China's long-awaited health care reform plan, which aims at providing universal medical service to 1.3 billion people, was released Tuesday for public debate.

The country wants a health care system that covers all urban and rural residents by 2020. According to the plan, that care should be safe, effective, convenient and affordable.

The plan breaks up the health care system into four departments: public health service, medical treatment, medical insurance and medicine supply.

Medical reform has been deliberated by authorities since 2006.

Growing public criticism of soaring medical fees, lack of access to affordable medical service, poor doctor-patient relationships and low medical insurance coverage compelled China to launch the new round of reforms.

China once prided itself for a government sponsored "socialized medicine" system, in which most Chinese, including urban and rural residents, enjoyed low-priced medical service.

However, when China began economic reforms in the early 1980s, the system was dismantled to ease government burdens and changed to a market-oriented health care system.

Insufficient government funding resulted in deficits for public health institutions, thus opening doors for hospitals to generate their own revenue by raising fees and aggressively selling drugs.

The reformed plan clarifies government's responsibility by saying that it plays a dominant role in providing public health and basic medical service.

"Both central and local governments should increase health funding. The percentage of government's input in total health expenditure should be increased gradually so that the financial burden of individuals can be reduced," the draft said.

The plan listed public health, rural areas, city community health services and basic medical insurance as four key areas for government investment.

The plan also promised to tighten government control over medical fees in public hospitals and to set up a "basic medicine system" to quell public complaints of rising drug costs.

The basic medicine system includes a catalogue of necessary drugs that would be produced and distributed under government control and supervision. Its goal is to ensure accessibility to a range of basic medicines and to prevent manufacturers and business people from circumventing existing price controls.

The draft was formulated by a team of officials and experts from 16 departments, including the Ministry of Health and the National Development and Reform Commission.

Bai Chong'en, one of the plan's authors, said the team has visited more than 20 provinces, municipalities and autonomous regions over the past two years.

"It's fair to say that the research was quite comprehensive and we've found where there are problems," said Tsinghua University Professor Bai.

He said the team also held many seminars on the key issues including the establishment of a basic drug system, governmental medical investment, medical insurance, drug pricing mechanisms and the development of private medical institutions.

"There were few disputes on the development of the public health sector and the bigger government responsibility. Debates focused on whether government should invest more money into basic medical insurance or into public medical service," Bai said.

To have a more balanced view, the Chinese government entrusted nine domestic and overseas organizations including the World Health Organization to conduct independent research. Their opinions were included in the draft.

In early 2007, the National Development and Reform Commission started a website, inviting public opinions on medical reform. The commission received 1,500 suggestions and 600 letters in less than six months.

The draft will be open for public debate until November 14. People can visit the website: shs.ndrc.gov.cn/yg to leave suggestions and comments.

(Xinhua News Agency October 14, 2008)