95 Yuan in year 1996 to 465.17 Yuan in year 1999 with an increasing rate at 50.08%, at the same time that in China increased from 233.50 Yuan to 331.90 Yuan with an increasing rate as 42.14% (Table 23). Table 23 Overall situation of Zhejiang’s health care budget from year 1996 to 1999 1996 1997 1998 1999 Total health care funding (in 13.638 15.871 19.667 20.781 trillion) GDP (in billion Yuan) 414.606 463.824 498.750 536.487 Proportion of GDP（%） 3.29 3.42 3.94 3.87 Expense per capita（Yuan） 309.95 358.89 442.27 465.17

(2) The funding proportion of total health care funding The government’s expense, individual’s expense and society’s expense in the total health care expense of Zhejiang province are all increasing of some extent, among what the increasing rate of individual’s expense is fastest with an increasing rate of 63.91% in three years from 1996 to

38 1999; the next is funding from society, which increased with a rate of 46.35% in three years, the slowest growing is that of government with a rate of 34.77% in three years. From the distribution proportion of the total health care funding, the proportion of government’s expense was 14.02% in 1999, which decreased 1.83% from 15.85% in 19996 (meanwhile that of China decreases 0.83% at the same time); the proportion of funding from society of 37.82% in 1999, which is higher than that of China at 12.32%; the proportion of

15.85

budget from government 44.78 funding from society individual's expense

39.37

Figure 9. The proportion of health care funding in Zhejiang of year 1996 individual’s expense is 48.17% in 1999 (Figure 9-10).

(3) The operation expense of health care service (including Chinese traditional medicine) The operation expense of health care service increases every year; it is 1.10866 billion in 1999, which increased 45.5% of 761.94 million in year 1996. The health care service expense per capita increases from 17.32 Yuan in year 1996 to 24.82 Yuan in year 1999 with an increasing rate of 43.3%, the increasing rate and actual increasing amount are both higher than the average level of China. The proportion of operation expense from the government funding in total health care funding has a tendency to decrease from 1996 to 1999, among which is lowest in 1998 and increased a bit in 1999 (Table 24).

14.02

48.17

37.82

Figure 10. The proportion of health care funding of year 1999

39 Table 24 The operation expense of Zhejiang from 1996-1999 1996 1997 1998 1999 Health care operation expense （ in 761.94 877.98 982.37 1108.66 million） Proportion in total health care 5.59 5.53 4.99 5.33 expense（%） Proportion of government 35.26 38.81 36.75 38.06 funding（%） Operation expense per 17.32 19.85 22.09 24.82 capita（Yuan）

(4) The tendency of change in the expense of outpatients and inpatients. Outpatient fee and hospital bed fee per time increase year by year with a fast speed in hospitals at villages and towns’ level or above. In year 2000, the outpatient fee and hospital bed fee is 82.02 Yuan and 3760.30 Yuan respectively, increased by 70.63% and 63.65% compared with that in 19996. Meanwhile, the average residents’ expense in Zhejiang of year 2000 is 4366.00 Yuan, increased 27.96% compared with that in 1996. The outpatient fee and hospital bed fee both increase faster than the average residents’ expense compared with the annual expense per capita (Table 25).

Table 25 expense of outpatients and inpatients in Zhejiang from 1996 to 1999 1996 1997 1998 1999 2000 Outpatient person- 1076317 1020136 1045156 1072453 1127164 time（persons） 30 70 27 09 02 Outpatient time per 2.45 2.31 2.35 2.40 2.50 capita（times） Outpatient fee pre 48.07 58.72 66.36 74.16 82.02 time（Yuan） Actual bed occupied 2259479 2172044 2128608 2182440 2277893 date（day） 2 3 7 4 4 Average inpatient day per 11.64 11.34 11.40 11.46 11.05 person（day） Hospital bed fee per 197.36 232.32 268.02 302.45 340.21 day（Yuan） Hospital bed fee per 2297.80 2634.08 3055.71 3466.13 3760.30

40 time（Yuan） Average residents’ 3412.00 3670.00 3784.00 3877.00 4366.00 expense（Yuan）

(6) The differences between the development of economy and health care The development of economy all over the Zhejiang province has great difference due to some factors as area, history, thought. After twenty yeas’ reformation and opening, currently, the north, middle and east parts of Zhejiang are relatively well developed compared with south and east part, whose GDP per capita, average disposable income of both urban and rural residents, average net income of rural residents are the lowest in Zhejiang. The increasing rates of national economy during the ninth five-year plan are the last two. So these two areas both are listed as now enough developed economy areas (Table 26).

Table 26 the economical and social situation of 11 cities in Zhejiang Total GDP Average Average Saving deposit The increasing population per capita disposable net income of both urban rate of GDP CITY （million） （Yuan） income（Y of rural and rural during the ninth uan） residents resident five-year (billion) plan（%）

Hangzhou 6.2158 22342 9668 4496 78.856 12.65 Ningbo 5.4094 21786 10535 4652 58.606 14.05 Jiaxin 3.3125 16359 9338 4457 32.689 10.99 Huzhou 2.5579 14794 8684 4067 16.028 10.70 Shaoxin 4.3269 18042 9422 4759 39.893 13.65 Zhoushan 0.9841 11586 8886 4228 8.539 9.18 Wenshou 7.3632 11360 12051 3951 46.415 15.46 Jinhua 4.4642 12271 9223 3464 30.92 9.90 Quzhou 2.426 6691 7592 2615 9.749 7.18 Taizhou 5.4662 12390 9225 4296 28.962 9.68 Lishui 2.4858 5515 7960 2227 9.478 7.69

About the configuration and utilization of the health care resources in every city, the number of hospital bed per thousand residents is over 2 except Wenzhou, Taizhou and Quzhou. But the number of doctor per thousand resident is below 2 in every city except Hangzhou and Zhoushan. Analyzed the areas with relatively more health care and medical resources, Hangzhou is the

41 capital, Ningbo is a independent planning city and the reason for Zhoushan is that due to its location: it locates on islands with dispersing residents who cannot share the resources (Table 27).

Table 27 Configuration and utilization of the health care resources of 11 cities in Zhejiang Operation Number of Number of Number of Number of Rate of fee per hospital bed technicians doctors per nurses per utilization of CITY capita（Yuan per per thousand thousand hospital ） thousand thousand residents residents bed（%） residents residents

Hangzhou 33.98 3.75 5.71 2.63 1.80 60.18 Ningbo 29.91 2.55 3.54 1.75 0.94 67.43 Jiaxin 16.60 2.58 3.22 1.57 0.91 58.82 Huzhou 13.64 2.88 3.38 1.61 0.96 56.27 Shaoxin 14.84 2.15 2.84 1.47 0.60 66.27 Zhoushan 36.54 3.29 4.24 2.08 1.25 59.35 Wenshou 19.30 1.64 2.90 1.24 0.57 59.50 Jinhua 12.69 2.24 3.65 1.81 0.82 64.68 Quzhou 13.63 1.89 2.87 1.50 0.67 52.34 Taizhou 16.00 1.73 2.71 1.19 0.60 70.34 Lishui 19.00 2.23 3.05 1.42 0.71 53.53

7.Health care administrative management system The health care department or bureau of province, city and county is the health care administrative management organization as the component of corresponding government and areas managed, which form the directive relationship from top to bottom. The health care department of Zhejiang province is a component of Zhejiang provincial government. It organizes and leads Zhejiang’s health care service under the provincial government, by implementing health care related general and specific policies, laws and regulations of the nation and province. The health care department is lead by the chief, the vice chiefs assist the chief to fulfill corresponding jobs. There are twelve executive business offices in health care department. The main function of health care department: 1). Investigate and draft bylaws, draft planning related with health care administrative management, organize to implement after approved; formulate related standard policies;

42 investigate and work out the development planning and strategic goal of health care service in Zhejiang; formulate and implement technical standard and local hygienic standard; investigate the directive standard for the configuration of health care resources, verify and supervise the implement of district health care planning. 2). Perform the management function of the whole health care field under law, responsible for the management and announcement of health care information. 3). Perform the management function of health care executive supervision according to law, supervise and control the prevention of infectious diseases, food, professional, environment radiation and schools’ hygiene and blood donation under law. 4). Carry out the prevention as main principle, develop general health care education of the nation; formulate the prevention planning of serious diseases for the masses, organize the comprehensive prevention of major diseases; organize and manage the health care technical staffs among the Zhejiang province, handle the accidental condition of disaster and epidemic situation. 5). Implement the principle to lay equal stress on the traditional Chinese and Western medicine, responsible for the heritage, renovation and the combination with Western medicine of traditional Chinese medicine, investigate and advance the modernization planning for traditional Chinese medicine and implement the supervision. 6). Direct, supervise and manage the commune health care service, the health care service in rural areas, basic health care service, the health care service for woman and children in Zhejiang province; implement the specific technique for pregnant woman and newborns. According to each responsibility, cooperate with the birth control department closely; provide birth control service and health care service for bearing babies related with bearing children, birth control and sterility. 7). Formulate the development planning of medical technology and education in Zhejiang; organize the implement of overcome of major medical academic difficulties; organize and improve the transformation and promotion of the medical academic achievements; organize the professional education as medical continuing education, general medical education and high medical education. 8). Investigate and direct the formation of medical health care service; responsible for the classification management of medical service. 9). Manage the internal medicine and utilities in the medical service, and accept the law-based supervision by the medicine supervision and management department; responsible for the analysis of the side effect of the medicine used in medical preventive department; manage the tender on medicines with other departments. 10). Formulate the development planning and professional ethics standard for health care

43 personnel in Zhejiang province; formulate and implement the personnel force criteria and the certificate of health care service personnel. 11). Investigate and formulate the development strategy and long-term development planning of economy in Zhejiang; supervise the state-owned capitals of the department owned medical service, coordinate the development of medical economy. 12). Organize and direct the bilateral and multilateral exchange and cooperation, both of government and civil level in medical and health care field, together with the medical aid in foreign countries; organize and coordinate the exchange and cooperation between Zhejiang and WHO or other world organizations; manage and develop the exchange and cooperation with Hong Kong, Macau SAR and Taiwan in medical health care field. 13). Responsible for the health care for leading comrades of the central authorities and important foreign guest in Zhejiang; responsible for and manage the health care service to the subjects defined by provincial health care committee. 14). Bear the daily operation of such organization as: provincial patriotic health campaign committee, provincial basic health care committee, provincial local diseases prevention leading group, provincial blood donation group. 15). Participate in the reformation of basic medical insurance system for both urban and rural residents, participate and formulate the implement details of the management of fixed medical service and the supervision on the service and management of such service, and the formulation of ; participate and formulate the service range, charge standard and project charge standard for such service. 16). Responsible for and manage the health care institution on provincial level. 17). Undertake some business by the provincial government. Meanwhile, the provincial health care department entrusts the 18 medical or health care institutions on provincial level, which are directed by the provincial government administratively, respectively. They provide specialized technical guide and supervision to Zhejiang in their specialized field. The health care bureaus of each city or country bear the same administrative responsibility and function in related district as that of provincial health care department.

8.Main issued health care policies and the effects of implement With twenty years’ of reformation and opening, China issued most health care policies after the foundation of the China. Especially after the national health care conference in 1997, the central committee of the communist party of china and state council issued the Decision on Health Care Reformation and Development; in year 2000, the state council transmitted the Directive Advice

44 on Reformation of Urban Medical and Health Care Service; this year, it transmitted the Directive Advice on Reformation and Development of Rural Medical and Health Care Service. After the announcement of every important health care policy by the nation, the provincial government and party committee will formulate relative implement methods and series of new policies according to the reality in Zhejiang. The main health care policies issued in Zhejiang recently years include:

1.Health care economical policy 1). The funding of the health care service by the government should be suited to the development of economy, whose increasing rate cannot be lower than the increasing rate of the local financial budget in that yea; some qualified towns and countries should increase the proportion of the funding of health care of the financial budget to 5. The operation fee for traditional Chinese medicine should be the same or even higher than 10% of the general operation fee for health care. 2). The funds of health care administrative departments at all levels, the health care supervision and execution organizations, and public health care services who provide public health care service like diseases prevention, health care for woman and children are provided by fiscal organ at the same level. 3). Some qualified towns and countries should step up the public medical succor funds, which is used to help the health care service to bear some fees unaffordable caused by some accidental events, and the debts caused by the humane succor for some patients disable to afford or without relatives. 4). Establish regulation funds for the development of health care service, which is particularly used for the development of prevention and the health care service in rural areas. The recourses of the funds can be from many ways as the donation by the society, financial support by the government, and the management charge on private hospitals (included joint stock, co- investment, cooperation hospitals), clinics and private drugstores. The local government according to the reality and economical development defines the concrete proportion or number.

2.Health care policies in the countryside 1). The health care service has been mainly managed by the collective. Commune hospitals manage the health care service in villages as an organic whole according to management model as unified management, personnel allocation, financial management, and the management on the recourses of stocking, the vocation and distribution of the drugs. 2). Local governments at all levels are responsible for the implement of medical cooperation in

45 rural areas under their jurisdiction. Related departments like health care, planning, finance, agriculture and civil administration are responsible for the direction of medical cooperation. The funding of medical cooperation is mainly dependent on private input, with support from collective and government. The some portion of the net income of the countries and collectives should be used in medical cooperation. The governments at all levels also need to appropriate proper fund, the specific amount and proportion should be defined by the local government. 3). We will continue to reinforce the prevention health care service and “three complete sets without one” (complete sets of personnel, facilities and funds without any unsafe house) construction of the commune hospitals. From 1997, the provincial government increases 10 million Yuan every year mainly as the subsidy for the development of commune hospitals in such areas as poor, remote and poor-developed areas. 4). Hospitals at country level or higher should choose a commune hospital in poor areas, as the counterpart object to assist; help it in personnel training, techniques, finance, utilities and management, and try to put an end to the backwardness of these hospitals in three years. 5). In order to encourage students graduated from universities, colleges and professional trainings to work in commune hospitals, every such health care technician graduated from universities or colleges and so on, who married a rural resident and works in medical or preventive service in rural areas or village for ten years, can be given consideration to let a single children under15 (under 18 as a high school student) to have non-rural registered permanent residence rather than rural registered permanent residence. The promotion of health care technician in rural areas should be based on the reality, concerning to such persons with professional skill and a high local credit and also qualified with other standard; their requirement on thesis and foreign language can relax. 6). Implement the system that all the health care technical staff in towns must serve in the rural area for a fixed period before their promotion.

3.Policies on the reformation of the health care prevention and supervision execution system 1). According to Regulations of the Organization and Establishment of Sanitation and Epidemic Prevention Station at all levels issued by health care department and former national editorial broad in 1980, with carefully consideration of some factors like working responsibility and population increase, we defined the establishment of the health care supervision sect and that of disease prevention center reasonable. And we try to establish standard and advanced comprehensive preventive health care system and form the health care supervision sect. 2). The operation fee of health care supervision office and diseases prevention and control center

46 is appropriated through the former sources as health care epidemic prevention station as the same level; all areas should ensure the fund for health care supervision and disease prevention and control according to the requirement by by the central committee of the communist party of China and state council. And based on the need of the development and financial ability, they can revise the appropriation portion and increase the funding of health care supervision and diseases prevention and control.

4.Policies on the reformation of both the management system and operation system in the medical health care service both in towns and cities 1). Insist the principle that the public ownership as the main part, all sorts of ownership co- develop; encourage social capitals hold medical service or other related service independently by all means. 2). Enlarge the decision-making power of state owned medical service, positively investigate such management system like hospital management committee, executive council, conscientiousness by the lead doctor; perfect the conscientiousness by the head of the hospital, and let such hospitals really to be an autonomous official person. Launch a pilot project the free job-seeking system for skilled doctors. 3). Encourage the multiple cooperation and coalition between state owned hospitals by techniques, funds and management, and they also can establish new medical service sect. 4). The enterprise’s hospitals in cities should be stripped off from the enterprises step by step, and be put into the medical service system in towns and countries by sorts of means. 5). Such commune health care service in towns and countries, which are defined as non profitable medical service, can be listed as official hospitals for basic health care insurance. 6). Some state owned hospitals, which implement property right system reformation, and qualified with local health care planning, implement directive prices for medical service items defined by the government and use the main income to improve the medical service conditions, can be defined as non profitable medical service.

5.Policies on the reformation in drug distribution system 1). Medical service is the behavior subject of the tender of medicine. Medical service, which has the ability to draft the tender documents and organize the accessing capability, can form the tender by itself or together with several other medical services, and it can entrust the eligible agency to invite tenders. 2). The medical service implements two management systems for revenue and expenditure. The

47 remaining portion of the balance of revenues and expenditure of the medicine should be turned over to the finance at the same level. The finance should earmark this portion for its specified purpose only, which should be used for health care service. The finance and health care administrative departments at all level cannot divert or withhold this portion, and cannot compensate and decrease the budget. 3). The remaining portion of balance of revenue and expenditure will be planned as a whole by both the health care and finance departments, which is mainly used in the development of hospitals, commune health care service and prevention health care service; the fund for commune health care service and preventive health care service cannot exceed 10% of the remaining portion of the balance of the revenue and expenditure. 4). Reasonable formulate the retail price for medicine purchased by tender. Concerning the difference between the actual tender price for tender medicines and current retail price, we should lower the retail prices of medicine step by step according to the principle as giving the most profit to consumers with consideration of the initiative of the medical service in tendering and allocating the lowered profit between the medical services and patients rationally after the subtract of the reasonable price difference should acquired by the medical services and distribution service.

6.Policies on the price of medical health care service 1). The price of medical service is practicing both government directive price and market regulative price, and canceling the government fixed price. The government directive prices for main medical service items are defined and revised by the province; other government directive prices of medical service items are formulated and revised by each city. 2). Third level hospitals can float the prices 20% low or high according to current charge standard by their selves; second level hospitals can float 10%. We can revise some charges as nursing fee, operation fee and traditional Chinese medicine service charge; in addition, we lower several high examination fees of large-scale medical facilities. 3). Relax the directive prices of the specialized service needed by non-profitable hospitals. The implement of so many policies will bring new opportunity and vitality for the development of health care service.

Analysis on the main health care policy

48 Although health care facility of our province has made great progress, it still lags behind the fast economic and social development. It also cannot match the increasingly demand by the masses on the medical service and health care. There are some drawbacks in some already formulated and practiced health policies. The main problems as followings:

1.The transformation of the government’s function does not apply to the development of the communist market-oriented economic system Market economy is law-based economy. Under the socialist market-oriented economic system, the main function of the government’s health care executive branch is to execute by the law, reinforce the scheme, supervision and management of health care development. But neither the policy circumstance at present nor the opinion of health care executive department does not adapt to the fast development of the market-oriented economy. This behaves as several points: A). The formulation of related health care policy is stagnant. For instance, the classification criterion of the profit-seeking and nonprofit-seeking medical facilities is not clear. The medical and profitable policy of the profit-seeking hospital is also not clear. There is no necessary policy available for the reformation of health care system in the rural area. The permit system of health care lacks of operation and authority. All of above affect the implement of the reformation. B). The function division of different government department is not defined. The overlap of the function and the multi-management appear. One example is the multi-investment and management in health care facilities; a family-plan guide section is established in every small town, but due to the similarity in function with that of hospital, it causes the unnecessary waste of the resource and the conflict between the government department and the facilities. Meanwhile, enforcement and supervision of some health-related products, like medicine, food are enforced by several departments like quality supervision section, commercial supervision section, health care supervision section and medicine supervision section. It not only causes the unclear of the major force, but also brings difficulties to the dealer. But the management and investment of health care insurance policy, which relates to the health guarantee for amply peasants like cooperative health care, is organized and applied by the department, which is supposed to be in charge of supplying health care service. This does not fit at all. And some tasks like the regeneration of the water-supply system in the rural area and the transformation of the schistosomiasis, which should be interposed by the construction department, agriculture department, water conservancy department and the forestry department, but they are finally managed by the health care department; C). Health care executive department itself does not change its role from the “runner” to the “manager”, it is busy with the daily issues, but not the macro-supervision, investigation, law-directed execution of the fast

49 development of health care service.

2.The change in the charts of diseases, causes of death, population brings great pressure on the reformation and development of health care service From the report on the occurrence of official infectious diseases: the occurrence rate is 257.19/100 thousand, 289.39/100 thousand, 294.52/100 thousand, 321.32/100 thousand, 299,95/100 thousand for the year from 1996 to 2000 respectively, in which the occurrence in 2000 is lower than hat of 1999 but still higher than that of 1998. There is not apparent decrease in the occurrence; some infectious diseases are still the major diseases, which harm the peoples’ health. No matters in towns or countries, the main diseases, which course the occurrence of the infectious diseases, are viral hepatitis, venereal diseases and tuberculosis. The increase of the venereal disease is especially apparent, which is double in the recent five years. The occurrence of the tuberculosis also increases to some extent. As the occurrence of the diseases, hepatitis B, gonorrhea and tuberculosis are the first three in the towns, in which gonorrhea is already in the first place of the occurrence in the infectious diseases. Although the first three diseases with the highest occurrence in the countries are the same as that of the towns, they increase with some extent. From the chart of the courses of death, the major courses of the death in our province are tumor, cardiovascular diseases, diseases in the breath system. Tumor has been the first course of the civilian in the town. The courses of death by the cardiovascular diseases have risen from the 5th position in the 1995 to the 2nd position in 2000. The occurrence of hypertension, as the major course of death in the cardiovascular diseases also increases. The position of the chronic lung diseases decreases from the 1st in 90’s to 2nd in the countries, 3rd in the towns. The course to death by injury and toxification increases dramatically in both towns and countries; they are the 5th and 4th course in the towns and countries respectively. In addition, among the small village and township enterprises in our province, there are a quiet number in such field like chemical, electroplate, printing and dyeing and tanning. They pollute and injure the environment, water sources and peoples’ health. The toxification by benzene and lead is very common in such companies in the recent years, which remind us that we should reinforce the supervision and investigation on health care, in order to protect the environment and prevent the professional injury.

50 3.The development of health care supervision executive department and personnel seriously lags behind the need by the development of the market-oriented economy By the transformation of the system of health care supervision executive department, the executive force has been reinforced to some extent. But there are still some problems. Nowadays, there are over twenty regulations and laws issued by the government, but personnel of health care supervision executive department are dispersed, the power of that is also weak and it lacks the authority in that. The particular manifestations of this are in several fields: 1). Although we already defined health care supervision section stands for health care executive department, which keep the continuance of health care execution. But this does not resolve the problem in the system of the administrative enforcement at all. Because health care supervision executive system is not directly leaded, and the large amounts of the personnel are not government official workers, both of which cause great difficulties in the enforcement. 2). The increase of the subjects of health care supervision, up to the end of 1999 in our province, there are over three hundred and eighty thousand companies in the food manufacture and supply field, along with over eight hundred and thirty thousand workers in this field, sixty and five thousand public places with over three hundred thousand workers, about three hundred companies in the cosmetic field with four thousand workers, over five thousand companies in the water supply field, about three companies with radioactive materials with a total number of workers around six thousand. But the total number of the personnel in health care supervision in our province is only six thousand, and the fund is insufficient, the facilities for the transportation, communication evidence collection and supervision is obsolete, some facilities are even behind than the subject to be supervised, all of these cause the ability falling short of our wishes. 3). Some currently in effect laws as “The regulation in the prevention of infectious diseases”, was issued many years ago, the strength of the punishment and manipulation of the clauses in such laws are weak and poor. And they cannot meet current needs.

4.The influx of the nonnative brings new problems in the public health care and the prevention of diseases Based on the investigation, the total number of the transient population which stay in our province over three months is from three million to four million, this maybe keep increasing with the sustained development of the economy. The direction of the influx is to the relatively active towns in the development of economy and the developing villages. Among the influx, about thirty and forty percent is from other province, mainly from relative poor provinces like Jiangxi, Anhui, Hunan, Guizhou, Sichuan. Other parts

51 are from the relative poor region in our province in the west. There are many examples of influx that move with the whole family, so in about every forty and fifty transient person, there is a child. Due to the sustained increase in the transient population, some problems are increasingly apparent in the public health care and the guarantee of the health in that population. 1). The resident in developing towns and villages, which has a large influx of transient population, increases dramatically. The public health care facilities as water supply system, housing, and disposition of the excrement, urine and wastes lag behind the development, especially in the area between the towns and countries. These affect the public environmental situation, and also cause the breaking out and prevalence of the gastroenterological infectious diseases. 2). Due to the limit in their education and techniques, the transient population are always engaged in labor-intensive field, even physical labor with some poisonous materials, which easily cause the professional injury and accidental casualties. And they are not acclimatized with the new place to some extent, which maybe cause some problems in mental health. 3). This group has a relatively low income together with a poor family, which also lacks essential social guarantee. So the rate of seeking for medical advice after having a disease is obviously lower than the local residents. The necessary health care for the children and women like the immunity of the children and health care for the pregnant women should be reinforced. Additionally, the transient populations maybe cause the input of the infectious disease like schistosomiasis, malaria and filariasis. Based on the statistic report on the occurrence of official infectious diseases in our province, the occurrences of measles, influenza, hepatitis B and gastroenterological infectious diseases are higher than permanently residents. The occurrences of malaria, infection by HIV and tetanus in newborns are even much higher. Therefore, as a high-risk group of above infectious diseases, transient population should reinforce the prevention and be paid more attention on.

5.The public health care awareness and health care consumption sense need to be improved Although the masses enter a relatively comfortable life, health care awareness still falls behind. Smoking, indulging alcohol, such bad habits are increasing not decreasing, the unclean sexual behavior among some persons cause the dramatically increase in the occurrence of venereal diseases. Some would rather like to eat and drink extravagantly, spend wastefully for birthdays and weddings, or buy any kind of nutritional products, but not to spend any money in physical training, entertainment and health care insurance. When to choose for the medical service, some for no reason whatsoever pursue the biggest, highest grade hospitals regardless of the situation of the diseases, which increase the unnecessary pressure for the big hospitals but also increase the

52 burden for nation and individuals. Irresponsible advertisements by some drug-dealers, hospitals and medias lead miscomprehension on health care consumption, but the improvement of health care is still in the former low level of health dissemination due to some reasons like the lack of the fund and intellectuals.

6.The unbalance among the health facilities, insufficient investment and wasting of sources Because the establishments of the organizations are based on the administrative area and department, hospitals and personnel are rich in the towns. The investment by the government to the health care service also focuses on the towns. Some hospitals expand the scope blindly, compete in buying expensive medical utilities, all of which cause overuse and waste in the resource configuration and utilization, this also cause the fast increase in the public medical expense. Compared with the towns, such works like the fundamental utilities and preventive health care are relatively weak, the investment by the government is apparent not enough, the number of personnel in the health care service is low together with low technical level, the health care service is obsolete with low technical content. All of above can not satisfy the basic medical and preventive health care demand by the resident in the countries. Among the investment in health care service, the total investment in health care service is 5.1% of GDP on national level, but it is only 3.87% in our province, which is obviously lower than on national level. Meanwhile, in the total expense on the health care by the three major sources like government, society and individual, the budget of the government increases with the lowest rate. Its ratio in the total expense on the health care has been decreased continuously; it is only 14.02% in 1999.

7.The investment environment of the development of health care for the private companies should be improved Although the dramatically development of the private companies provide good opportunities for enlarging the fund of health care service, which also improve the optimal configuration of the health care resources by the market competitive system, this kind of positive factor does not make full effect because of some reasons as related policies and thinking. There are some reasons for the restriction of the private hospital: a). The related policies on this kind of hospitals from the government are not clear, social investors doubt about the future development of those hospitals, some factor like mentioned above affect the investing scale and strength for those hospitals. b). There are some miscomprehensions of those hospitals among the masses, which do not trust those hospitals very well. Higher quality skilled persons and new-

53 graduated students are not willing to seek a position in those hospitals. Both affect the competition of those hospitals. c). Those hospitals lack of persons who have management knowledge; the administrative and technical management are relatively poor. d). They lack necessary directing policies and atmosphere for their development. Private capital will pursue a non-profitable name although they want to invest a profitable sect. On the other hand, there are very few private investors who are willing to invest for a non-profitable sect by themselves. Besides above mentioned, some private hospitals did not conduct enough investigation before the establishment, which causes the non-competitive after set up.

8.The internal reformation of the medical service lags behind and cannot match the change in the development of the market-oriented economy and the masses’ health care demand Because of the long-term effect of the planned economy and thinking, both the administrative and executive systems of the health care service still are short of vitality. Although the reformation till now make some progress, but it does not involve the fundamental aspect in the system and mechanism, which cause the some health care service sects lack the initiation and awareness to reform by the development of the market-oriented economy and the demand by the society. Such sects pursue for the profit blindly, focus on the external expand but not the internal development, lack of awareness of the competition with low quality of service and low productive efficiency, overstaffed. The masses cannot feel the benefit by the reformation of the hospitals. Especially after our country acceded the WTO, neither administrative department nor the executive department both lack the investigation on the effect and related reply policies on current health care system and mechanism by our country’s promise to open the medical and dental service, both of them lack the feeling of crisis and urgency. Besides, health care executive department is still in the role of “runner” but not a “manger” of the health care service. The right of the owner and runner of the hospital is not clear, and the responsibility. Hospitals also lack talents with professional management ability. The administration system by the corporation for current state-owned hospital couldn’t be established now is another reason for the behind of the reformation.

9.The problems in the health care insurance for residents in the countries are prominent The medical insurance for the worker in towns is under promotion step by step, and about a quarter population of the residents in the countries participate some kind of medical insurance like cooperative health care service. But the total coverage of the medical insurance is still low, and the level of guarantee is low also. A considerable number of the workers in towns do not have

54 basic medical insurance. Especially, the establishment of the medical guarantee system in most countries makes slow progress. Besides a small number of civil servants like teachers, government office workers and medical service personnel have the basic towns-works’ medical insurance; almost all of the residents in the countries do not enjoy the basic medical service organized by the government. They need to pay the entire medical service fee by themselves. The current organization and investment level of the cooperative medical service in our province and so on cannot match the market-oriented economy and the development of the economy. We need to explore actively for the new systems and ways, which are suitable for the reality.

10.The formulation and execution of the health care related policies and reformation measure lags behind Although the absolute investment in the health care service by the government increases every year, but compared with the demand by the nation “the rate of the accruement of the appropriations on the health care service by the government cannot lower than the rate of the accruement of the total expenditure”, together compared with the development of the economy in Zhejiang province, the appropriation on the health care service by all levels of governments is definitely insufficient. The percentage of the appropriation on the health care service in 6.6% in 1980, it decreased to 4.59% in 1992, and even 3.78% in 1999. Nowadays, not only the increasing rate of the appropriation on the health care service is low, but also the distribution of the appropriation is not reasonable, which do not fundamentally change the distribution focused on the towns and medical service but not the countries and prevention. In 2000, the total expenditure on prevention is only 3.32% of the total appropriation on health care service, which cause the impossibility to execute the prevention and to improve the standard, make the whole system be tired out by too much running around. All of above cause the low efficiency in the medical and health care service and the low benefit. The lag of the reformation cause the distortion of the policies of the health care, which cause the insufficient appropriation by the government where need to be sufficient funded, and shortness and waste by the unfair distribution among the limited appropriation. It also causes the medical service sect to execute the policies like “paid service,” allowed by the government in order to make up the insufficiency of appropriation. Although these kind of policies apparently improve the ability and standard of the service, resolve the shortness of the public health care service, but it does not make reasonable change according to the reformation in the economy system, incapable to make up the cost, cannot reflect the value of the technical service, all cause the rapid increase in the medical burden of the society and the masses.

55 District health care planning is an important means to execute the macro-administration of the health care. But now, its significance and value does not get enough attention for all respects. The already formulated planning lack stability, and they are influenced by many interfere during execution, weak in authority, so they cannot bring the function into full play. Under the new situation as we entered the WTO, the fact that the stated-owned hospital occupy a dominant position will change with the influx of foreign capital into the medical market of the large and middle towns, as the foreign invested hospitals into service. The competition in the medical service will be more vigorous with the entering of foreign advanced techniques, utilities and management into our province. With the opening of the insurance service market, the medical insurance service will be varied again the unitary nowadays. It is possible to open a hospital by the medical insurance sect; the diversification of the hospital host and the management will make the stated-owned hospitals feel the pressure to survive. Intellectual property rights related policies will be more perfect, which cause the intellect-concentrated health care service to face the more comprehensive legal standard, bring many new challenge like the macro planning and configuration in health care resources, health care supervision and execution, establishment of the fair competitive market to the health care administration sect. The health care job of our province really face a great challenge, but it also face the rare opportunity for development. First, the continuous fast development of the economy in our province, not only provide more financial support for the social public utilities like health care service, but also improve the expense on health care service by the increase in the income. The diversification of the need of health care service will be appeared. The health care service will be developed. Especially, as our province first advance and promote to fulfill the goal of socialist modernization in advance, it will promote the health care service’s development greatly. Second, our province is one of the provinces, which have relatively early developed and fast developing private economy. Private capital is already set foot in the health care service. The appearance of the private hospitals not only expand the investment channels for the development of health care service, but also bring the competitive market situation with the stated-owned hospitals. All of them optimize the configuration of the health care resources and improve the standard and efficiency of the health care service by the order market competition. Third, from last year, the central government and all level of governments in our province announced several series of policies to promote the reformation and development of the health care service in both towns and countries. These policies define the goal, mission and concrete steps to deepen the comprehensive reformation on the aspects like residents’ medical insurance

56 system, the health care administration systems in urban and rural areas, the manufacture and distribution management system for the medicines, the price policies on medical service and medicines, the model of health care service. The province government and related departments also announced several related and completed policies, which provide a relatively complete frame for the reformation and development of the health care service. Fourth, China’s entering into WTO brings up new opportunities for the reformation and development of the health care service. According to market and international goal, we will refer to the useful experiences from the already matured reformation in the state-owned companies, combine that with the attribution and characters in the health care services, fully utilize the domestic and international resources, build more fair and formulated market competition and order, develop the health care service in our province and serve the residents in our province.

The suggestion on the main health care policy

Whereas the fast development of Zhejiang’s economy, and the lag of the development of health care service, we formulated the Modernization of Zhejiang’s Health Care Service, 2001-2002 in order to promote the development of the health care service and ensure the realization of strategy as basically realizing the modernization in Zhejiang in thirty years advance by the provincial party committee. We raise the whole goal of the development of Zhejiang’s health care service as following: up to 2020, we will establish the comprehensive and suitable health care system for the socialist market-oriented economy and the need by the masses, which include health care supervision and execution, the prevention and control of the diseases, the health care service in community relating with comprehensive hospital and specialist hospitals. These will let the masses enjoy the good health care service according to the modern life, and satisfy the need at multi-level and desire by the society, decrease the health difference between the areas and populations, extend the life span expected by the masses, make the main national health index close to the middle developed countries, fulfill the goal as “powerful province in health care service”. In order to reach the above mentioned goal, based on the retrospection, analysis and investigation on the year 2000’s situation, policies and so on, we raise following countermove and suggestion of the next step in the reformation and development in Zhejiang’s health care service.

57 1.Reinforce the government’s function, support by the policies and macro management The direction on the health care service by the government firstly is the guide and support by the right policies. With the Retrospection to the reformation and development on the health care service in Zhejiang, the most profitable are policies. In the future, government will keep formulating and perfect the new policies for the development of the health care service, and supervise the implement. The guide and regulation on following aspects need to be reinforced especially:

1). Enlarge the input to the social development facilities including health care service, and improve the distribution of the input. The function of the government under market-oriented economy ought to focus on the development of public facilities, organize public service and provide public products. In the health care field, government should regard the resolve of the need in the basic health care by the masses as its duty, pay attention on the input to the construction of fundamental health care infrastructure, which satisfy the basic health care service by the grass-rooted level population. Recent years, the government of Zhejiang province enlarged the support to the health care service. For instance, between the years 1997 and 1999, the project “Do not leave the unsafe building of the commune hospital in countries to the 21st century”, issued by the government was fulfilled in 2000 by enlarging the transferal payment of provincial finance and the strive of the government of all levels and the society. The total raise of the fund is 100 million Yuan, the number of hospitals rebuilt is 1220; remove 330 thousand square meters unsafe building. At the same time, a total number of 33 billion and 880 thousand Yuan fund is invested to add medical utilities for the commune hospitals in twenty-eight relatively poor countries, which brought the change from the “five old items” into “five new items”, and improved the grass-rooted service condition. This year, in the related policies on the system reformation of the health care system in the towns and rural areas announced by the provincial government, it is clearly defined that the input to the health care service by the government should match the development of the economy; the rate of increase of the appropriation on the health care service can not be lower than the total rate of increase pf the appropriation by the local government that year; the portion of input to the health care service in the total financial appropriation should increase every year, in some qualified towns and countries this should be over 5% step by step. In order to set as an example, the fiscal year 2001 of Zhejiang province expand the input to health care service at its level, the increase of the appropriation on the health care service is apparently higher than last year, as that of education and technology. It extends the transferal payment, appropriate a special fund to

58 support the health care service in relatively poor towns and countries. It establishes a special fund for the prevention of key diseases in our province like tuberculosis, AIDS, schistosomiasis. We hope and trust that with the further development of Zhejiang’s economy and society, the government of all in Zhejiang will expand the direction and support on the reformation and development of health care service further. In addition, our province also should to absorb, direct and utilize the private capital as fully as possible, raise the fund for the development of the health care service via multiple channels. And we should formulate the favorable policies to attract social fund for the development of health care service, perfect the market regulation for the social fund, direct and encourage the investment by the social fund to non-government conducted non-profitable health care service and community health care service

2). Expand the regulation on the development by the government and configure the health care resources reasonably. Regulation the configuration of the health care resources is an important function of government. According to present situation including the structural irrational on the configuration of the health care resources, low efficiency of usage, the relative lag of the development in rural area and preventive health care service, lack of funding for the intervene of the key diseases and health care supervision, and in order to reinforce the macro regulation of the development of health care service, based on the principle of the plan of the district health care service issued by the central government, Zhejiang province already announced the standard principle of the configuration of the health care resources. The eleven cities in Zhejiang province also formulated local health care service configuration based on this principle. The next step of the development of the health care service is under the direction of such principle to control the expand of the health care service sect in the towns, focus on the construction of health care net-work service both in towns and countries, execute prevention on the key diseases which can harm health of the masses seriously. Practically focus the configuration of the health care resources on the communities both in towns and rural areas and the preventions, resolve the acquirement of the basic health care service. Based on the rules of the classification management of the hospitals formulated by the central government, in order to ensure the basic health care service, our government need to put fund and energy together to run several non-profitable medical service sects well, which can represent the local development level. After ensuring prerequisite that the non-profitable medical service sects play a major and directive role, the government can organize and direct the reformation of the

59 property right and operation system in several state-owned medical service sects, which will bring the formation of competitive system.

3). Change the government function of the health care service executive sects, enhance the management on the whole field and macro management directed by law. The health care service executive sects of the government ought to accelerate to match the need of the socialist market-oriented economy system, change the function, reinforce the management on the whole field by the means like law, administration and economy. Enhance the supervision on the action, quality, efficiency and benefit of the health care service, uphold the competition, and ensure to provide health care service with reasonable price and good quality to the masses.

2.In accordance with the new challenge by the fast development of the economy in Zhejiang province, adopt suitable policy and strategy for the development of health care service Zhejiang province is one of the provinces with greatest energy in the economical development in China. From twenty years ago, the natives of Zhejiang make the economical development rate among the highest in China, with the spirit as“ constantly strive to become stronger, persistent and dauntless, bold in making innovations and lay stress on practical results”. The next step of the reformation and development on health care service should formulate and execute suitable policy and strategy according to the reality in Zhejiang and carry forward such spirit.

1). The ability to afford to health care service by the masses increases with the general accruement of the income; the total amount of the health care demand also increases. Meanwhile, the income difference between different populations increases. Based on the statistics in year 2000, the ratio of the income between the populations in towns and rural areas was up to 2.8:1. The difference in income causes the different level of the demand on health care service. Therefore, the development of health care service should not only match the need by the average income population but also the special need by the population with high income.

2). The formation of the companies and markets around Zhejiang province absorbs a large amount of social labor force, these not only alleviate the employment pressure on the government but also bring new problems in the health care service and management in the large amount of transient population. These should lead to the attention by the government of all levels and other aspects of the society: first, we should adopt series of policies on the aspects such as salary, welfare and labor safety for the workers, ensure their safety in the aspects such as labor, food and

60 water, based on the policy “who recruit that is responsible”, establish and implement the social laid-off insurance, medical insurance and other guarantee remuneration by steps. Second, related with the activities of the establishment of civilized towns and communities, depended on the communities and grass-rooted organization, set up safe, health and economical apartments for external labor force in the areas with high external labor force density. And provide basic health care service for them like that of local residents. Third, in accordance to some particular health problems in the transient population, launch health care promotion activities according to their knowledge; the health care department should bring these activities into the key activities of the communities. The community doctors and health care specialists should go down to the communities and the areas with high transient population density to comprehend their demand for medical service, adopt the doorstep medical service, timely provide women health care service and planning immunity service for the women and children in the transient population.

3). Fully utilize the advantages in Zhejiang province such as the abundant fund from the private and their fervencies to anticipate into the health care service development, expand the channels for funding, promote the fair competition among the medical service sects, satisfy the medical demand on different levels. In the course of the guiding the development of the private hospitals, the health care administrative departments at different levels and related department in the government should treat private and public hospitals equally without discrimination, support and direct the development of the private hospitals ardently; allow, appraise and decide the application for non- profitable medical service by the qualified private hospitals, and compensate for the public health care duty by them at a reasonable amount. Qualified private hospital can be listed on the key hospitals of medical insurance. In addition, the health care administrative department can put the private hospitals into the configuration of the district health care planning, reinforce both the allowance of the organization, personnel, utilities and techniques of the hospitals and the supervision of the charge, conduct standard and service quality. For such private hospitals decided as profitable hospitals, the related department of the government should clarify the time, range and specific rate for the tax. In the transformation of the administrative system of the medical service, we should allow and direct the private capital to set up some market competitive and specialized private hospitals by the reformation, purchase and recombination of some public hospitals.

3.Highlight three important strategic points; promote the harmonious development of the

61 health care service Whether the transformation of the medical model from the biomedicine to the biopsychological social medicine, or the change in the charts of population, diseases and courses of death of Zhejiang province, indicates that the development of the health care service is already into a new phase, in which the development of the health care service must base on the human beings, regard the improvement of health of the crowds as its goal, and the satisfaction of the crowds’ need as the start point, highlight three important strategic points as health care in rural area, prevention health care and development of Chinese traditional medicine, fulfill the unification between the equity and efficiency, quality and profit, transformation and development.

1). Rural area, agriculture and peasants are the corner stone and starting point for all problems in China, which relate with the overall economical development situation and the stabilization of Chinese society. 80% of the populations in Zhejiang province live in rural area, which are the key population for health care service in Zhejiang province. In addition, only two third of rural residents go to seek medical advice after they fall ill. The condition in the rural grass-rooted level should be improved. To reinforce the health care service in rural area, we should regard the fulfill of the fundamental health care service as the key point, further clarify the role, nature and function in the fundamental health care service of the rural area by the local government and commune hospitals. We also need to implement related economical policies, constant deepen the transformation of the administrative and operative systems of the commune hospitals in rural area, improve the vitality of such hospitals; the transformation of the commune hospitals in rural area should avoid the direction as “comprehensive hospital”, and they will change to community health care service step by step, provide comprehensive, convenient and good service to the rural residents. We should promote the development of medical technical intellectuals for the rural area, especially the formal development and transforming training of the general physicians, and actively promote the communities’ health care service. We also need to improve the unified arrangement of the rural environment, stress the transformation of the water-supply system and lavatory closely related with the life of rural residents, reinforce the health care education to the rural residents in order to guide them to good health habits and soundly civil life style and ensure their physical health thoroughly.

2). “Rely mainly on prevention” is a long-term guiding principle for China’s health care service, which has such advantages as low input, wide coverage and good cost profit. Facing with the serious situation of prevention health care, in order to improve the prevention health care, we

62 must establish and perfect the system as “ district coverage, service without having go to far, comprehensive function”, recombine the preventive departments and adjust the function by the district health care planning, reasonable simplify the preventive departments which are configured scattered by strips currently, set up comprehensive preventive department. Develop the total profit of the preventive recourses; constantly explore the field of preventive health care service, improve the efficiency and coverage of the service. The government also will increase the input in preventive health care service, prefect the compensation system. The government needs to increase the input of the funding such as houses, facilities and personnel and fundamental preventive health care and enough fund for the prevention and control of some serious diseases. According to the prevention of infectious diseases, we should summarize and use long-term accumulated experience in prevention practice, continue to develop the patriotic health campaign of a mass character, develop function of three levels preventive health care network both in urban and rural area. Concerning to the fast spread venereal diseases in recent years, we should implement comprehensive measures, improve the health promotion. With regard to the prevention and control of non-infectious chronic diseases, we should implement related countermoves according to the infectious courses. Such as implementing screening, determining and behavior intervening for the tumor, cardiovascular diseases, in order to determine, and diagnosis and treat in the early stage.

3). Chinese traditional medicine is profound and lasting in Zhejiang province and rich in natural resources together with many famous doctors. Eight medicinal herbs of Zhejiang are worldwide known. Nowadays, the increase of some chronic diseases as cardiovascular diseases and tumors in Zhejiang and the increasingly demand for a good and health physique by the masses provide a wide market for the development of Chinese traditional medicine. China’s entering WTO also brings a good opportunity for traditional medicine to foreign countries. We will continue to reinforce the intension development of the traditional medicines departments, improve the development of technical personnel of the traditional medicines departments, and try our best to inherit the knowledge and experience from experts, develop high-tech research in traditional medicine by using modern advanced techniques, promote and popularize Chinese traditional medicine techniques and modern technical achievements, further expand the communication and collaboration between the traditional medicine and foreign resources.

4). Regard the satisfying the basic medical care demand by the masses as the goal, energetic

63 develop commune health care services both in urban and rural areas. Regardless in urban or rural areas, commune health care service should press close to residents and families, provide convenient, good and cheap basic health care service, which combine the education of medical aid, prevention, health care, recover and physique and the guide of birth control to the masses. In addition, develop specific services of different content and standard service and facilities for the well-off population in order to satisfy the health care demand by different population. Commune health care service is a major part in the grass-rooted community operation, which is needed the support and cooperation by the government and grass-rooted organization at all levels. Now, most projects of the commune health care services in Zhejiang such as the establishment of health document, doorstep service and health consultation are all free, related departments in the government did not set up the standard for price et, which make them uneasy to run in the future. Therefore, related departments in the government should run their own function and cooperate closely, and give enough financial input. Social insurance handling institutions should be allowed to be a part of official medical insurance units; prices in such institutions should be formulated as soon as possible according to the service prices standard. Health care administrative departments should develop a group of skilled general physician intensively, and make great effect to supervise the quality of service.

4.Continue to reform and renovate, improve the quality and efficiency and the health care service During the process to establish and perfect the socialist market-oriented economy system, the particular laws of value, supply and demand, and competition of the market-oriented economy, affect the development of the health care service more and more widespread and profound. Therefore, we must consider according to the long-term development, continuously prefect the service, management and operation systems of the health care service, suitable for the socialist market-oriented economy system. The reformation of the management system in medical institutions should highlight to expand the decision-making power of the state-owned hospitals, implement the independent management in such hospitals, and intensify the artificial person administrative system, practice the separation of the ownership, managerial authority and domination of the property; establish and perfect the internal encouragement and restrain system. The hospitals’ heads should compete publicly, and be appointed on the basis of competitive selection according to the engagement standard, and implement the system of job term responsibility. We should further investigate the professionalization of hospitals heads, develop a group of skilled person step by step.

64 We also should develop the reformation of the hospitals’ ownership system positively and reliably. Such hospitals with solid strength can establish groups by combining, annexing other hospitals; develop the establishment of hospitals management companies promote the professional and standard management and linked operation. The Non-profitable hospitals defined by the government are the major part in all hospitals is not to say that the non-profitable hospitals managed by the government should also be the major part. We can encourage the private investment into the recombination, merge and coalition of some current state-owned hospitals, which will cause the fair competitive pattern between non-profitable hospitals of different system of ownership. Deepening the reformation of the management system in the medical service should make a breakthrough in the personnel and distribution system, the key point is to fulfill the transformation from the “unit person” to the “social person” of the staffs in hospitals, especially for the doctors, and implement the two-way selection between the hospitals and staffs, positions and employees. According to the planning by the Zhejiang provincial government, we launch a pilot project as “professional free system” for advanced titled doctors in Hangzhou, Ningbo and Wenzhou. We also will establish all sorts of rules and regulations in which the position responsibility system is the core, implement the service standard for medical techniques seriously, formulate the medical conducts and ensure the quality of medical service; the staffs’ salary should be related with skill, attitude and achievement, actively form the running system with responsibility, encouragement, constrain, competition and vigor. The reformation of the medical service departments in rural areas should seriously based on the instructed and commented by the State Council. The commune hospitals in the rural areas are the key positions in health care service in the rural areas, it has particular concepts, and it is government’s responsibility to manage them well. The commune hospitals’ brands cannot be sold, their non-profitable characteristics cannot change also, state-owned property in such hospitals cannot be sold and the service function cannot change in such hospitals. If all of above are kept, they can provide better basic health care service to the masses by deepening the reformation in management and operation system in order to arouse the activity.

5.Quicken the implement of the modernization in health care technology Zhejiang province is among the provinces, which advance and promote to fulfill the goal of socialist modernization in advance. In order to serve the masses’ health and socialist modernization better, the health care cause

65 should realize self-modernization by system renovation and technical creation. The health care modernization includes the modernization of management ideas and standard, the modernization of service system and model, the modernization of knowledge and technique and the modernization of insurance system. That is to say: based on the human beings, regarding the health as the core, managed by law and improve the supervision to enhance the health care achievement and level of information; strengthen health care service system, implement the optimization configuration of the resources, perfect the commune health care service and make the health care service fair, high efficient, convenient and easy reachable; make the composition of the health care personnel reasonable and high quality, the rudimental facilities and technical equipment suitably advanced, health care service can match the demand by different population; the investment into health care service can meet the development of itself, the share of the health care expense reasonable, the operation system suitable for the socialist market-oriented economy and the development of health care service itself. The modernization of the health care service is in such aspects as: enhancement of the health standard of the residents, improvement of living quality (expected life time, the death rate of infants, the death rate of pregnant woman); increase the input into the health care service, optimize the configuration of resources (the increasing rate of government’s health care service fund, number of doctors per thousand persons, the index of comprehensive modernization of medical facilities); expand the health care service satisfy the basic health care demand by the masses (the coverage rate of the general medical service for commune residents, coverage of basic medical insurance of the residents both in urban and rural areas, the rate of qualification of food sanitation); provide good living environment, develop health life style (the quality of drinking water in rural area according to national standard, the popularization rate of restroom in rural areas, adult physique index); advance the education standard for health care technology, fulfill the information of health care (contribution rate of medical science, health care information index).

6.Establish the system to share the risk of diseases, alleviate the diseases’ burden of the masses Based on the guide and advice to the reformation and development of the medical service departments in rural areas issued by the central government recently, and related with the reality in Zhejiang province, the medical insurance system for rural residents is to reinforce the organizing and mobilizing function by the government, continue to practice cooperative medical system in rural areas, positive investigate medical insurance suitable for the rural residents in Zhejiang province. And this system is more suitable for rural economy and rural residents’

66 consciousness in some aspects as funding accumulation, management model and democratic supervision. We will keep summarizing such methods as serious diseases insurance carried out in some areas in Zhejiang province, perfect and promote them step-by-step. In some rural areas, which are highly developed in economy, we can accord to the basic medical insurance for residents in the towns, try out basic medical insurance system for rural residents. After the transformation from “charge” to “tax” in rural areas, the central government will return parts of it to establish the medical insurance for rural residents. The government is the major executive department, which is responsible for the medical insurance system for rural residents according to the demand of comprehensively establish and amplify social insurance system for the whole society. Related departments should cooperate positively. We should pay close attention to the population in towns, which is not covered by the basic medical insurance system, and implement sorts of measures to ensure them to acquire the basic health care service. Commercial insurance companies should provide much more and more different level medical insurance programs for the masses; we will encourage the masses to buy commercial insurance to improve the standard of medical insurance. Government should increase the funding for public health care related projects and health care service funding for weak population like olds and disables by enhancing the budget ratio of public finance; and investigate to establish the emergency funding for poor population both in urban and rural areas. Trying to alleviate the disease’ burden is another responsibility for medical service department at all levels. We should the diagnose, prescript and charge reasonably together with the improvement of medical service standard; we also need to reinforce the scientific management, implement cost assess, develop socialized logistic services, improve the efficiency and lower the operative cost.

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